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Re: Is Neurontin superior to Gabitril for social ph? 3 Beer Effect

Posted by Elizabeth on December 16, 2001, at 13:23:54

In reply to Is Neurontin superior to Gabitril for social ph?, posted by 3 Beer Effect on December 15, 2001, at 22:08:20

I don't know about Gabitril vs. Neurontin. Neurontin has been studied a bit (in SP and other anxiety disorders -- panic, PTSD -- too) and the results so far are positive, while Gabitril hasn't yet. Neurontin is worth a try, maybe to augment the Klonopin if your new doctor is as benzophobic as the present one. Lamictal might also be worth trying. There has been one study of Depakote, with negative results. Pregabalin, an anticonvulsant that is still in the pipeline, is similar to gabapentin and seems to work in anxiety disorders as well.

Benzos work, although your dose is on the low end of the effective range. 1 mg twice a day of Klonopin would not be at all unreasonable, and any doctor who thinks Klonopin is all that addictive is ignorant and needs a good continuing education course on benzos! I don't think that there's evidence that any benzo works better than any other. The ones that have been systematically evaluated are Klonopin, Xanax, and Ativan. Klonopin is slow to kick in, as you say, but it works well if you take it around-the-clock (as you're taking it -- two or maybe three times a day) so you always have some in you. I take benzos as-needed, so Xanax, which works faster, is better suited to my needs.

Exactly what antidepressants have you tried, and what happened? How long did you take them and at what doses?

Have you ever tried a MAOI? RIMAs may work, and if you can get them easily it might be worth trying them before moving on to the irreversible MAOIs. I think Nardil is the best of these, but Parnate works well too and may have fewer annoying side effects (weight gain, sexual dysfunction). You can take MAOIs along with benzos and anticonvulsants, but not with other antidepressants that work for social phobia. (The primarily noradrenergic antidepressants don't work for SP, and most tricyclics are therefore ineffective. Clomipramine, which has the most effect on serotonin of all the TCAs, can work well, but it has some pretty nasty side effects.)

Finally, as I've said before, opioids work the best for me -- Nardil is the only thing that's come close. But I don't know whether what I have is regular social phobia.

Mitch mentioned he takes Risperdal. I just wanted to let you know that I don't know of any evidence that antipsychotics help in SP, and there is a chance they might make it worse. Of course, everybody's different, but I would put antipsychotics way down at the bottom of the list of things to try.

Another med that Mitch mentioned was Adderall. I think that stimulants can help some people with SP -- they can sort of give you the extra push you need to be able to be social. That's just my opinion though, and I'm sure it doesn't apply to everyone with SP; some people may find that stimulants just make them more nervous.

I hope this helps. Keep in mind, there are lots of options. I especially urge you to get an adequate dose of Klonopin, or add something to it that gives you adequate relief -- any of these drugs is *much* healthier than alcohol!

best,
-elizabeth


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poster:Elizabeth thread:86944
URL: http://www.dr-bob.org/babble/20011213/msgs/87103.html