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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by comftnumb on November 24, 2002, at 6:14:49
I am currently taking SSnRI (Effexor) and Wellbutrin for depression and social anxiety, and have been for 3months. I also take 2mg Klonopin for social anxiety, which I have found works well, for a month. I have also done intense CBT (Feeling Good, Dr. Burns) for social anxiety for a month. However, because I still have social anxiety I'm wondering if I should switch from "Effexor and Wellbutrin" to an MAOI. I have found two websites that are big proponents of the MAOIs for social anxiety. You have to scroll a bit but this one http://www.socialfear.com/ states that the MAOI Nardil is best for social anxiety. This one http://www.anxietynetwork.com/spmed.html says that Parnate as opposed to Nardil works best, although both websites acknowledge that either one can work. My question is threefold. First, is it worth going off the Effexor and Wellbutrin and trying an MAOI. The biggest problem here is the month long wash-out period that would be necessary. But a month is nothing if it really works better. Second, has anyone with social anxiety been on Nardil or Parnate, and if so what experiences have they had? Third, between Nardil and Parnate, which one should I choose?
Posted by joy on November 24, 2002, at 8:14:21
In reply to Do I switch from SSRI to MAOI for social anxiety? , posted by comftnumb on November 24, 2002, at 6:14:49
Hi. I think social anxiety is just a catch phrase. Social anxiety is really lack of confidence in oneself, or fear of seeming foolish to others, especially to the opposite sex, shyness, etc. I found Paxil to help me in that area, but after a few months the side effects got to me, and I weaned off. I do not think anybody can say that one type of antidepressant is better for any condition, such as 'social anxiety' or 'OCD', etc. It;s trial and error. An MAOI would be a last resort in the antidepressant family, one factor being there are problems right now getting Nardil, and this could happen again. Effexor [SNRI]usually works for about 4 in 10 people while Wellbutrin is considered agitating for many. Dosing is often trial and error. I would try something easier to use than an MAOI before going to that type of med. Prozac, with an occasional small doses of a benzo [Klonopin, Xanax, Ativan] helps some people. If you find that nothing helps you in the SSRI/SNRI family, then you can talk to a Psychiatrist who is well versed in MAOIs, Tricyclics, etc. Regards.
Joy
Posted by cosis on November 24, 2002, at 10:43:32
In reply to Do I switch from SSRI to MAOI for social anxiety? , posted by comftnumb on November 24, 2002, at 6:14:49
CBT helped me at first but I think taken with combination of a drug is the way to go.. I started taking Nardil about 3 months ago.. It has really helped my personality. Things I use to be afraid to do or say are no longer a problem. It took care of my depression also and I have more energy now. I haven't had a problem with it's availability. I don't think it will be a problem come next month when it is back in production.
My doc said Parnate is more known as a depression drug but he said there wasn't much difference between it and Nardil. If your doc is letting you take a MAOI I would choose Nardil. The SSRI's I believe were to weak for my social anxiety. I had a pretty bad case of it..
The side effects of Nardil are kind of a pain at first also.. The only one that really bothers me is the anorgamsia.. After about 3 months it improved a little bit. I am at 90mg right now so if I cut down in the future I am sure it will come back.
I read up a lot on Nardil before I decided to take it. Just about every search I did on social anxiety or phobia turned up Nardil as the best drug to take. Parnate was also mentioned just not as much....... anyway good luck.. it took about 4 weeks for Nardil to kick in for me, but when it did it was a big help.
nick
Posted by jumpy on November 24, 2002, at 17:23:11
In reply to Do I switch from SSRI to MAOI for social anxiety? , posted by comftnumb on November 24, 2002, at 6:14:49
The best treatment for social anxiety is thought to be the MAOI Nardil. Unforunately, it also has the most side effects of all the antidepressants. Many people find great relief from a combination of moderate doses of an antidepressant and a benzo. Parnate is mentioned as a medication useful in social anxiety by some individuals, but as a whole, most find it far to stimulating and anxiogenic. So, if you can tolerate Phenelzine, if is probably the most potent antianxiety/antipanic medication. Be that as it may, it does cause a mirad of side effects as well.
(SSRI, TCAs, benzos, neurontin are also helpful with less side effects)
Jumpy
PS Of course, everyone reacts to each medication alittle differently. I sure there will be several people would will respond to this post with opposite experiences. So, you mileage may vary.
Posted by comftnumb on November 24, 2002, at 22:30:16
In reply to Nardil is most Effective » comftnumb, posted by jumpy on November 24, 2002, at 17:23:11
Everywhere I read that Nardil is the best for social anxiety. Personal testimonies too. The side effects vary from person to person so I just hope that I tolerate it. My mind is pretty much set on changing drugs now.
