![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 58. This is the beginning of the thread.
Posted by Mark on November 27, 1999, at 1:47:01
I have had generalized social anxiety for many years and didnt try any medication until last year. Zoloft worked wonders for me, but after a bad marijuana experience, the Zoloft stopped working. I've tried Prozac, Paxil, Celexa, tricyclics, Buspar, nothing seems to work. I'm starting to talk with my docotr about possibly using an MAOI: specifically, Parnate, Moclobemide, or Marplan. I'm staying away from Nardil due to the weight gain side effect. If anyone has had any experience with these medications, or with recovery from bad drug trips, please help me out. In particular, effectiveness, side effects, and need to strictly adhere to diet. Thanks a lot.
Posted by Jane on November 27, 1999, at 10:58:05
In reply to social anxiety-HELP!!!, posted by Mark on November 27, 1999, at 1:47:01
hi mark, buspar (which youve tried) is indeed indicated for GAD and im sorry it didnt work for you! did your doctor go up to the maximal dose (60 mg/day)? i tend to ask this question because if the medication had a partial response at the therapeutic dose (30 mg/day or above), its better to go up to the max than switching meds to avoid drug interactions and secondary side effects. having said that, ive found a link for general info on MAOI for ya: http://www.depression.com/health_library/anti_depressant_therapies/anti_04_mao.html
hope this helps you start looking for the right info :-)
jane
Posted by paul on November 27, 1999, at 14:59:10
In reply to Re: social anxiety-HELP!!!, posted by Jane on November 27, 1999, at 10:58:05
I recently saw a TV ad for Paxil in which it was claimed that Paxil is the first FDA-approved medication for the treatment of "social anxiety." All of my previous reading about social phobia/anxiety gave me the impression that SSRIs didn't show any particular promise in alleviating the condition and that MAOIs were the "gold standard" in this regard.
I am curious about a couple of things. Were the MAOIs ever approved by the FDA for the treatment of social phobia/anxiety? If they have been proven effective, even without FDA approval, is it misleading for SmithKline Beecham to imply that Paxil is a sort of medical breakthrough for this condition? Also, is there anything about Paxil in particular that (in theory) makes it more effective for social phobia, as opposed to Zoloft or Prozac? I'm very curious, because I have been taking Zoloft for over a year, and I'm skeptical that Paxil is really that much different. My hunch is that SKB just happened to test Paxil for this indication first and beat the rest to the finish line, but I could be wrong...
Posted by noa on November 27, 1999, at 20:42:40
In reply to FDA's approval of Paxil for social anxiety, posted by paul on November 27, 1999, at 14:59:10
That is my hunch, too. If you look in pubmed, you will be able to locate the study, I think I cam across it, and it was a big one, specifically studying paxil and social phobia. That is how the system works. You put the money up for a study, you get your drug approved. While in reality, lots of docs use drugs for "off label" purposes, named this only because no company had the profit motive to fund a big study for using the med for that purpose (such as ritalin as an augmentor to ADs--why bother? It is on the market, comes in generic, is relatively safe, and works for the purpose in question. No one feels the need to fund a study. Only managed care companies give us patients a hassle based on the FDA approval thing).
Posted by Elizabeth on November 28, 1999, at 3:14:05
In reply to FDA's approval of Paxil for social anxiety, posted by paul on November 27, 1999, at 14:59:10
> I am curious about a couple of things. Were the MAOIs ever approved by the FDA for the treatment of social phobia/anxiety?
Nope. (Tegretol was never approved for bipolar disorder, either, nor any tricyclic or MAOI for panic disorder.)
> If they have been proven effective, even without FDA approval, is it misleading for SmithKline Beecham to imply that Paxil is a sort of medical breakthrough for this condition?
Misleading? Yeah, I'd say so. :) False advertising? Probably not.
> Also, is there anything about Paxil in particular that (in theory) makes it more effective for social phobia, as opposed to Zoloft or Prozac?
No, other than expectation effects due to extensive advertising!
> My hunch is that SKB just happened to test Paxil for this indication first and beat the rest to the finish line, but I could be wrong...
If only they'd do the same with Parnate, the cooler of their two antidepressants IMHO...!
Posted by Chris on November 28, 1999, at 8:54:06
In reply to social anxiety-HELP!!!, posted by Mark on November 27, 1999, at 1:47:01
> I have had generalized social anxiety for many years and didnt try any medication until last year. Zoloft worked wonders for me, but after a bad marijuana experience, the Zoloft stopped working. I've tried Prozac, Paxil, Celexa, tricyclics, Buspar, nothing seems to work. I'm starting to talk with my docotr about possibly using an MAOI: specifically, Parnate, Moclobemide, or Marplan. I'm staying away from Nardil due to the weight gain side effect. If anyone has had any experience with these medications, or with recovery from bad drug trips, please help me out. In particular, effectiveness, side effects, and need to strictly adhere to diet. Thanks a lot.
