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Re: social anxiety-HELP!!! (Follow-up to Rick)

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

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 treatment

It's important to type social phobia in caps as well as capitalize the AND. Later, you might want to search
"social phobia" AND moclobemide

or "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.

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




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