Posted by Phil on February 18, 2003, at 22:02:59
In reply to My problem, posted by daizy on February 18, 2003, at 9:36:06
Top Stories
FDA Approves New Use For Zoloft
By Jamie Talan
STAFF WRITERFebruary 18, 2003
Feeling so uncomfortable around other people, one 55-year-old accountant routinely waited until 3 a.m. to take out the garbage to avoid running into neighbors. At work, the social interactions were so painful that he quit.He's one of millions of Americans with social anxiety disorder, also known as social phobia. He's been a volunteer in a nationwide study to test the effectiveness of Zoloft, a popular antidepressant that is now being used for a variety of behavioral disorders. For him, that pill helps him navigate the world every day. He has not only returned to work, but now lunches with his colleagues. And he now takes the garbage to the curb at a more civilized hour, without hearing the thump, thump, thump of his heart.
Last week, the Food and Drug Administration approved Zoloft, a so-called selective serotonin-reuptake inhibitor, or SSRI, for the additional use of treating social phobia.
Ever since the development of the SSRIs - Eli Lilly's Prozac was the first on the scene in 1987 - pharmaceutical companies have been testing their powers against a range of behavioral conditions. These medicines are now prescribed for obsessive-compulsive disorder, post-traumatic stress disorder, panic and premenstrual dysphoric disorder. In 1999, the FDA approved the antidepressant Paxil for the short-term treatment of social anxiety disorder. Last week, Pfizer's Zoloft became the first medicine for the long-term treatment of social phobia.
In the latest studies of social phobia, scientists recruited 600 patients and first tested the medicine's effect during a 12-week trial. About 55 percent had significant relief from their anxiety, said Dr. Michael Liebowitz, director of the anxiety disorders clinic at the New York State Psychiatric Institute in Manhattan, who was a principal investigator in the study. Then, about 100 patients who improved while taking the medicine were entered into a longer study, and half received the medicine and the others took a placebo. Virtually all of those on the medicine remained free of symptoms during the 20-week study. About 35 percent of those on placebo returned to their previous social anxiety-ridden state.
Scientists don't really understand this disorder - long thought to be psychological - but the fact that medicines that regulate serotonin work to alleviate such powerful fears suggests a possible biological link. Social phobics have many of the symptoms that are seen in people with panic attacks - the racing heart, the sweaty palms, shortness of breath, increased blood pressure and light-headedness - but it is limited to times when they feel they are in a stressful social situation. For many, it is public speaking, but others can be immobilized by a one-on-one encounter, as well. Liebowitz and his colleagues studied the biological underpinnings of social phobia by asking patients to stand before a group and talk while their blood pressure, heart rate and blood levels of key chemicals were monitored. People with social phobia had higher levels of adrenaline than normal volunteers who completed the same experiment.
For years, beta blockers - generally used to increase heart blood flow - have been used successfully on occasions when people with social phobia had to perform in public. Now SSRIs have proven safe and effective. These drugs have fewer side effects, and people with social phobia would take beta blockers only occasionally.
Liebowitz said that another patient in the study had left his job and family in search for answers. He wound up at Columbia Presbyterian Medical Center's New York State Psychiatric Institute, and the Zoloft helped ease the social tensions in his life. He's now returned to his life, Liebowitz said.
Zoloft's effectiveness supports the theory that biology is at work. And probably more than just serotonin and adrenaline is involved in social phobia, scientists agree. Experiments conducted on men and monkeys show that another brain chemical called the D2 dopamine receptor is depleted in a certain area of the brain. Other animal studies have suggested that altering the environment of the animal changes the D2 receptor activity in the brain. This is good news, scientists say. Because it means the brain can actually reorganize itself in response to a more positive experience. "Once a person feels better, they can build up confidence to do other things," Liebowitz added.
He and others have come to believe that roughly 4 percent of the population may suffer from social phobia. Many of these people are born with shy temperaments. Shyness per se doesn't mean that a person will develop social phobia, but it most certainly increases one's risk. Liebowitz suspects that many people don't even know they suffer from this condition, or that there is medicine available that can help. For some people, cognitive behavioral strategies and relaxation techniques also help them through anxious social situations. Columbia researchers are now testing the benefits of a combination of behavioral therapy and medicine.
Copyright © 2003, Newsday, Inc.
poster:Phil
thread:201464
URL: http://www.dr-bob.org/babble/social/20030215/msgs/201712.html