Psycho-Babble Medication Thread 15364

Shown: posts 1 to 24 of 24. This is the beginning of the thread.

 

My newly prescribed "social phobia" meds - fyi

Posted by JohnB on November 17, 1999, at 8:41:52

hi, thought it might be worth sharing with you my visit yesterday to my pschiatrist/psychopharmacologist. He has previous experience with a large university-based anxiety disorder's program and is a true psychopharmacologist. That is, we don't have much talk therapy, but focus on fine-tuning the neurotransmitter imbalance which causes my social phobia. I've tried to become very informed of individual meds, results of open-label and closed-label studies, augmentation therapies, etc. I've also been treated for social phobia about the last 7 years, and have tried Nardil, Parnate, Buspar (low dose), Gabapentin (low dose), Celexa, Remeron, Effexor, and Klonopin. As Rick (another psychobabbler) say's, "I'm always looking for the 100% solution, with no negative side effects."

Regardign my appointment with my psychopharmacologist, first, I discussed numerous possibilities, based upon PubMed research, Medscape research, and contact with various psychdocs who have previously communicated with me regarding new meds. Alternatives I mentioned included:
(1) Pindolol 5mg bid, plus Klonopin 1 mg tid, plus Buspar 15 mg bid. Pindolol, although a beta-blocker, exerts significant activity at the 5HT1 receptor, as does Buspar. Pindolol has been found to potentiate buspar and, possibly, potentiate or augment Klonopin, by exerting a similar anxiolytic effect. This would also keep me off the SSRI's or SNRI's or MAOI's, which have all caused either some degree of sexual function, weight gain, dry mouth,or insomnia. Further, Pindolol is often use to reverse/eliminate the cognitive side effects caused by SSRI's, SNRI's, and benzodiazepines.

- this was my doctors preferred route, and what he ended up prescribing. Rick armed me with some information regarding his experience with Pindolol and Klonopin, and that helped a lot. If I experience any sexual side effects, we will augment with selegiline.


(2) Buspar monotherapy, 15 mg qid (equals 60 mg/day). Recent studies suggest Buspar at 60 to 90 mg/day may be efficacious for treating social phobia. Previous "guidance" of 15 to 30 mg/day, as monotherapy, was found to have been subtherapeutic.

- although some recent studies seem convincing, this isn't too different from alternative one, yet alternative one allows me to stay on the Klonopin, which is very effective, until I'm sure the Pindolol or Buspar polytherapy is effective. I'd like to eventually stop taking a benzodiazepine due to amnestic and cognitive effects, which are common with all CNS depressants.


(3) Zoloft (sertraline) and Buspar combination. One psychdoc in "Pscychopharmacology Tips" referred to this combination as "magical." I e-mailed him a question about what he meant by magical. He responded by saying that sertraline was no longer available in New Zealand. When I questioned him a second time about the "magical" effect, he ignored my e-mail. I understand from some postings that, while this combo is quite activating and good for drive deficient states, there's still an issue of significant weight gain.

- bottom line, we scratched this alternative

(4) Gabapentin (Neurontin) monotherapy. Although recent studies "imply" the efficacy of gabapentin for social phobia in the 3600mg/day to 4800 mg/day range, there have been no fixed-dose closed-label, placebo-controlled large scale studies. Parke-Davis is expected to conduct a follow-up study using high fixed dose buspar for social phobia, based upon promising results of this past summer's study.

- I was a little more reluctant to try this than was my psychdoc. He had been prescribing 1800 - 2400 mg/day, and had not gone as high as 3600 mg/day. As with many psychotropic medications, benefits do not "kick-in" until higher dosages are used. For that reason, there's typically not a linear relationship between dosage and benefit. That is, you may not receive any benefit until 3600mg/day plus. My bottom line, here, was to wait and see the results of the follow-up high fixed dose study.


So, to conclude, I'm just starting the Pindolol (5mg twice a day), Buspar (15 mg, twice a day), and Klonopin (1 mg, three times a day). Will let you know in several weeks how this is working.

Hope this helps someone.

JohnB.

 

Re: My newly prescribed "social phobia" meds - fyi

Posted by Justitia on November 17, 1999, at 10:37:27

In reply to My newly prescribed "social phobia" meds - fyi, posted by JohnB on November 17, 1999, at 8:41:52

Are you the one who went to a MEds Doctor in Houston? How did you like him?

