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Re: Social Phobia - Jimmy's Algorithm

Posted by jimmygold70 on April 21, 2001, at 9:02:25

In reply to Re: Social Phobia - Jimmy's Algorithm, posted by kate9999 on April 20, 2001, at 3:18:37

I would wait longer for Nardil. It should be reserved as a third line therapy. Side effects on Naril are so severe for some people, that they might cease all drug treatments forever. My personal experience was negative, and most physicians would agree that it should be reserved as a third line.

Also, one might yry a nonselective SRI (clomipramine) before Nardil. It is very potent. Also, I believe that some of the positive effects of Nardil are from its anticholinergic activity, which clomipramine has planty of.

Jimmy


> I don't know if I'd wait so long to try Nardil - particularly if you're talking severe generalized sp, (or especially with atypical depression).

I haven't thought of that. A good idea. We don't have Parnate sold around here, but it is a sound option. RIMAs are less effective, that's true.

> Also if Nardil side effects are too much, maybe switch first to Parnate - my experience was though I had side effects with both, they were very different side effects, so it would be worth the switch - since I think the RIMAs are maybe less effective.


> > My algorithm - GAD+SP
> >
> > 1. SSRI (Celexa is my favorite) for 2 months
> > 2. Doesn't work - raise the dose to the MAX
> > 3. Didn't work as well, wait for a month
> > 4. Partial response - Add buspirone up to 60mg/day
> > 5. Insufficient response: Swith to Effexor
> > 6. Partial response - raise dose to the MAX
> > 7. Insufficient response - Switch to Klonopin
> > 8. Insufficient response to Klonopin - switch to Nardil, up 90mg/day
> > 9. Too many side effects on Nardil (though full response) - Swith to Manerix / Aurorix
> > 10. Too many side effects Klonopin (though full response) - Swith to Nerontin
> > 11. No or little response to the above - RECONSIDER DIAGNOSIS OF SOCIAL PHOBIA
> >
> > Note that there is no perfect treatment for Social Phobia. The more severe condition you are in, the more response you're gonna get. 30% reduction in symptoms is fair.
> >
> > Also, many other conditions occur with or mimic Social Phobia: Avoidant/Schizoid PD, Borderline PD (!), PTSD to name a few.
> > My 2 cents.
> >
> > Jimmy


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poster:jimmygold70 thread:60399
URL: http://www.dr-bob.org/babble/20010417/msgs/60678.html