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Re: SSRI augmentation for SP intensive CBT » Cairo

Posted by Ilene on August 18, 2005, at 23:09:31

In reply to Re: SSRI augmentation for SP intensive CBT, posted by Cairo on August 18, 2005, at 19:35:37

Here's a listing of CBT practioners:
http://www.cognitivetherapy.com/others.html
If one of them is in your area s/he might be able to help.


Here are two abstracts about combination drug therapy for social phobia:

CNS Drugs. 2005;19(5):377-91.
Social anxiety disorder : current treatment recommendations.

Muller JE, Koen L, Seedat S, Stein DJ.

Medical Research Council's Unit on Anxiety Disorders, Department of Psychiatry, University of Stellenbosch, Tygerberg, Cape Town, South Africa. jemuller@sun.ac.za

Social anxiety disorder (SAD) is a prevalent and disabling disorder associated with significant co-morbidity. An increased awareness of SAD over the past two decades has given impetus to advances in the pharmacotherapeutic and psychotherapeutic treatment options for this disorder. On the basis of consistent data from randomised controlled trials, present consensus supports the use of SSRIs as the first-line treatment in generalised SAD, partly because of established short- and long-term efficacy in this disorder, evidence for safety and tolerability, and ability to treat co-morbid conditions. There is more recent evidence that venlafaxine XR (extended release) may also be considered a first-line treatment in SAD. Second-line treatments include MAOIs (e.g. phenelzine) and reversible inhibitors of monoamine oxidase A (e.g. moclobemide), while some benzodiazepines and antiepileptics (e.g. clonazepam and pregabalin) may also be useful. Over the past two decades, cognitive behavioural therapies for SAD have gained increasing empirical support. The optimal approach to the management of treatment-refractory SAD patients requires additional study.


2: Nihon Shinkei Seishin Yakurigaku Zasshi. 2004 Jun;24(3):133-6. Related Articles, Links

[Recent trends in pharmacotherapy for anxiety disorders]

[Article in Japanese]

Tajima O.

Department of Mental Health, Kyorin University, School of Health Sciences, Miyashita-cho, Hachioji, Tokyo, 192-8508 Japan.

Since the introduction of SSRIs, pharmacotherapy for anxiety disorders has significantly changed. Although the SSRIs are considered to be a first-line treatment for the most of anxiety disorders benzodiazepines are still widely used in clinical practice despite the risk of dependence and strong recommendation for their use as a second-line. The SSRIs only replaced tricyclic antidepressants and the MAO inhibitors especially in the treatment of panic disorder, obsessive-compulsive disorder and social phobia. Combination of the SSRIs and the benzodiazepines is widely used. Recently it has been suggested that the combination of SSRI and benzodiazepine is rational, because each drug has a different mechanism of action, the benzodiazepines enhancing GABAergic transmission, and the SSRIs stimulating the 5-HT1A receptor that may inhibit the postsynaptic neuronal excitability in the amygdala and the prefrontal cortex that comprise the brain circuit of fear and anxiety. Recent imaging studies suggested the hyperactivity of the amygdala in the patients with generalized social anxiety disorder and successful treatment with cognitive behavioral therapy or SSRI might significantly reduce the hyperactivity of the amygdala. It was suggested that the rational combination of SSRIs and benzodiazepines seems to be an effective and practical way of treatment for most anxiety disorders.

Best of luck, I.


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