 

Re: My newly prescribed "social phobia" meds - fyi

Posted by Elizabeth on November 18, 1999, at 1:24:29

In reply to My newly prescribed "social phobia" meds - fyi, posted by JohnB on November 17, 1999, at 8:41:52

Pindolol + Buspar has been something I've wanted to try. Let me know how it goes. Good luck!

 

Re: My newly prescribed "social phobia" meds - fyi

Posted by Adam on November 18, 1999, at 17:43:45

In reply to My newly prescribed "social phobia" meds - fyi, posted by JohnB on November 17, 1999, at 8:41:52

>
> So, to conclude, I'm just starting the Pindolol (5mg twice a day), Buspar (15 mg, twice a day), and Klonopin (1 mg, three times a day). Will let you know in several weeks how this is working.
>
> Hope this helps someone.
>
> JohnB.

I'm just curious:

Is the idea here to antagonize presynaptic 5-HT1a autoreceptors and agonize postsynaptic 5-HT1a receptors,
all the while preserving unsuppressed 5-HT neurotransmission? Could the addition of Serzone give this
therapy a little boost, by inhibiting 5-HT reuptake and guarding against sexual side effects (5-HT2
antagonism)?

What dose of selegiline would you try? 5mg b.i.d.?

 

To: Justitia

Posted by JohnB on November 18, 1999, at 22:32:23

In reply to Re: My newly prescribed "social phobia" meds - fyi, posted by Justitia on November 17, 1999, at 10:37:27

> Are you the one who went to a MEds Doctor in Houston? How did you like him?

No, you may have me confused with someone else. I don't live in Texas. Sorry. JohnB :)

 

To: Adam

Posted by JohnB on November 18, 1999, at 23:11:04

In reply to Re: My newly prescribed "social phobia" meds - fyi, posted by Adam on November 18, 1999, at 17:43:45

Adam,

I think you have much of the theory down cold - activate presynaptic and postsynaptic 5HT1A (by the 5HT1A agonist Buspirone)in the presence of the presynaptic 5HT1A antagonist Pindolol. Result is a rapid and posibly potentiated effect of Buspirone, as well as augmentation of the anxyiolytic effect of Clonazepam. As both Pindolol and Buspirone do not affect 5HT2 (at least not to any significant degree), there's really no 5HT2 antagonism to guard against. Sertraline could certainly be augmentation therapy for my social phobia, possibly potentiated or at leasted hastened in its effect by Pindolol, by I'd like to stay away from its weight gain side effects. Further, I'm fairly sensitive to sexual dysfunction caused by changes in 5HT2. However, higher dose Buspar (45-90 mg/day), which frequently causes nausea, may be mitigated by low dose mirtazapine, which has a small 5HT3 component, or the very expensive ondansetron 5HT3 antagonist.

I was primarily thinking of selegiline, 5 mg tid dosing, to further address Clonazepam congitive side effects, as well as to enhance sexual arousal, stimulation, and time to orgasm. I'm still only partially recovered from Marplan induced anorgasmia.

Thanks.

JohnB


 

Re: To: adam

Posted by Adam on November 19, 1999, at 10:12:30

In reply to To: adam, posted by johnb on November 18, 1999, at 23:43:12

Actually, my suggestion was not to use sertraline but Serzone (nefazodone) as an augmentation. It seems a specific serotonergic response
(stimulation of postsynaptic 5-HT1a receptors) is what you're after, and Serzone, being an SSRI of sorts would boost serotonin in the synapse
while simultaneously protecting against potential sexual side effects (via 5-HT2 antagonism). Perhaps Remeron (mirtazapine) might be an even
better choice in some respects (blocks both 5-HT2 and 5HT3), but its effect on serotonin potentiation is indirect.

I'm not criticizing this augmentation strategy (buspirone + pindolol), I just don't understand it completely, and wish to ask further questions
(the idea interests me too, as far as dealing with OCD while taking an MAOI). Buspirone is a partial 5-HT1a agonist while pindolol is a complete
presynaptic 5-HT1a antagonist. As far as what "partial" and "complete" mean pharmacologically, I'm making a guess that this has to do with
binding affinities for the receptor (delta Gs of binding or however pharmacologists express this). If there is a significant difference in
binding kinetics between the two, why shouldn't pindolol swamp any initial benefits you might get from from early presnaptic 5-HT1a agonism? Why
would there be any potentiation via that pathway? Would it be better to start off with buspirone and follow with pindolol?

