Posted by willyee on May 4, 2007, at 12:24:50
In reply to Efficacy of alprazolam v clonazepam-social anx. » natedog539, posted by Jedi on May 4, 2007, at 1:37:05
I think klonopin is better liked for people who benifit from mood stablizers.Klonopin when tolerated through its initial start,kinda builds a backbone that some fine they need,and others find dulling and too depressing,but it seems to be strong on both ends, a must for either.
Xanax is hard and direct,prob more helpful for people just needing to address anxiety at certain times,which it will do.
I laugh at how the xanax/klonpin scenerio kinda resmles the parnate/nardil one.Well not actualy laugh,but i think its weid how they both share the similarity differance and both have a love hate realtionship with users.
> > for me klonopin (generic) does not work near as well as xanax. It does some but maybe by does it too low. For example I took 1.5 mg today and feel alright, but still socially anxious. It seems that xanax works better for me. I hopefull am going to try Nardil though and I will ask to you klonopin with it. Thanks for all your support Jedi. I appreciate it.
> > nathan
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> A lot of people on this board feel the alprazolam works better for them than clonazepam. There is even some research that clonazepam has a depressant effect. The half-life of alprazolam is somewhat shorter than clonazepam; this would make it a little more difficult to titrate off of if necessary. Many people say that getting off of clonazepam is very difficult also. Hey, if it works, let's not worry about getting off of it.
> Jedi
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> Pharmacologic Treatments for Social Anxiety
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> Link: http://www.aafp.org/afp/991115ap/2311.html
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> It is important to distinguish between the circumscribed and generalized types of social phobia before initiating pharmacotherapy, because the circumscribed type has responded to an "as-needed" schedule (typically of beta blockers), whereas the generalized type has responded better to standing dosage schedules (typically of specific antidepressants) of at least three months' duration. Although the outcome literature supports the efficacy of several agents, it does not indicate a clearly superior one. Treatment selection therefore involves matching the individual patient's preferences, symptoms and treatment goals with the relative benefits and risks of the following treatment options.
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> Monoamine Oxidase Inhibitors
> The monoamine oxidase inhibitors (MAOIs) have performed well in clinical trials for treatment of generalized social phobia. Phenelzine (Nardil), in particular, has been tested extensively in placebo-controlled studies.1214 Open and controlled trials suggest that approximately two thirds of patients will show clinically significant improvement during acute treatment with these agents.
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> The MAOIs have restrictions and adverse-effect risks that should be considered during treatment planning. The required low-tyramine diet, which prohibits many popular foods (Table 5), will deter some patients from accepting therapy with MAOIs. Patients risk a potentially fatal hypertensive reaction if they do not comply with the diet. Common adverse effects at therapeutic dosages (usually 45 to 90 mg per day for phenelzine) include postural hypotension, sedation, sexual dysfunction and weight gain. Some common over-the-counter medications, such as cold and cough remedies, are contraindicated in patients using MAOIs. Reversible MAOIs such as moclobemide, which do not require dietary restrictions, showed promise in early trials15 but mixed results in more recent ones,16,17 and to date they are not available in the United States.
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> The advantages and disadvantages of MAOI therapy for social phobia are summarized in Table 6. Although their advantages have led many to consider MAOIs an appropriate first-line treatment, their disadvantages have prompted others to relegate them to a second-line position behind the newer antidepressants.18
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> SSRIs and monoamine oxidase inhibitors have been shown to be effective in the treatment of generalized social phobia.
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> Selective Serotonin Reuptake Inhibitors
> Several studies support the efficacy of selective serotonin reuptake inhibitors (SSRIs), including large controlled trials of paroxetine (Paxil)19,20 and fluvoxamine (Luvox)21; smaller controlled trials of sertraline (Zoloft)22 and fluvoxamine23 and, most recently, an open, uncontrolled trial of citalopram (Celexa).24 As a group, SSRIs have shown acute-treatment improvement rates ranging from 50 to 75 percent of patients. Relatively safe and well tolerated, SSRIs are currently considered an appropriate first-line consideration. The advantages and disadvantages of SSRI therapy for social phobia are shown in Table 6.
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> When used in low doses on an as-needed basis, beta blockers appear to be a clinically effective treatment for mild to moderate circumscribed performance anxiety.
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> Benzodiazepines
> The benzodiazepines are fast-acting, well-tolerated anxiolytics that have shown efficacy in the acute treatment of social phobia, but they have also revealed some significant drawbacks related primarily to difficulties with discontinuation. Controlled studies of alprazolam (Xanax)12 and clonazepam (Klonopin)25 report acute-treatment improvement rates ranging from approximately 40 to 80 percent, with clonazepam showing more favorable results. However, standing dosages are sometimes difficult for patients to taper and discontinue without symptomatic worsening and a high risk of acute relapse.12
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poster:willyee
thread:755025
URL: http://www.dr-bob.org/babble/20070502/msgs/755774.html