Hi Mark,
Yeah, I certainly know how you feel. Its happened
loads of times to me, I seem to be OK then I have
a bad experience on weed or other and it goes
pear-shaped. I was OK on paxil for a while then went
to Amsterdam and came back worse than ever. Paxil
did work for me (Seroxat over here in UK) until
Amsterdam, I've just gone back on it after being
on moclobemide for 3 months. Moclobemide worked
wonders at first and I felt better than I'd ever
felt before in loads of ways, then it started to
make me worse, more depressed etc. This apparently
happens to some people so it may be good for you.
Very few side effects at all other than sleeplessness
at first (which soon goes)if it works properly.
Phenelzine works very well but has loads of side
effects: inorgasmia, headaches, very strict diet
to name just a few.
Klonopin (clonazepam) is meant to be excellent and
is what I'm after at the moment but I haven't tried
this as yet.Anyway good luck
Chris
Posted by Jane on November 28, 1999, at 23:20:24
In reply to Re: social anxiety-HELP!!!, posted by Chris on November 28, 1999, at 8:54:06
id say that it's "misleading" if SKB markets paxil as a breakthrough for social phobia simply because "an SSRI is an SSRI is an SSRI." if paxil works, then prozac, zoloft, and celexa should also work because they all belong in the SSRI class. each of these meds actually try to be "department store" drugs, trying to get indication for every single "dysphoric" condition they can find, to of course, prolong their patent and not become generic too soon... have to take the business side of things into consideration as well.
jane
Posted by jb on November 29, 1999, at 12:29:00
In reply to social anxiety-HELP!!!, posted by Mark on November 27, 1999, at 1:47:01
hi. i've tried parnate, nardil, klonopin, celexa, remeron, and now, marplan for social phobia. i had the high weight gain and complete sexual dysfunction on nardil. parnate was very activating (had complete insomnia for the first 3 days - slower dose titration could have helped), not nearly as effective as Nardil, FOR ME, and caused a very dry mouth. i've been on marplan for two months, and i think this is the best "social phobia" drug of those that i have used. i've started to work my way up from 60 mg/day to 80 mg/day to see if i can receive even more help for my social phobia. don't yet know if the higher dose is more effective. i still supplement the marplan with klonopin when i know i have a big presentation or other circumstances where my social phobia is a problem.
jb
Posted by Rick on November 29, 1999, at 14:19:58
In reply to social anxiety-HELP!!!, posted by Mark on November 27, 1999, at 1:47:01
Use the Psycho-Babble search function to seek "social phobia" or "social anxiety" and you'll find a wealth of information. Unfortunately you have to search each archive separately.
I actually started a gradual DIET when on Nardil (my first ever), and lost 40 of my 230 pounds with a lot less trouble than I expected (glad I hadn't heard about the "notorious" weight-gain side effect until AFTER losing the weight!). I ate "helthy" during the week, and then ate whatever I wanted on weekends (still do).
But Klonopin, with a little help from Pindolol, has been doing wonders for my Social Phobia for months (much better than Nardil) with no side effects after the first few weeks of occasional fatigue passed.
The trick is to not take more than you need (by all means ignore studies that suggest 3-6 mg...although I've noted, oddly, that I seem to need a little bit more since eating more over the holidays.Like everyone says: We're all different. There are lots of things to try, and several drug companies are focused on testing new Social Phobia medications (not just the familiar anti-depressants)as we speak.
Good Luck,
Rick
----
> I have had generalized social anxiety for many years and didnt try any medication until last year. Zoloft worked wonders for me, but after a bad marijuana experience, the Zoloft stopped working. I've tried Prozac, Paxil, Celexa, tricyclics, Buspar, nothing seems to work. I'm starting to talk with my docotr about possibly using an MAOI: specifically, Parnate, Moclobemide, or Marplan. I'm staying away from Nardil due to the weight gain side effect. If anyone has had any experience with these medications, or with recovery from bad drug trips, please help me out. In particular, effectiveness, side effects, and need to strictly adhere to diet. Thanks a lot.
Posted by Kevin on November 30, 1999, at 12:29:38
In reply to social anxiety-HELP!!!, posted by Mark on November 27, 1999, at 1:47:01
** I think the first thing for you to do- if you haven't already- is to cut out the herb dude- it drastically exacerbates social anxiety.
As far as MOAI's go, Manerix (Moclobemide)is supposedly efficacious for social phobia. This is what they call a selctive MAOI, which has far fewer side effects and dietary interactions than the older versions. But If you are an American, I don't think you can get it. I know nothing else about this drug. (N.B., anyone with pertinent info or experiences please E-mail at once.