Also, how does buspirone potentiate clonazepam? I should know this, as I knew someone who took it for years, but I'm not familiar with this
drug's mechanism of action.

As for using selegiline to counteract drug-induced cognative deficits: I have a bit of a theory regarding this, that might A) be total B.S., or
B) be worth thinking about. See the "Memory" thread above. I guess it may depend on what cognative deficits you are trying to counteract.

Thanks in advance to you or whoever takes the time to answer these questions. Like I said, I've wondered how to target the serotonin system while
taking an MAOI (and, like I said, deal with some issues involving OCD) without it leading to serotonin syndrome. I'm not sure if any currently
available strategy would work or be safe, but maybe buspirone and/or pindolol might be worth looking into.

> ccAdam,
>
> I think you almost have the theory down, just a bit of a twist. Actually, agonize (activate) both presynaptic and postsynaptic 5HT1A (by the 5HT1A agonist Buspirone)in the presence of the presynaptic 5HT1A antagonist Pindolol. Result is a rapid and posibly potentiated effect of Buspirone, as well as augmentation of the anxyiolytic effects of Clonazepam. As both Pindolol and Buspirone do not affect 5HT2 (at least not to any significant degree), there's really no 5HT2 antagonism to guard against with an SSRI such as Sertraline. However, Sertraline could certainly be augmentation therapy for my social phobia, possibly potentiated or at leasted hastened in its effect by Pindolol, by I'd like to stay away from its weight gain side effects. Actually, I'd like to stay away from SSRI's, SNRI's, and MAOI's altoghether. Further, I'm fairly sensitive to sexual dysfunction caused by ehanced in 5HT2, particularly 5HT2A. However, the nausea side effect of higher dose Buspar (45-90 mg/day), may be mitigated by low dose mirtazapine, which has a small 5HT3 component, or the very expensive 5HT3 antagonist, Ondansetron.
>
> Regarding Selegiline, I was primarily thinking of that, 5 mg tid dosing, to further address Clonazepam cognitive side effects, as well as to enhance sexual arousal, stimulation, and time to orgasm. I'm still only partially recovered from Marplan induced anorgasmia.
>
> Thanks.
>
> JohnBAdam,
>
> I think you almost have the theory down, just a bit of a twist. Actually, agonize (activate) both presynaptic and postsynaptic 5HT1A (by the 5HT1A agonist Buspirone)in the presence of the presynaptic 5HT1A antagonist Pindolol. Result is a rapid and posibly potentiated effect of Buspirone, as well as augmentation of the anxyiolytic effects of Clonazepam. As both Pindolol and Buspirone do not affect 5HT2 (at least not to any significant degree), there's really no 5HT2 antagonism to guard against with an SSRI such as Sertraline. However, Sertraline could certainly be augmentation therapy for my social phobia, possibly potentiated or at leasted hastened in its effect by Pindolol, by I'd like to stay away from its weight gain side effects. Actually, I'd like to stay away from SSRI's, SNRI's, and MAOI's altoghether. Further, I'm fairly sensitive to sexual dysfunction caused by ehanced in 5HT2, particularly 5HT2A. However, the nausea side effect of higher dose Buspar (45-90 mg/day), may be mitigated by low dose mirtazapine, which has a small 5HT3 component, or the very expensive 5HT3 antagonist, Ondansetron.
>
> Regarding Selegiline, I was primarily thinking of that, 5 mg tid dosing, to further address Clonazepam cognitive side effects, as well as to enhance sexual arousal, stimulation, and time to orgasm. I'm still only partially recovered from Marplan induced anorgasmia.
>
> Thanks.
>
> JohnBAdam,
>