Posted by djmmm on November 25, 2002, at 19:03:46
In reply to Nardil must be most effective, posted by comftnumb on November 24, 2002, at 22:30:16
Listen to me, only because i have been taking Nardil for a few years, and just swiched to Parnate (a few weeks ago)
It is my understanding tha Nardil and Parnate are the most effective medications for social anxiety, primarily because they are potent antidepresants, and are the two antidepressants most extensively studied (for social phobia)
Nardil tends to be prescribed more often for social phobia, because it raises GABA levels, Parnate does not effect GABA levels, this is probably why most pro-Parnate web sites, etc also promote using Klonopin.
My experience with Nardil was wonderful, for me, the side-effects were much less pronounced then with the SSRIs, Effexor, Wellbutrin, etc.
I have been on Parnate for a few days now (30mg) and haven't noticed a difference between the two meds.
When making the decision to switch to a new med, esp. a MAOI, becareful to only listen to people who have a first hand (personal) experience with it. There is a lot of misinformation, and unnecessary fear surrounding MAOIs.
Posted by djmmm on November 25, 2002, at 19:24:56
In reply to Re: Do I switch from SSRI to MAOI for social anxiety? , posted by joy on November 24, 2002, at 8:14:21
> Hi. I think social anxiety is just a catch phrase. Social anxiety is really lack of confidence in oneself, or fear of seeming foolish to others, especially to the opposite sex, shyness, etc.
> JoyThat's the definition of social anxiety that someone NOT suffering from social anxiety, would give.
Social phobia is much more pervasive, it effects, and disrupts your everyday life. It's the difference between a fear and a phobia...in short, it is much more than shyness.
Shyness is to social phobia as "the blues" are to depression
Most healthy people can get over shyness, and "the blues." At the hieght of my illness, i couldnt even talk on the phone, or go to a store...that goes far beyond confidence, or lack of...such things are irrational, and at the heart of social phobia.
Posted by bluedog on November 25, 2002, at 23:10:34
In reply to Re: Do I switch from SSRI to MAOI for social anxiety? , posted by djmmm on November 25, 2002, at 19:24:56
> > Hi. I think social anxiety is just a catch phrase. Social anxiety is really lack of confidence in oneself, or fear of seeming foolish to others, especially to the opposite sex, shyness, etc.
> > Joy
>
> That's the definition of social anxiety that someone NOT suffering from social anxiety, would give.
>
> Social phobia is much more pervasive, it effects, and disrupts your everyday life. It's the difference between a fear and a phobia...in short, it is much more than shyness.
>
> Shyness is to social phobia as "the blues" are to depression
>
> Most healthy people can get over shyness, and "the blues." At the hieght of my illness, i couldnt even talk on the phone, or go to a store...that goes far beyond confidence, or lack of...such things are irrational, and at the heart of social phobia.
>
>Well said djmmm. It's surprising that even on a message board such as psychobabble that there is such a lack of understanding about the misery that those of us suffering from social anxiety endure in our day to day lives.
I have taken the liberty of linking to a post made some time ago by 3 Beer Effect in response to another post that demonstrated a distinct lack of insight into social anxiety. I think his response addresses the issue perfectly.
see http://www.dr-bob.org/babble/20020322/msgs/100046.html
Posted by joy on November 26, 2002, at 9:41:06
In reply to Social anxiety is NOT just shyness - Joy » djmmm, posted by bluedog on November 25, 2002, at 23:10:34
I am sorry if I came across as insensitive. I did not mean to sound dismissive. I have had shyness myself which took many years to get over [still there a little bit], but never to the effect of others on this Board who have real social anxiety. Thank you for sharing 3 Beers' former post; it was very moving.
Joy
Posted by comftnumb on November 26, 2002, at 13:34:15
In reply to Re: Nardil must be most effective, posted by djmmm on November 25, 2002, at 19:03:46
Parnate seems to have a much better side-effects profile than Nardil. Especially in terms of weight gain from Nardil, Parnate does not cause it. But you haven't really been on Parnate long enough to know if it is as good as Nardil. The effect on GABA levels is critical, i think, because anxiety is so closely related to GABA levels. That's why alcohol, which does not affect serotonin or dopamine as far as i know, reduces social anxiety. But Parnate has a stronger effect on dopamine levels, so maybe if your social anxiety is one of those "dopamine induced" ones, and there is evidence that there exists such SA, maybe Parnate will work just as well. I think I'm going to stick with Nardil though because I think it has a better chance of working: more websites recommend it, it influences GABA, and more people here have used it and said it works wonders.
What you said about Nardil having much fewer side effects than the SSRI, Effexor, Wellbutrin was very comforting. I really hope it doesn't have any sexual side effects.
