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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Zabadoo on December 16, 2003, at 7:00:08
Does anyone have experience with both Parnate and the SSRI's for social anxiety. I know that Nardil is the "gold standard" but it is not available in my backward country. If, as according to www.socialfear.com, nardil is 65-85% effective, whereas ssris are 20% effective, then what's the relative efficacy of Parnate? There don't seem to be many studies on this, and I had to convince my doctor to give me this stuff. And after I mentioned the word "klonopin" he started looking at me funny.
Posted by brussell on December 16, 2003, at 10:41:15
In reply to Parnate vs SSRIs for social anxiety, posted by Zabadoo on December 16, 2003, at 7:00:08
Everyone responds to these drugs differently, so you shouldn't take percentages TOO seriously.
Personally, I would try an SSRI first. It's been years since I took Prozac, but I remember it seemed to make me less socially inhibited--in particular, more mellow and less likely to be hurt by insignificant criticism.
I've been taking Parnate for a week now, and I seem to feel more timid than usual. It's probably too early to tell what this drug's social anxiety effect will be for me.
In general, most people would suggest starting with an ssri, simply because you don't have to worry about the MAOI food/drug interactions. Don't forget that people can respond well to one SSRI and not to another. Have you tried Paxil?
Good luck.
Posted by cybercafe on December 16, 2003, at 12:50:13
In reply to Parnate vs SSRIs for social anxiety, posted by Zabadoo on December 16, 2003, at 7:00:08
> Does anyone have experience with both Parnate and the SSRI's for social anxiety. I know that Nardil is the "gold standard" but it is not available in my backward country. If, as according to www.socialfear.com, nardil is 65-85% effective, whereas ssris are 20% effective, then what's the relative efficacy of Parnate? There don't seem to be many studies on this, and I had to convince my doctor to give me this stuff. And after I mentioned the word "klonopin" he started looking at me funny.
parnate is much better than SSRIs for anxiety in my experience, and i think it says so on the website too no??
Posted by Kon on December 16, 2003, at 23:12:13
In reply to Parnate vs SSRIs for social anxiety, posted by Zabadoo on December 16, 2003, at 7:00:08
>I know that Nardil is the "gold standard" but it is not available in my backward country... And after I mentioned the word "klonopin" he started looking at me funny.
Two fairly recent meta-analysis done comparing the effectiveness of different meds on SAD suggest that benzos particularly clonazepam (Klonopin) may be the most effective medication:
From Blanco (2003),"Our analysis found that clonazepam, based on a single study, had the largest mean effect size of all medications. The effect sizes of SSRIs and phenelzine (Nardil) were similar to each other and numerically (but not statistically) smaller than those of clonazepam"
"Until relatively recently, phenelzine (Nardil)was considered the gold standard in the treatment of SAD. However, results from the meta-analysis suggest that its efficacy is not superior to that ofthe SSRIs or clonazepam, although it has never been directly compared to those medications."
Effect size based on Liebowitz Social Anxiety Scale:
Benzos (clonazepam)-1.54
Nardil (Phenelzine)-1.02
SSRIs -0.65Effect size based on Clinical Global Impression Scale:
Benzos (i.e. Clonazepam)-16.61
Phenelzine (Nardil) -5.53
SSRIs -4.1
Similarily from Federoff et al. (2001)meta-analysis:Effect size based from self-report:
Benzos-2.095
SSRIs -1.697
MAOIs -1.078Effect size based on Clinician-rated measures:
Benzos-3.150
SSRIs -1.540
MAOIs -1.235
Despite these impressive values for benzos both these authors go on to still favour SSRIs because of fewer side effects and less addiction potential. Their evidence for this argument, however, was not given. In fact if one looks at WHO data and UK yellow-card reports the SSRIs are significantly worse than benzos both wrt withdrawl and dependence-related problems. See:
Posted by JoshM on December 17, 2003, at 0:27:56
In reply to Clonazepam (Klonopin) vs. Nardil vs SSRIs, posted by Kon on December 16, 2003, at 23:12:13
In my experience SSRIs relieve social anxiety somewhat, but they do so by numbing your emotions. Yeah you aren't filled with anxiety anymore, but you no longer have a desire to be sociable, so it's kinda a catch 22. Of course everybody is different, but that is how it was with me..
Posted by scott-d-o on December 17, 2003, at 1:55:05
In reply to Clonazepam (Klonopin) vs. Nardil vs SSRIs, posted by Kon on December 16, 2003, at 23:12:13
> Despite these impressive values for benzos both these authors go on to still favour SSRIs because of fewer side effects and less addiction potential. Their evidence for this argument, however, was not given. In fact if one looks at WHO data and UK yellow-card reports the SSRIs are significantly worse than benzos both wrt withdrawl and dependence-related problems.
> See: http://www.socialaudit.org.uk/4390EU61.htm
> http://www.socialaudit.org.uk/43800047.htm
I'm afraid their evidence for this argument most likely can be found in their wallet, which is now much thicker for coming to this conclusion; though even their own data supports just the opposite.
This is the end of the thread.
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