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Brain Chemistry/Lasting Social Phobia Benefits Lisa01

Posted by Rick on January 21, 2002, at 3:40:48

In reply to Re: MAOI dose and dizziness-Seamus, posted by Lisa01 on January 20, 2002, at 19:02:47

> It shows you how desperate we are for relief from symptoms--of Social Anxiety in my case--that we will put up with such things. I just sometimes wonder what the long-term result will be.

The general wisdom -- and I'm not saying it's 100% correct -- is that medication changes brain chemistry temporarily; while successful CBT can effect permanent changes.

On the other hand, the continuation vs. discontinuation summarized study below shows clear evidence of maintained post-treatment benefit from Klonopin (clonazepam), the med which has demonstrated the highest level of controlled-study efficacy to-date for SP. Despite the overblown fears of dependence, addiction (HUGELY exaggerated), and tolerance (excuse me, why have I been able to REDUCE my theraputic dose from 3mg to 1mg over two years??), this med is physically safer than AD's and generally a lot more tolerable. But I digress...I'd imagine the kinds of post-treatment Social Phobia benefits described here would likely apply to MAOI responders as well.

P.S. Despite my Klonopin boosterism I think if you stick it out you have a great chance of doing well with Parnate. And if even if not, there are quite a few meds than can help, with some promising new ones in development.

Rick
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J Clin Psychopharmacol 1998 Oct;18(5):373-8

Discontinuation of clonazepam in the treatment of social phobia.

Connor KM, Davidson JR, Potts NL, Tupler LA, Miner CM, Malik ML, Book SW, Colket JT, Ferrell F.

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.

Patients with social phobia who responded well to 6 months of open-label treatment with clonazepam were assigned to receive either continuation treatment (CT) with clonazepam for another 5 months, or to undergo discontinuation treatment (DT) using a clonazepam taper at the rate of 0.25 mg every 2 weeks, with double-blind placebo substitution. Clinical efficacy was compared between the CT and DT groups using three different social phobia scales. Benzodiazepine withdrawal symptoms were also measured. Relapse rates were 0 and 21.1% in the CT and DT groups, respectively. Subjects in the CT group generally showed a more favorable clinical response at midpoint and/or endpoint, although even in the DT group clinical response remained good. With respect to withdrawal symptoms, the rates were low in both groups (12.5% for CT and 27.7% for DT) with no real evidence suggesting significant withdrawal difficulties. At the end of 11 months of treatment with clonazepam, however, a more rapid withdrawal rate was associated with greater distress. This study offers preliminary evidence to suggest that continuation therapy with clonazepam in the treatment of social phobia is safe and effective, producing a somewhat greater clinical benefit than a slow-taper discontinuation regime. However, even in the DT group, withdrawal symptoms were not found to be a major problem. The study can be taken as supportive of benefit for longterm clonazepam treatment in social phobia, as well as being compatible with a reasonably good outcome after short-term treatment and slow taper.



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