Posted by PaulB on December 3, 2001, at 17:53:14
In reply to Re: SSRIs and MAOIs for SP » PaulB, posted by Elizabeth on December 3, 2001, at 1:22:17
> Hi Paul.
>
> I can't say much about your combination because Zoloft is a drug that has many uses and I'm not too familiar with the over-the-counter drugs you're supplementing with (SAMe and 5-HTP).Zoloft does have many uses. It is the best antidepressant I have ever taken. It lacks the agitation and hypomania of Fluoxetine and Paroxetine. It is a calming antidepressant that just makes me feel very emotionally fit. I havent felt this good in ten years. When the effect of the Sertraline will start to wear off I will load up on 5-HTP(the precursor to serotonin)and take a course of Lorazepam until the Sertraline begins to work again. We use Lorazepam because Clonazepam(esp) and Diazepam have anticovulsant properties that may hinder the effectiveness of the antidepressant when it kicks in by lowering serotonin levels during the process of down-regulation.
>
> The strategy for dealing with Zoloft poop-out is one that I have never encountered. Does it work well to keep you going? How often does the Zoloft poop out on you?>Yes it works well to keep me going but poops out approximately every 6-7 months
>
>How do you think the SAMe helps you? Do you use a particular brand?>SAM-E enhances the synthesis of neurotranmsitters and there is significant evidence that it restores monoamine receptors. SAM-E also has the ability to improve the bodys ability to manufacture phospholipids for use in brain cells which helps with the fluidity of cell interaction. I take the Nutralife form.
>
> >This may not always be my combination therapy because there is clear evidence that the MAOI's are better for social phobia(my biggy)than the SSRI's.
>
> I'm not sure there's clear evidence...but everybody seems to think so who's tried both!
>
> > The problem is that the MAOI's are not selective and I believe that is a disadvantage.
>
> Why would that be a problem -- why do you think that "selectivity" is necessarily a desirable thing?Because as I wrote in my last post 'selectivity' allows what little serotonin there is in a depressed/anxious person to circulate for longer at certain serotonin sites i.e.5-HT2c rather than allowing the serotonin to be used up all too quickly at 5-HT1,5-HT2,5-HT3 and all its subtypes together. Read this carefully and Im sure you will understand where Im coming from but not necessarily agree. I have explained it as best as I can.
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> As far as MAOIs go, I think that reversibility is the characteristic that makes the difference -- unfortunately, it seems to make them less powerful.
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> > Have you heard of augmeting Nardil; perhaps with an atypical antipsychotic or a 5-HT3 antagonist which were being investigated for social phobia a short while ago.
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> With atypical antipsychotics, yes (not necessarily for social phobia -- mainly for borderline personality and some kinds of depression). With 5-HT3 antagonists, no -- I don't know anybody who's found those helpful for psych disorders (except Remeron, which has so many other effects that it's hard to say whether the 5-HT3 antagonism plays much of a role).>So you are saying augmentation of Nardil with an atypical antipsychotic such as Zyprexa, as commonly done with Prozac could be tried.
> >The problem is that the MAOI's interact with many drugs so polypharmacy with them could be dangerous and potentially lethal.
>
> Actually, it can be done safely as long as you know what you're doing. I've combined lots of things with MAOIs, and I've always felt confident (correctly, as it turned out) that I could deal with any problem that might arise. (Furthermore, such problems were rare.) There are a few types of mechanisms that should be avoided in combination with MAOIs; as long as you know what these are and are familiar with the drugs you're taking (which you should always be, of course), you should be fine.
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> > But what a weapon against social phobia a selective MAOI would be, dont you think?
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> No. I think the RIMAs are probably about as effective as the SSRIs for social phobia, panic disorder, and depression. I don't think they have the special whatever-it-is that makes the irreversible MAOIs (Nardil especially, but also Parnate) work so well (especially for people with conditions that have otherwise been hard to treat effectively).>Sorry, but you misundersttood me here. I meant wouldnt a "irreversible" MAOI be a powerful weapon against social phobia if it was combined with an 5-HT antagonist. I was not referring to the newer reversible MAOIs.
> I am sort of interested in clorgyline -- an irreversible MAO-A inhibitor which was never marketed (AFAIK). I suspect it works about as well as the nonselective, irreversible MAOIs with about the same side effect profile.
>
>Well it didnt sound very promising. If people want to try Moclobemide fine but I think those articles I quoted may have been inaccurate.BTW...my experience has been that the opioids work far better for social anxiety symptoms than any other drug I've tried. But my case may be complicated by Asperger's, which might make it very different from the typical case of SP. Still, I'd like to see such drugs as Ultram looked at more closely for SP -- so far, all we have to go on are case reports (albeit very enticing ones).
I would be very grateful to hear more form you about the use of opiods for social phobia. I do not condone or approve of narcotic drugs but I do see that they have some utility for treatment-restant patients, in my opinion, and thats just my opinion. I too have Aspergers and all too frequent a symptom of Aspergers is social phobia. See my post:
http://www.dr-bob.org/babble/social/200010915/msgs/11773.html
I would like you to give me some basic information on Buprenorphine. Im sure you know a lot about it and tell me how it is different from other opioids and what may make it a useful tool for managing social phobia. I dont hold much promise for Ultram.
I am enjoying this discussion and I hope you post another responsePaulB
poster:PaulB
thread:85575
URL: http://www.dr-bob.org/babble/20011202/msgs/85892.html