Posted by Rick on November 30, 1999, at 13:47:22
In reply to Re: social anxiety-HELP!!!, posted by Kevin on November 30, 1999, at 12:29:38
Yes, moclobemide (Manerix is the brand in Canada and the UK) may be worth trying at some point. Like so many meds, it seems to have helped some people a lot, helped others moderately, and was ineffective for the rest. The general consensus (both research and anecdotally) seems to be that it's generally not as effective for severe Social Phobia as the "Cheese Effect"-type MAOI's like Nardil. But who knows, it could turn out to be great help for you if given enough time to kick in.
I know that U.S. citizens CAN legally import Manerix from Canada, but I'm not sure of the process. I have a feeling your local pdoc can procure it for you from a Canadian pharmacist.
Also, Moclobemide *is* a NON-selective MAOI just like Nardil, since it helps preserve both serotonin and dopamine. What eliminates the food/drug restrictions (and may make it less potent) is that its effects are *reversible*, unlike non-reversible MAOI's like Nardil, Parnate, and Marplan.
While I'm confident I've got the facts straight here, there are other posters who could better explain the details surrounding selectivity, reversibility, and how to get Manerix over the border.
Rick
---
> ** I think the first thing for you to do- if you haven't already- is to cut out the herb dude- it drastically exacerbates social anxiety.
> As far as MOAI's go, Manerix (Moclobemide)is supposedly efficacious for social phobia. This is what they call a selctive MAOI, which has far fewer side effects and dietary interactions than the older versions. But If you are an American, I don't think you can get it. I know nothing else about this drug. (N.B., anyone with pertinent info or experiences please E-mail at once.
Posted by Adam on November 30, 1999, at 14:40:22
In reply to Re: social anxiety-HELP!!! (Follow-up to Kevin), posted by Rick on November 30, 1999, at 13:47:22
I believe moclobemide is a fairly selecitve inhibitor of monoamine oxidase A, and has a very
low affinity for MAO-B. It (like befloxatone and brofaromine) is thus referred to as a
reversible inhibitor of MAO-A (RIMA). Its effect on dopamine is thus more modest than for
the non-specific MAOIs. I guess it is generally thought of as less robust an antidepressant
than the non-specific, irreversible MAOIs, though there is often a question of dosing:
Moclobemide doses a couple times higher than commonly prescribed often help people who do not
respond to it in the "usual" range (300-600mg/day). I've heard of doses of 900mg-1000mg
being used.As for the indication of social phobia, results for moclobemide are mixed. Many studies suggest
moc. is beneficial, but there have been some recent studies calling that assessment into
question. One example:Placebo-controlled trial of moclobemide in social phobia.
Schneier FR, Goetz D, Campeas R, Fallon B, Marshall R, Liebowitz MR
Department of Therapeutics, New York State Psychiatric Institute, NY 10032, USA. [email protected]
BACKGROUND: Moclobemide, a reversible inhibitor of monoamine oxidase A, previously has been reported to have efficacy in the treatment of social phobia. METHOD:
Seventy-seven non-responders to one week of single-blind placebo were randomly assigned to moclobemide or placebo for eight weeks of double-blind treatment. Outcome was
assessed by independent evaluator, treating psychiatrist and self-ratings. After eight weeks, patients who were at least minimally improved continued treatment for a further eight
weeks. RESULTS: Intention-to-treat sample response rates at week 8 were 7/40 (17.5%) for the moclobemide group and 5/37 (13.5%) for placebo (NS). Moclobemide was
significantly superior to placebo on 2 of 10 primary outcome measures. Moclobemide was well tolerated. CONCLUSIONS: Moclobemide may have efficacy in the treatment of
social phobia, but absence of significant differences on most primary outcome measures and small effect sizes for all outcome measures suggest that the magnitude of its clinical effect is
small.> Yes, moclobemide (Manerix is the brand in Canada and the UK) may be worth trying at some point. Like so many meds, it seems to have helped some people a lot, helped others moderately, and was ineffective for the rest. The general consensus (both research and anecdotally) seems to be that it's generally not as effective for severe Social Phobia as the "Cheese Effect"-type MAOI's like Nardil. But who knows, it could turn out to be great help for you if given enough time to kick in.
>
> I know that U.S. citizens CAN legally import Manerix from Canada, but I'm not sure of the process. I have a feeling your local pdoc can procure it for you from a Canadian pharmacist.
>
> Also, Moclobemide *is* a NON-selective MAOI just like Nardil, since it helps preserve both serotonin and dopamine. What eliminates the food/drug restrictions (and may make it less potent) is that its effects are *reversible*, unlike non-reversible MAOI's like Nardil, Parnate, and Marplan.
>
> While I'm confident I've got the facts straight here, there are other posters who could better explain the details surrounding selectivity, reversibility, and how to get Manerix over the border.
>
> Rick
>
> ---
> > ** I think the first thing for you to do- if you haven't already- is to cut out the herb dude- it drastically exacerbates social anxiety.