> I think you almost have the theory down, just a bit of a twist. Actually, agonize (activate) both presynaptic and postsynaptic 5HT1A (by the 5HT1A agonist Buspirone)in the presence of the presynaptic 5HT1A antagonist Pindolol. Result is a rapid and posibly potentiated effect of Buspirone, as well as augmentation of the anxyiolytic effects of Clonazepam. As both Pindolol and Buspirone do not affect 5HT2 (at least not to any significant degree), there's really no 5HT2 antagonism to guard against with an SSRI such as Sertraline. However, Sertraline could certainly be augmentation therapy for my social phobia, possibly potentiated or at leasted hastened in its effect by Pindolol, by I'd like to stay away from its weight gain side effects. Actually, I'd like to stay away from SSRI's, SNRI's, and MAOI's altoghether. Further, I'm fairly sensitive to sexual dysfunction caused by ehanced in 5HT2, particularly 5HT2A. However, the nausea side effect of higher dose Buspar (45-90 mg/day), may be mitigated by low dose mirtazapine, which has a small 5HT3 component, or the very expensive 5HT3 antagonist, Ondansetron.
>
> Regarding Selegiline, I was primarily thinking of that, 5 mg tid dosing, to further address Clonazepam cognitive side effects, as well as to enhance sexual arousal, stimulation, and time to orgasm. I'm still only partially recovered from Marplan induced anorgasmia.
>
> Thanks.
>
> JohnBAdam,
>
> I think you almost have the theory down, just a bit of a twist. Actually, agonize (activate) both presynaptic and postsynaptic 5HT1A (by the 5HT1A agonist Buspirone)in the presence of the presynaptic 5HT1A antagonist Pindolol. Result is a rapid and posibly potentiated effect of Buspirone, as well as augmentation of the anxyiolytic effects of Clonazepam. As both Pindolol and Buspirone do not affect 5HT2 (at least not to any significant degree), there's really no 5HT2 antagonism to guard against with an SSRI such as Sertraline. However, Sertraline could certainly be augmentation therapy for my social phobia, possibly potentiated or at leasted hastened in its effect by Pindolol, by I'd like to stay away from its weight gain side effects. Actually, I'd like to stay away from SSRI's, SNRI's, and MAOI's altoghether. Further, I'm fairly sensitive to sexual dysfunction caused by ehanced in 5HT2, particularly 5HT2A. However, the nausea side effect of higher dose Buspar (45-90 mg/day), may be mitigated by low dose mirtazapine, which has a small 5HT3 component, or the very expensive 5HT3 antagonist, Ondansetron.
>
> Regarding Selegiline, I was primarily thinking of that, 5 mg tid dosing, to further address Clonazepam cognitive side effects, as well as to enhance sexual arousal, stimulation, and time to orgasm. I'm still only partially recovered from Marplan induced anorgasmia.
>
> Thanks.
>
> JohnBAdam,
>
> I think you almost have the theory down, just a bit of a twist. Actually, agonize (activate) both presynaptic and postsynaptic 5HT1A (by the 5HT1A agonist Buspirone)in the presence of the presynaptic 5HT1A antagonist Pindolol. Result is a rapid and posibly potentiated effect of Buspirone, as well as augmentation of the anxyiolytic effects of Clonazepam. As both Pindolol and Buspirone do not affect 5HT2 (at least not to any significant degree), there's really no 5HT2 antagonism to guard against with an SSRI such as Sertraline. However, Sertraline could certainly be augmentation therapy for my social phobia, possibly potentiated or at leasted hastened in its effect by Pindolol, by I'd like to stay away from its weight gain side effects. Actually, I'd like to stay away from SSRI's, SNRI's, and MAOI's altoghether. Further, I'm fairly sensitive to sexual dysfunction caused by ehanced in 5HT2, particularly 5HT2A. However, the nausea side effect of higher dose Buspar (45-90 mg/day), may be mitigated by low dose mirtazapine, which has a small 5HT3 comp

 

Adam - counteracting MAOI sexual dysfunction

Posted by Michael on November 19, 1999, at 23:18:23

In reply to Re: To: adam, posted by Adam on November 19, 1999, at 10:12:30

adam, i noticed you referred to MAOI's in your previous thread. have you any successful experience in counteracting MAOI induced sexual dysfunction (primarily anorgasmia or significantly delayed ejaculation)? i'm currently taking Marplan 80 mg/day, along with pindolol 15 mg/day (5 mg tid). This is very effective for my social phobia. I understand certain dopaminergic agonists (such as pergolide) have been used to reverse the sexual problems, as has Bupropion (even though it is contraindicated).

Any help greatly appreciated.