Posted by SLS on November 26, 2002, at 22:03:38
In reply to Nardil must be most effective, posted by comftnumb on November 24, 2002, at 22:30:16
> Everywhere I read that Nardil is the best for social anxiety. Personal testimonies too. The side effects vary from person to person so I just hope that I tolerate it. My mind is pretty much set on changing drugs now.
Hi Jumpy.
The adage of "start low and slow" will give you the best chance of tolerating Nardil. I have worked up to 120mg in the past. If you can be patient, try starting at 15mg and raise the dosage by 15mg every two weeks. This should help you avoid things like orthostatic hypotension (dizziness upon standing from a seated position due to a temporary drop in blood pressure). I found that if I moved up too quickly, not only would I trigger side effects such as low blood pressure and inability to initiate urination (micturation) at the higher dosage, but found that these side effects persisted when I returned at the lower dosage. Perhaps the key is to not trigger them in the first place.Nardil is an excellent drug for social anxiety and social phobia. The diet is not nearly as restrictive as was initially conceived. You might find some recommendations offered here on Psycho-Babble by using the "Search" function.
Here's one:
http://www.dr-bob.org/babble/20010814/msgs/75408.html
I am currently taking 90mg of Nardil for depression.Good luck! I'm all for your decision to try this wonderful drug.
- Scott
Posted by djmmm on November 27, 2002, at 7:33:27
In reply to So you think Parnate is as good as Nardil?, posted by comftnumb on November 26, 2002, at 13:34:15
You are right, I haven't been on Parnate long enough to know if it is as effective.
Im guessing a little, based on the fact that it has been a week since I haven't had Nardil (no washout period) and I havent relapsed (as far as depression, or social anxiety). Typically, being without Nardil for even one day would elicit a variey of discontinuation effects (nightmares, etc)
As far as research, I think Nardil is generally considered the better drug for social anxiety, but this may be because no other drug has been as extensively studied for this specific illness (including Parnate)
As far as GABA is concerned, I totally agree with you..but in my case, I havent noticed a difference in anxiety level, so it makes me wonder If the GABA connection is as significant as research states.
I totally believe my problems are not primarily serotonin related, simply because Nardil was the first med that really worked on me.
FWIW, give Nardil a try, you may (probably will) be surprised, it's a great drug. In the begining, I experienced some minor blood pressure issues (low blood pressue when standing up) but it passed after the first week. As far as sexual side-effects, the only time i really had a problem was when I took 75mg instead of 60mg. In any event, the ssris, etc turned me into a libido-less, emotion-less zombie...I feel like a human being on a MAOI
Posted by SLS on November 28, 2002, at 1:12:48
In reply to Re: So you think Parnate is as good as Nardil?, posted by djmmm on November 27, 2002, at 7:33:27
Hi.
Parnate can very definitely be effective for social phobia. I haven't looked for anything comparing Parnate to Nardil with regard to SP, but I still get the feeling that Nardil would help more people. Although it might not be important, Nardil causes the levels of GABA to increase by inhibiting GABA-transaminase (an enzyme used by the body to help break-down excess GABA). If this is indeed important, perhaps finding a GABAergic drug to add to Parnate would increase one's chances of responding.
- Neurontin (gabapentin)
- increase GABA synthesis
- Gabitril (tiagabine)
- GABA reuptake inhibitor
- Sabril (vigabatrin)
-GABA-transaminase inhibitor
- Depakote (valproate)
- increases GABA turnover
- increased GABA synthesis (glutamic acid decarboxylase)
- decrease GABA break-down (GABA-transaminase)Note: Like Nardil, Sabril inhibits the GABA-transaminase enzyme. Perhaps adding Sabril to Parnate would yield a positive result.
Just taking a few stabs at it...
- Scott
Posted by Kath on November 28, 2002, at 15:59:17
In reply to Re: So you think Parnate is as good as Nardil?, posted by SLS on November 28, 2002, at 1:12:48
Hi Scott - I suppose this post should be at Social-Babble, but I happened to see you here.
Don't know if you even remember me, but since checking in lately, the occasional time here, I've thought of you from the past (must be 2 years ago!)
Hope you're doing well.
warm thoughts, Kath
Posted by SLS on November 28, 2002, at 20:44:04
In reply to Re: So you think Parnate is as good as Nardil? » SLS, posted by Kath on November 28, 2002, at 15:59:17
Thanks for the warm thoughts. I feel less cold now. :-)
- Scott
Posted by Kath on December 5, 2002, at 10:47:49
In reply to Re: So you think Parnate is as good as Nardil? » Kath, posted by SLS on November 28, 2002, at 20:44:04
Good! That was the idea. hugs, Kath
This is the end of the thread.
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