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My newly prescribed "social phobia" meds - fyi

Posted by JohnB on November 17, 1999, at 8:41:52

hi, thought it might be worth sharing with you my visit yesterday to my pschiatrist/psychopharmacologist. He has previous experience with a large university-based anxiety disorder's program and is a true psychopharmacologist. That is, we don't have much talk therapy, but focus on fine-tuning the neurotransmitter imbalance which causes my social phobia. I've tried to become very informed of individual meds, results of open-label and closed-label studies, augmentation therapies, etc. I've also been treated for social phobia about the last 7 years, and have tried Nardil, Parnate, Buspar (low dose), Gabapentin (low dose), Celexa, Remeron, Effexor, and Klonopin. As Rick (another psychobabbler) say's, "I'm always looking for the 100% solution, with no negative side effects."

Regardign my appointment with my psychopharmacologist, first, I discussed numerous possibilities, based upon PubMed research, Medscape research, and contact with various psychdocs who have previously communicated with me regarding new meds. Alternatives I mentioned included:
(1) Pindolol 5mg bid, plus Klonopin 1 mg tid, plus Buspar 15 mg bid. Pindolol, although a beta-blocker, exerts significant activity at the 5HT1 receptor, as does Buspar. Pindolol has been found to potentiate buspar and, possibly, potentiate or augment Klonopin, by exerting a similar anxiolytic effect. This would also keep me off the SSRI's or SNRI's or MAOI's, which have all caused either some degree of sexual function, weight gain, dry mouth,or insomnia. Further, Pindolol is often use to reverse/eliminate the cognitive side effects caused by SSRI's, SNRI's, and benzodiazepines.

- this was my doctors preferred route, and what he ended up prescribing. Rick armed me with some information regarding his experience with Pindolol and Klonopin, and that helped a lot. If I experience any sexual side effects, we will augment with selegiline.

(2) Buspar monotherapy, 15 mg qid (equals 60 mg/day). Recent studies suggest Buspar at 60 to 90 mg/day may be efficacious for treating social phobia. Previous "guidance" of 15 to 30 mg/day, as monotherapy, was found to have been subtherapeutic.

- although some recent studies seem convincing, this isn't too different from alternative one, yet alternative one allows me to stay on the Klonopin, which is very effective, until I'm sure the Pindolol or Buspar polytherapy is effective. I'd like to eventually stop taking a benzodiazepine due to amnestic and cognitive effects, which are common with all CNS depressants.

(3) Zoloft (sertraline) and Buspar combination. One psychdoc in "Pscychopharmacology Tips" referred to this combination as "magical." I e-mailed him a question about what he meant by magical. He responded by saying that sertraline was no longer available in New Zealand. When I questioned him a second time about the "magical" effect, he ignored my e-mail. I understand from some postings that, while this combo is quite activating and good for drive deficient states, there's still an issue of significant weight gain.

- bottom line, we scratched this alternative

(4) Gabapentin (Neurontin) monotherapy. Although recent studies "imply" the efficacy of gabapentin for social phobia in the 3600mg/day to 4800 mg/day range, there have been no fixed-dose closed-label, placebo-controlled large scale studies. Parke-Davis is expected to conduct a follow-up study using high fixed dose buspar for social phobia, based upon promising results of this past summer's study.

- I was a little more reluctant to try this than was my psychdoc. He had been prescribing 1800 - 2400 mg/day, and had not gone as high as 3600 mg/day. As with many psychotropic medications, benefits do not "kick-in" until higher dosages are used. For that reason, there's typically not a linear relationship between dosage and benefit. That is, you may not receive any benefit until 3600mg/day plus. My bottom line, here, was to wait and see the results of the follow-up high fixed dose study.

So, to conclude, I'm just starting the Pindolol (5mg twice a day), Buspar (15 mg, twice a day), and Klonopin (1 mg, three times a day). Will let you know in several weeks how this is working.

Hope this helps someone.





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