> > As far as MOAI's go, Manerix (Moclobemide)is supposedly efficacious for social phobia. This is what they call a selctive MAOI, which has far fewer side effects and dietary interactions than the older versions. But If you are an American, I don't think you can get it. I know nothing else about this drug. (N.B., anyone with pertinent info or experiences please E-mail at once.
Posted by GS on December 1, 1999, at 22:30:53
In reply to Re: social anxiety-HELP!!! RIMAs, posted by Adam on November 30, 1999, at 14:40:22
Benzodiazapines with longer half lives already mentioned in this thread such as klonipin and even shorter acting like ativan or xanax are perfectly safe and effective for anxiety disorders. That is what they are made for and why they are named "anti-anxiety".
Why are these drugs overlooked or simply not mentioned as a first line of treatment???
GS
Posted by Kevin on December 2, 1999, at 9:55:06
In reply to Re: social anxiety - benzos., posted by GS on December 1, 1999, at 22:30:53
> Benzodiazapines with longer half lives already mentioned in this thread such as klonipin and even shorter acting like ativan or xanax are perfectly safe and effective for anxiety disorders. That is what they are made for and why they are named "anti-anxiety".
>
> Why are these drugs overlooked or simply not mentioned as a first line of treatment???
>
> GS***Because they can be addictive and can impair cognition, memory, and motor skills. Apparently the withdrawal from Xanax, in particular, can be quite fearsome (even to the point of involving seizures).
-Kevin
Posted by Rick on December 2, 1999, at 12:36:37
In reply to Re: social anxiety - benzos., posted by Kevin on December 2, 1999, at 9:55:06
GS is right, and many studies support his assertions.
According to my pdoc (licensed, practicing PhD/MD since 1979), weaning off of Klonopin (if and when I choose to do so) will be no problem whatsoever, as long as I don't exceed 3 mg/day, and taper gradually when the time comes. Now, this was addressed specifically to me; perhaps for someone with a history of alcohol abuse or recreational drug use, the story would be different. Having taken Xanax, Tranxene, and now Klonopin, Xanax was indeed the only one that felt as if it could conceivably lead to addiction by making you "feel good".
This is not to say that my pdoc particularly *likes* Klonopin; he'd prefer that the Nardil had worked for my Social Phobia. But what would *you* choose:
Nardil: Long wait for kick-in + inconsistent effect + anorgasmia + severe hypotension (I started out slightly hypertensive)+ dizziness and falling down + insomnia + urinary problems + occasional spaciness, etc., or
Klonopin: Quick, consistent 75-100% improvement + no side effects (other than fatigue the first week)? And, at least at low doses, cognitive impairment is NO problem for me. In fact, my mind is sharper because I'm focusing on important and/or fun things instead of anxiety. Indeed, my company and my client have recently given me separate awards for creative, impactful business analyses. And when I present or speak in a meeting, I can actually think clearly and express my thoughts instead of freezing up and trembling. If that's "cognitive impairment" and memory loss, then please, impair away!
Rick----
> > Benzodiazapines with longer half lives already mentioned in this thread such as klonipin and even shorter acting like ativan or xanax are perfectly safe and effective for anxiety disorders. That is what they are made for and why they are named "anti-anxiety".
> >
> > Why are these drugs overlooked or simply not mentioned as a first line of treatment???
> >
> > GS
>
> ***Because they can be addictive and can impair cognition, memory, and motor skills. Apparently the withdrawal from Xanax, in particular, can be quite fearsome (even to the point of involving seizures).
>
> -Kevin
Posted by Rick on December 2, 1999, at 12:49:57
In reply to Re: social anxiety - benzos., posted by Rick on December 2, 1999, at 12:36:37
One more thing worth mentioning: If you read the literature (the serious research, not the "sky is falling" stuff that is way too easy to find on the net), you'll see that that benzo-induced problems with cognition, memory, and motor skills are found primarily in the elderly. So doctors do need to exercise extra caution in prescribing benzos to senior citizens.
But I'm NOT elderly (yet), and Nardil made me fall down several times -- once in a public restroom, and once resulting in a nasty bruise on my head from my own bathroom sink. But I certainly haven't had any such problem on Klonopin.
Rick
Rick
---
> GS is right, and many studies support his assertions.
>
> According to my pdoc (licensed, practicing PhD/MD since 1979), weaning off of Klonopin (if and when I choose to do so) will be no problem whatsoever, as long as I don't exceed 3 mg/day, and taper gradually when the time comes. Now, this was addressed specifically to me; perhaps for someone with a history of alcohol abuse or recreational drug use, the story would be different. Having taken Xanax, Tranxene, and now Klonopin, Xanax was indeed the only one that felt as if it could conceivably lead to addiction by making you "feel good".