Michael

 

Re: Adam - counteracting MAOI sexual dysfunction

Posted by Adam on November 20, 1999, at 0:49:54

In reply to Adam - counteracting MAOI sexual dysfunction, posted by Michael on November 19, 1999, at 23:18:23

Michael,

I'm sorry, I can't help you with that one. I currently am taking selegiline,
and have experienced no sexual side effects from it; or if there are side effects,
they have caused somewhat enhanced functioning rather than dysfunction. So I
haven't needed to try any antidotes. My knowledge is fairly limited in this
stuff, and I don't know if I could suggest anything more than what you have.
One suggestion that I hesitate to make (given my own issues with an anxiety
disorder) might be to try switching to selegiline, and to augment that with
pindolol, as you have been doing with Marplan. Selegiline is a non-hydrazine
MAOI, and is quite activating, which might make it a less-than optimal choice
for anxiety. However, I have read coments on this board indicating selegiline
helped some with social phobia.

I'm sorry I couldn't be of more help. I know how frustrating your problem is
from personal experience (with SSRIs). The only solution I found, despite
trying a couple antidotes myself, was to change medications or put up with it.
I hope you find a better solution. Best of luck to you, and please let us know
if you find something that works.

> adam, i noticed you referred to MAOI's in your previous thread. have you any successful experience in counteracting MAOI induced sexual dysfunction (primarily anorgasmia or significantly delayed ejaculation)? i'm currently taking Marplan 80 mg/day, along with pindolol 15 mg/day (5 mg tid). This is very effective for my social phobia. I understand certain dopaminergic agonists (such as pergolide) have been used to reverse the sexual problems, as has Bupropion (even though it is contraindicated).
>
> Any help greatly appreciated.
>
> Michael

 

Re: Adam - counteracting MAOI sexual dysfunction

Posted by Scott L. Schofield on November 20, 1999, at 9:45:05

In reply to Adam - counteracting MAOI sexual dysfunction, posted by Michael on November 19, 1999, at 23:18:23

> adam, i noticed you referred to MAOI's in your previous thread. have you any successful experience in counteracting MAOI induced sexual dysfunction (primarily anorgasmia or significantly delayed ejaculation)? i'm currently taking Marplan 80 mg/day, along with pindolol 15 mg/day (5 mg tid). This is very effective for my social phobia. I understand certain dopaminergic agonists (such as pergolide) have been used to reverse the sexual problems, as has Bupropion (even though it is contraindicated).
>
> Any help greatly appreciated.
>
> Michael

I'm sure you know that much of the traditional pharmaceutical sensibilities have contraindicated such combinations, as well they should have. For instance, I have been on combinations that include: MAO-inhibitor + tricyclic + amphetamine. The pharmacist did an excellent job of screening for a dangerous combination of drugs that were perhaps overlooked. He required that he speak directly to my doctor before filling the prescription.

I have also been on a combination of Parnate + Wellbutrin (bupropion). I know that a Dr. J Feighner (Feighner Institute) has had a bit of experience with this combination (personal communication with my doctor). It doesn't seem that he has published any articles about it, though. I could not find any studies or anecdotal references of this combination while performing a quick search using Medline. I am in NO way recommending this as a treatment alternative for anyone.

I saw a bunch posts a few years ago in which bupropion was added to an ongoing SSRI treatment to counteract the sexual side-effects. It seemed to be successful. This combination itself seemed to have its own unexpected side-effect. Some of those who had responded only partially to the SSRI alone experienced a robust response after the bupropion was added. At the time, most of these posts involved Zoloft (sertraline). This must be viewed with the caveat that Zoloft was being used as the treatment of first-choice by many, if not most psychiatrists.

As I've written in other posts, it has been my experience with MAOIs that these changes in orgasm disappear over time. I sometimes get the feeling, however, that such may not be the case with SSRIs. I don't know.

You should expect that it might take several months before your pattern of orgasm returns to something more familiar to you. I know that I can't speak for anyone else but myself, but I think it's worth the investment of time if the drug works for you. I'm not sure, but it may be that this side-effect, along with others, are viewed within the scope of weeks rather than months. I hate to think that people quit an MAOI because they experience a side-effect that might go away. I would say that it might pay to be patient. At least you wouldn't be accused of being premature.

Good Luck.


