Posted by zeugma on May 15, 2004, at 12:59:28
In reply to Re: Klonopin - Makes you talk more or less ?? » zeugma, posted by finelinebob on May 14, 2004, at 20:39:34
> > I think this is true, but there is more to it than that. I mean that if someone is not merely "painfully shy," but suffers from true social phobia/avoidant personality disorder, it is not a lack of social skills that causes the inhibition. it is a disproportionate, uncontrollable reaction to social stimuli, and things like CBT become a farce compared to the way Klonopin can treat this disorder.
>
> All that is true. I use "painfully shy" here as a euphemism for social anxiety/related disorders. When there is a biological substrate to some behavioral issue, CBT just ain't going to cut it. What I wanted to stress was that klonopin or other such meds can get you to a place where things like CBT can take you the rest of the way -- but they're not going to take you all the way.
>
> Well, unless you're a natural schmoozer, viciously cut-off from your true calling by the despotic rule of a few misguided, aberrant genes.... ;^)
>
> flbI agree that Klonopin or any med isn't going to reverse behavioral patterns that have taken years to become entrenched. It's important to note that the average age of onset of social phobia is around 10, while the average age of those seeking treatment for this disorder is around 30. That's 20 years of 'biologically enforced' avoidance, and who can say what the effect on one's 'natural' personality is? when so many of us are forced to live lives based around our anxiety? Not to mention that social phobia is often comorbid with other disorders, above all depression, which takes its own, enormous toll.
I feel bitter about my CBT trial, because I was convinced that Klonopin, or Nardil, would have made the process workable instead of driving me up the walls with terrible anxiety. My CB therapist, to whom I mentioned these concerns, seemed to take my desire to augment therapy with appropriate meds as a sign that I was looking to avoid the hard work that CBT inevitably involves. The bible of CBT, David Burns' "Feeling Good", blasts benzodiazepines as addictive, escapist, and likely to interfere with the CBT process, uniquely among classes of psychotropic meds (he endorses the use of AD's in conjunction with CBT). The problem I have isn't simply that burns doesn't like benzos. the problem I have concerns the misunderstandings that circulate among mental health professionals, including therapists, psychiatrists, and leading researchers in the field, about what even meds that have been around as long as benzos actually do in terms of therapeutic effect.
As an example, consider the work of Joseph LeDoux, a leading researcher in the field of of fear and anxiety, and author of "Synaptic Self", an otherwise brilliant book which contains a number of important errors, significantly concerning the medications used to treat the disorders of fear and anxiety. he says on page 275,
"Over the past decade or so, a number of different SSRI's have been marketed, including Prozac, Zoloft, Paxil, Luvox, and celexa. These drugs are as effective as tricyclics in helping depressed people, but probably not more so. This is to be expected, since both classes of drug basically do the same thing- make more serotinin available at synapses. But the SSRI's do the job with fewer side effects- they are selective for serotonin, so the side effects caused by enhancing norepinephrine are eliminated."
This is an outrageous error, and sets off all kinds of alarm bells when he later touts SSRI's as doing basically the same thing as benzos, but with fewer side effects. There is a very strong argument to be made that not only are SSRi's significantly less effective for depression than TCA's, that their side effect profile is actually FAR worse (I would rather have a dry mouth and constipation than amotivation and emotional blunting, for example) and that SSRI's are also far more s/e-ridden, not to mention unequivocally less effective, in cases of severe anxiety than benzos. When one of the experts in the field can make statements like these, it makes me wonder where else the lights are out, too. A disquieting thought.
poster:zeugma
thread:346884
URL: http://www.dr-bob.org/babble/20040515/msgs/347156.html