>
> This is not to say that my pdoc particularly *likes* Klonopin; he'd prefer that the Nardil had worked for my Social Phobia. But what would *you* choose:
>
> Nardil: Long wait for kick-in + inconsistent effect + anorgasmia + severe hypotension (I started out slightly hypertensive)+ dizziness and falling down + insomnia + urinary problems + occasional spaciness, etc., or
>
> Klonopin: Quick, consistent 75-100% improvement + no side effects (other than fatigue the first week)? And, at least at low doses, cognitive impairment is NO problem for me. In fact, my mind is sharper because I'm focusing on important and/or fun things instead of anxiety. Indeed, my company and my client have recently given me separate awards for creative, impactful business analyses. And when I present or speak in a meeting, I can actually think clearly and express my thoughts instead of freezing up and trembling. If that's "cognitive impairment" and memory loss, then please, impair away!
> Rick
>
> ----
> > > Benzodiazapines with longer half lives already mentioned in this thread such as klonipin and even shorter acting like ativan or xanax are perfectly safe and effective for anxiety disorders. That is what they are made for and why they are named "anti-anxiety".
> > >
> > > Why are these drugs overlooked or simply not mentioned as a first line of treatment???
> > >
> > > GS
> >
> > ***Because they can be addictive and can impair cognition, memory, and motor skills. Apparently the withdrawal from Xanax, in particular, can be quite fearsome (even to the point of involving seizures).
> >
> > -Kevin
Posted by Louise on December 2, 1999, at 21:09:44
In reply to Re: social anxiety - benzos. - ADDENDUM, posted by Rick on December 2, 1999, at 12:49:57
Rick,
I disagree with your analysis of Klonopin v. Xanax and Ativan. I took Xanax for a couple of years and then wanted to try a longer-lasting benzo, so my pdoc prescribed Klonopin. Did you know that Klonopin is roughly twice as strong as Xanax mg. for mg.?
I had strange side effects while on Klonopin that I had never had before, such as depression, aggression, unrealistic anger, memory loss, depersonalization, etc. The person taking that drug was not me, so after almost 6 months I was asked by my family to go back on Xanax. End of story, right? Wrong!
While I was on Xanax I was taking approximately 3 mg. per day. For most of the 6 months I was on Klonopin I was taking 2.5 mg. per day, so when I went back to Xanax I assumed 2.5 mg. would be sufficient. I soon started having severe withdrawal ... had there been any Klonopin in the house I would have taken it. I had to increase the Xanax to 4 mg. until the withdrawal from the decreased benzo level went away (took about a week for the withdrawal symptoms to completely go away). In time I was able to wean back down to my usual 3 mg. of Xanax per day.
I'm not exactly knocking Klonopin ... it just didn't work for me. Everybody's different and someone else might have a completely different reaction while taking it, but to say that Klonopin is less addicting than Xanax or Ativan is just plain nonsense. I've been there and done that.
Louise
Posted by JohnB on December 2, 1999, at 23:35:52
In reply to Re: social anxiety-HELP!!! (Follow-up to Kevin), posted by Rick on November 30, 1999, at 13:47:22
Rick's right on. Moclobemide is another MAOI, selective for MAO-A, and reversible. This avoids the tyramine induced "cheese effect" which Rick referred to. This is what also makes Moclobemide popular. The New York State Psychiatric Institute conducted two studies regarding the efficacy of Moclobemide. Their most recent study, results published 1/98, suggests that ". . . the magnitude of its clinical effect is small."
Nevertheless, if you want it, you need to speak with a Canadian pharmacist and see what he or she requires. There are CVS pharmacies in Windsor, Ontario, which is right across the river from Detroit, Michigan. So, you can dial information and ask for the number of a CVS pharmacy there. I understand (just word of mouth), that some pharmacies will honor prescriptions written by U.S. docs, while others required a Candian MD. I'm sure your doc could get a Windsor doc to write a prescription if your psychdoc is willing to speak with him/her. Separately, there are some mail-order firms in Europe from whom you can order prescription drugs. You can find them through a web search. However, the more legitimate firms require a physician's prescription. Also, you'll likely pay more than you would having your prescription filled in Canada.
I considered Moclobemide and even a Moclobemide\Selegiline combination. My psychdoc said that, with a Moclobemide\Selegiline combination, he could vary the levels of MAO-A and MAO-B selectivity to achieve an optimal combination. However, on later reflection, he mentioned it wasn't that simple. Neither drug would alter GABA levels, as is the case with the "gold standard," Nardil. Nardil elevates GABA 100%, and GABA is the primary inhibitory neurotransmitter in the brain. So, I'd say there are a host of meds, other than Moclobemide, which have demonstrated greater efficacy in clinical studies and, therefore, more likely to give you the benefit you're seeking, without the inconvenience of having a prescription filled in Canada.
