Posted by SalArmy4me on July 28, 2001, at 21:43:18
In reply to social phobia what meds work need help!!!, posted by jason60 on July 28, 2001, at 19:46:55
My review of the Literature:
Gabapentin:
Pande, Atul C. MD, FRCPC et al. Treatment of Social Phobia With Gabapentin: A Placebo-Controlled Study. J of Clin Psypharm. 19(4):341-348, Aug 99:
{NOT FROM MEDLINE}"This study has shown that gabapentin produced a significantly greater decrease in the symptoms of social phobia than did placebo as measured by the LSAS. Treatment response seemed to be influenced by age and gender, an observation for which only speculative explanations can be offered. Because women exhibited greater responses to placebo, the drug-placebo treatment difference was smaller for women than for men. Despite the influence of these variables, gabapentin seems to have anxiolytic activity, which confirms the anxiolytic profile seen in preclinical behavioral experiments."
MAOI's:From "MAOI PRESCRIPTIONS: Way down, but still not out." American Journal of Nursing. 100(1, PART 1 OF 2):71, January 2000:
"Only 2% of psychiatrists recently surveyed reported prescribing monoamine oxidase inhibitors (MAOIs) frequently. This is down from 25% 10 years ago, before the widespread use of selective serotonin reuptake inhibitors (SSRIs). Meanwhile, the majority of respondents, 92%, acknowledged the usefulness of MAOIs for treating atypical depression, and a substantial percentage found them useful for major depression (melancholic type), panic disorder, SOCIAL PHOBIA, and other disorders. They are particularly useful for patients who don't respond to SSRIs and can't tolerate the side effects associated with tricyclic antidepressants."
Specifically Phenelzine (MAOI):
Heimberg, Richard G. PhD. Cognitive Behavioral Group Therapy vs Phenelzine Therapy for Social Phobia: 12-Week Outcome. Archives of General Psychiatry. 55(12):1133-1141, December 1998:
"Despite similar percentages of response after 12 weeks, phenelzine therapy was also superior to Cognitive-Behavioral-Therapy on several measures. On the whole, phenelzine therapy responders seemed to be "better responders" than CBGT responders. Because CBGT was characterized by an increased rate of response between midtreatment and posttreatment, it is unclear whether patients receiving CBGT had achieved "the maximum" after 12 weeks. An extended period of intensive treatment may benefit CBGT efficacy, a proposition we are currently evaluating. We are also studying the utility of combination treatment, which may be especially relevant for the most impaired patients...Adverse effects are always a concern in studies of MAOI treatment. However, we observed few serious problems. No hypertensive crises occurred, and no patient was precluded from dosage escalation because of adverse effects..."
Buspirone:Cottraux, J. PhD. A Controlled Study of Cognitive Behaviour Therapy with Buspirone or Placebo in Panic Disorder with Agoraphobia. British Journal of Psychiatry. 167(5):635-641, November 1995:
"Either buspirone or placebo was taken orally in the form of 10 mg pills, which could be split into two parts of 5 mg. Starting with 5 mg t.i.d. treatment was increased by 5 mg up to 60 mg daily. After adaptation, the patients took about 30 mg daily. The medication was given for 16 weeks and tapered off during the week following the post-treatment assessment...A stronger, although significant, effect of buspirone on the social phobia scale may support results in a previous report (Munjack et al, 1991)."
Sertraline has a prophylactic Effect:
Katzelnick, David J. MD. Sertraline for Social Phobia: A Double-Blind, Placebo-Controlled Crossover Study. American Journal of Psychiatry. 152(9):1368-1371, September 1995."Although the carryover effect was not statistically significant, the patients who were treated initially with sertraline did not return to their pretreatment levels of social anxiety while taking placebo; thus, the treatment effect was attenuated. This finding, while gratifying for the patients, is in contrast to that for other anxiety disorders, such as obsessive-compulsive disorder, for which relapse occurs rapidly when treatment with potent serotonin reuptake inhibitors is discontinued [33,34]. We suspect that absence of rapid relapse by these chronically ill patients (average illness duration, 22.00 years) was related to the effects of naturalistic exposure therapy represented by the study visits and, more important, social situations that they no longer avoided. While drug carryover might be a possibility, the three patients who stopped taking sertraline after the study (all of whom were responders) did not relapse until 6 weeks after discontinuation. The mean difference in scores (sertraline minus placebo) on the Liebowitz Social Anxiety Scale in the first half of the trial was 19.0. This compares with mean differences of 3.5 found with atenolol [4], 27.2 with phenelzine [4], 27.3 with moclobemide [35], 24.4 with clonazepam [7], and 19.3 with fluvoxamine [21].
poster:SalArmy4me
thread:72267
URL: http://www.dr-bob.org/babble/20010725/msgs/72285.html