You should do your own Medline search and see for yourself. It's completely free, and there's no registration, password, etc. Most or many of the studies and reports have abstracts, from which you can cull key information. The address is
http://www.ncbi.nlm.nih.gov/PubMed/
Also, it's sponsored by that National Institute of Health (NIH), which is a government agency. That means there's no hidden agenda, and no one is trying to sell you anything. Pretty neat. I'd suggest you initially search by typing in the phrase
"social phobia" AND treatmentIt's important to type social phobia in caps as well as capitalize the AND. Later, you might want to search
"social phobia" AND moclobemideor "social phobia" AND nefazodone
or "social phobia"
Also, try to use the generic drug name, such as nefazodone instead of Serzone, when doing a search. Most authors will use just the generic name, and you'll miss the articles if you don't use it in your search terms.
See you. JohnB :)
------------------------Br J Psychiatry 1998 Jan;172:70-7
Placebo-controlled trial of moclobemide in social phobia.
Schneier FR, Goetz D, Campeas R, Fallon B, Marshall R, Liebowitz MR
Department of Therapeutics, New York State Psychiatric Institute, NY 10032, USA. [email protected]BACKGROUND: Moclobemide, a reversible inhibitor of monoamine oxidase A, previously has been reported to have efficacy in the treatment of social phobia. METHOD: Seventy-seven non-responders to one week of single-blind placebo were randomly assigned to moclobemide or placebo for eight weeks of double-blind treatment. Outcome was assessed by independent evaluator, treating psychiatrist and self-ratings. After eight weeks, patients who were at least minimally improved continued treatment for a further eight weeks. RESULTS: Intention-to-treat sample response rates at week 8 were 7/40 (17.5%) for the moclobemide group and 5/37 (13.5%) for placebo (NS). Moclobemide was significantly superior to placebo on 2 of 10 primary outcome measures. Moclobemide was well tolerated. CONCLUSIONS: Moclobemide may have efficacy in the treatment of social phobia, but absence of significant differences on most primary outcome measures and small effect sizes for all outcome measures suggest that the magnitude of its clinical effect is small.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 9534836, UI: 98196335
Posted by Rick on December 3, 1999, at 14:17:09
In reply to Re: social anxiety - benzos - to Rick., posted by Louise on December 2, 1999, at 21:09:44
Louise -
Sorry to hear about your bad experience with Klonopin. But you'll note that -- despite my pdoc's pronouncement that he has rarely seen a withdrawal problem in a situation like mine -- I am very careful to use qualifiers like "primarily" in my posts. I did not, and would not, make an absolute statement, because I know there are sometimes cases like yours where things work out differently. While research and years of professional experience have conclusively demostrated that Klonopin is far less likely to cause withdrawal difficulties than the shorter-acting benzo Xanax, that certainly does not mean no one ever has the opposite reaction (or rebound anxiety which presents as withdrawal symptoms). You said it yourself: everybody's different. Statistically speaking some people are going to end up as outliers, or atypical cases.
As for the relative potency of the two benzos, I could write a thesis here. (And I hate to point this out once again, but some parts of Dr. Bob's wonderful site have info which is controversial and/or has not been updated with the most recent research -- including the benzo equivalency chart.) But suffice to say that, here again, individual body chemistry is a more important determinant of benzo "equivalencies" than some set mathematical formula. To get the same anti-anxiety effect as X mg. of Xanax, Person A may need X/2 mg. of Klonopin, Person B needs X mg. of K, person C needs 2X mg., and person D just doesn't get any help from it at all.
This is why, even more so than for antidepressants, you often see the term "highly individualized" applied to benzo dosing.
For me, .5 mg of Xanax puts me to sleep, while I can take .5 mg of Klonopin with no fatigue at all.
Rick
---
> Rick,
>
> I disagree with your analysis of Klonopin v. Xanax and Ativan. I took Xanax for a couple of years and then wanted to try a longer-lasting benzo, so my pdoc prescribed Klonopin. Did you know that Klonopin is roughly twice as strong as Xanax mg. for mg.?
>
> I had strange side effects while on Klonopin that I had never had before, such as depression, aggression, unrealistic anger, memory loss, depersonalization, etc. The person taking that drug was not me, so after almost 6 months I was asked by my family to go back on Xanax. End of story, right? Wrong!
>
> While I was on Xanax I was taking approximately 3 mg. per day. For most of the 6 months I was on Klonopin I was taking 2.5 mg. per day, so when I went back to Xanax I assumed 2.5 mg. would be sufficient. I soon started having severe withdrawal ... had there been any Klonopin in the house I would have taken it. I had to increase the Xanax to 4 mg. until the withdrawal from the decreased benzo level went away (took about a week for the withdrawal symptoms to completely go away). In time I was able to wean back down to my usual 3 mg. of Xanax per day.
>
> I'm not exactly knocking Klonopin ... it just didn't work for me. Everybody's different and someone else might have a completely different reaction while taking it, but to say that Klonopin is less addicting than Xanax or Ativan is just plain nonsense. I've been there and done that.
>
> Louise
Posted by Jane on December 3, 1999, at 16:32:38
In reply to Re: social anxiety - benzos - to Louise., posted by Rick on December 3, 1999, at 14:17:09
rick, while i think that benzos with long half lives provide a "buffer" of safety against addiction, as you have read previously everyone is different, and i think most doctors are aware that regardless of benzos, these still contain the potential for addiction and this may be why it is not often mentioned as often as first line therapy. keep in mind too, that many times people suffering from anxiety require long term therapy and benzos in the long term are often associated with dependence and withdrawal syndrome. another factor is the interaction of benzos with alcohol. how often do you think people suffering from anxiety "self-medicate" by drinking a bit to relax? if they continually drink while taking benzos, they can be in serious risk for injury or accident if they're active because of the potentiating effect of benzos on alcohol effects. so i think collectively these factors make benzo less than stellar a choice in treating anxiety disorders for most individuals who are active and need to work during the day. of course there are exceptions to the rule, but exceptions are in minority.
jane
Posted by GS on December 3, 1999, at 23:55:46
In reply to Re: social anxiety - benzos - to Rick, posted by Jane on December 3, 1999, at 16:32:38
> rick, while i think that benzos with long half lives provide a "buffer" of safety against addiction, as you have read previously everyone is different, and i think most doctors are aware that regardless of benzos, these still contain the potential for addiction and this may be why it is not often mentioned as often as first line therapy. keep in mind too, that many times people suffering from anxiety require long term therapy and benzos in the long term are often associated with dependence and withdrawal syndrome. another factor is the interaction of benzos with alcohol. how often do you think people suffering from anxiety "self-medicate" by drinking a bit to relax? if they continually drink while taking benzos, they can be in serious risk for injury or accident if they're active because of the potentiating effect of benzos on alcohol effects. so i think collectively these factors make benzo less than stellar a choice in treating anxiety disorders for most individuals who are active and need to work during the day. of course there are exceptions to the rule, but exceptions are in minority.
> jane
************************************************
Here we go again! Please read under the posts grouped "99 Sept.14" a thread near the top of the list entitled "Lorazepam". Starting August 4th with my post (GS) and onward for quite a few posts on the subject, this has been hashed and rehashed. It was a very enlightening discussion on the so called "addiction and withdrawl" aspects of benzos. vis a vis the treatment of chronic anxiety. I hope that it can serve as somewhat informational before jumping off the cliff into making the usually uninformed generalizations about anxiolytics such as klonopin, xanax, and lorazapam.
GS
************************************************
Posted by GS on December 4, 1999, at 8:47:12
In reply to Re:social anxiety & benzos - here we go again..., posted by GS on December 3, 1999, at 23:55:46
> Please read under the posts grouped "99 Sept.14" a thread near the top of the list entitled "Lorazepam". Starting August 4th with my post (GS) and onward for quite a few posts on the subject, this has been hashed and rehashed.
************************************************
Actually, I just noticed that nearer the top of THIS list there is a thread with one post "RE: Benzo Risks - to Sean" that has the entire thread listed that I'm talking about(at the bottom of the actual post once you get in there). So once you click on that post - there it is - the entire thread - without having to go to the archive "99 Sept. 14".
Hope this makes it easier.GS
**************************************************
Posted by Elizabeth on December 4, 1999, at 9:10:23
In reply to Re: social anxiety - benzos - to Rick, posted by Jane on December 3, 1999, at 16:32:38
> rick, while i think that benzos with long half lives provide a "buffer" of safety against addiction, as you have read previously everyone is different, and i think most doctors are aware that regardless of benzos, these still contain the potential for addiction and this may be why it is not often mentioned as often as first line therapy.
For the record, I asked my therapist once what drug(s) he would consider as first-line treatments for panic disorder (not social phobia, but treatments are similar). He said either Klonopin or an SSRI would be his choice.
People with anxiety disorders are very sensitive to the side effects of antidepressants, so sometimes if they don't have depression also, there is a compelling reason to use a benzo instead.
> keep in mind too, that many times people suffering from anxiety require long term therapy and benzos in the long term are often associated with dependence and withdrawal syndrome.
(sigh) IMHO the problem is that many doctors aren't familiar with the proper way to discontinue a benzo...or worse, assume that any patient who has withdrawal symptoms must be "addicted" or abusing the benzo. I'm sure that all the people here who had withdrawal symptoms upon discontinuing Paxil, Effexor, etc. would be rather offended if their doctors had treated them like drug addicts or suggested that the withdrawal was their fault and they just had to suffer through it. Benzos have to be tapered very slowly, much more so than antidepressants. Doctors need to be aware of this. IMHO a good procedure is: (1) determine that it actually is time to stop taking the benzo; make sure the patient *consents* to the change (2) decrease by a small amount (e.g., 0.25mg/day of alprazolam) (3) continue decreasing *as tolerated* (if once a week is too often, do it once every 2 weeks, etc.); go more slowly when close to zero.
> another factor is the interaction of benzos with alcohol. how often do you think people suffering from anxiety "self-medicate" by drinking a bit to relax? if they continually drink while taking benzos, they can be in serious risk for injury or accident if they're active because of the potentiating effect of benzos on alcohol effects.
If someone is abusing alcohol, that's a special case. However, you should realize that benzos are a major part of the treatment for alcohol withdrawal! If someone truly has just been "self-medicating" with alcohol, benzos should serve as a safer, more effective substitute, and the person should no longer need alcohol.
Also of course it is not safe to assume that anyone with an anxiety disorder is an alcoholic! (I hardly ever drink, for example.)
> so i think collectively these factors make benzo less than stellar a choice in treating anxiety disorders for most individuals who are active and need to work during the day.
Huh? Anybody who is going to work drunk has a serious alcohol problem that needs to be addressed. This goes beyond having an anxiety disorder.
> of course there are exceptions to the rule, but exceptions are in minority.
The above is your opinion -- what you base it on is not clear. But here's a fact: anxiety patients almost never abuse prescribed benzodiazepines.
Posted by Louise on December 4, 1999, at 11:19:09
In reply to Re: social anxiety - benzos - to Louise., posted by Rick on December 3, 1999, at 14:17:09
Rick,
I'm certainly not benzophobic, but for whatever reason I wasn't able to tolerate Klonopin, and it's true that we're all different. However, according to several pdocs I've talked with, Klonopin is well known to cause depression in SOME people.
It's silly to say that just because a benzo is longer lasting that it's less likely to cause dependency. Any benzo will eventually cause dependency if taken continually for several weeks.
For me, the big issue is not dependency. I don't have a problem being dependent for the rest of my life on a medication that allows me to function normally. If Xanax, Ativan, Valium, and even Klonopin allows you, me or anyone else to have a good quality of life, then what's the big deal?!
BTW, if the benzo equivalency chart is inaccurate, I would be interested in seeing it corrected, although most people I've talked with have pretty much agreed with its accuracy.
Louise
> Louise -
>
> Sorry to hear about your bad experience with Klonopin. But you'll note that -- despite my pdoc's pronouncement that he has rarely seen a withdrawal problem in a situation like mine -- I am very careful to use qualifiers like "primarily" in my posts. I did not, and would not, make an absolute statement, because I know there are sometimes cases like yours where things work out differently. While research and years of professional experience have conclusively demostrated that Klonopin is far less likely to cause withdrawal difficulties than the shorter-acting benzo Xanax, that certainly does not mean no one ever has the opposite reaction (or rebound anxiety which presents as withdrawal symptoms). You said it yourself: everybody's different. Statistically speaking some people are going to end up as outliers, or atypical cases.
>
> As for the relative potency of the two benzos, I could write a thesis here. (And I hate to point this out once again, but some parts of Dr. Bob's wonderful site have info which is controversial and/or has not been updated with the most recent research -- including the benzo equivalency chart.) But suffice to say that, here again, individual body chemistry is a more important determinant of benzo "equivalencies" than some set mathematical formula. To get the same anti-anxiety effect as X mg. of Xanax, Person A may need X/2 mg. of Klonopin, Person B needs X mg. of K, person C needs 2X mg., and person D just doesn't get any help from it at all.
> This is why, even more so than for antidepressants, you often see the term "highly individualized" applied to benzo dosing.
> For me, .5 mg of Xanax puts me to sleep, while I can take .5 mg of Klonopin with no fatigue at all.
> Rick
Posted by Jane on December 4, 1999, at 11:51:45
In reply to Re: social anxiety - benzos - to Rick, posted by Elizabeth on December 4, 1999, at 9:10:23
> The above is your opinion -- what you base it on is not clear. But here's a fact: anxiety patients almost never abuse prescribed benzodiazepines.
----------------------
i'm basing it on reading scientific literature that you can pull off medline (not the abstracts but the entire articles). in the introductory remarks that follows the abstract, and also in the discussion section many times you will find the researcher state the reason why physicians continue to look for alternatives to benzos is the fact that inherently there is a potential for addiction and withdrawal syndrome. the very fact that benzos are a schedule IV and therefore a controlled substance comes from clinical studies that FDA decided to warrant such restrictions.some here seems to feel very vehement about defending benzos - i dont think benzos should *not* be first line given the right circumstance, ie the doctor does not believe the patient is a potential substance abuser or have family history of such (they also don't want to be liable) - i think that all medications *including* benzos are effective given the right patient type. the problem arises when doctors who do not spend the time for each patient to carefully assess the situation indiscriminantly prescribe benzos for every anxious patient they see because its generic and cheap and also out of habit.
jane
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