- Scott

 

Re: My newly prescribed "social phobia" meds - fyi

Posted by Chris on November 20, 1999, at 14:50:20

In reply to My newly prescribed "social phobia" meds - fyi, posted by JohnB on November 17, 1999, at 8:41:52

> hi, thought it might be worth sharing with you my visit yesterday to my pschiatrist/psychopharmacologist. He has previous experience with a large university-based anxiety disorder's program and is a true psychopharmacologist. That is, we don't have much talk therapy, but focus on fine-tuning the neurotransmitter imbalance which causes my social phobia. I've tried to become very informed of individual meds, results of open-label and closed-label studies, augmentation therapies, etc. I've also been treated for social phobia about the last 7 years, and have tried Nardil, Parnate, Buspar (low dose), Gabapentin (low dose), Celexa, Remeron, Effexor, and Klonopin. As Rick (another psychobabbler) say's, "I'm always looking for the 100% solution, with no negative side effects."
>
> Regardign my appointment with my psychopharmacologist, first, I discussed numerous possibilities, based upon PubMed research, Medscape research, and contact with various psychdocs who have previously communicated with me regarding new meds. Alternatives I mentioned included:
> (1) Pindolol 5mg bid, plus Klonopin 1 mg tid, plus Buspar 15 mg bid. Pindolol, although a beta-blocker, exerts significant activity at the 5HT1 receptor, as does Buspar. Pindolol has been found to potentiate buspar and, possibly, potentiate or augment Klonopin, by exerting a similar anxiolytic effect. This would also keep me off the SSRI's or SNRI's or MAOI's, which have all caused either some degree of sexual function, weight gain, dry mouth,or insomnia. Further, Pindolol is often use to reverse/eliminate the cognitive side effects caused by SSRI's, SNRI's, and benzodiazepines.
>
> - this was my doctors preferred route, and what he ended up prescribing. Rick armed me with some information regarding his experience with Pindolol and Klonopin, and that helped a lot. If I experience any sexual side effects, we will augment with selegiline.
>
>
> (2) Buspar monotherapy, 15 mg qid (equals 60 mg/day). Recent studies suggest Buspar at 60 to 90 mg/day may be efficacious for treating social phobia. Previous "guidance" of 15 to 30 mg/day, as monotherapy, was found to have been subtherapeutic.
>
> - although some recent studies seem convincing, this isn't too different from alternative one, yet alternative one allows me to stay on the Klonopin, which is very effective, until I'm sure the Pindolol or Buspar polytherapy is effective. I'd like to eventually stop taking a benzodiazepine due to amnestic and cognitive effects, which are common with all CNS depressants.
>
>
> (3) Zoloft (sertraline) and Buspar combination. One psychdoc in "Pscychopharmacology Tips" referred to this combination as "magical." I e-mailed him a question about what he meant by magical. He responded by saying that sertraline was no longer available in New Zealand. When I questioned him a second time about the "magical" effect, he ignored my e-mail. I understand from some postings that, while this combo is quite activating and good for drive deficient states, there's still an issue of significant weight gain.
>
> - bottom line, we scratched this alternative
>
> (4) Gabapentin (Neurontin) monotherapy. Although recent studies "imply" the efficacy of gabapentin for social phobia in the 3600mg/day to 4800 mg/day range, there have been no fixed-dose closed-label, placebo-controlled large scale studies. Parke-Davis is expected to conduct a follow-up study using high fixed dose buspar for social phobia, based upon promising results of this past summer's study.
>
> - I was a little more reluctant to try this than was my psychdoc. He had been prescribing 1800 - 2400 mg/day, and had not gone as high as 3600 mg/day. As with many psychotropic medications, benefits do not "kick-in" until higher dosages are used. For that reason, there's typically not a linear relationship between dosage and benefit. That is, you may not receive any benefit until 3600mg/day plus. My bottom line, here, was to wait and see the results of the follow-up high fixed dose study.
>
>
> So, to conclude, I'm just starting the Pindolol (5mg twice a day), Buspar (15 mg, twice a day), and Klonopin (1 mg, three times a day). Will let you know in several weeks how this is working.
>
> Hope this helps someone.
>
> JohnB.

hi JohnB,

I suffer from quite severe social phobia and atypical depression.I live in the UK, and have managed to persuade my doctor to try moclobemide which helps but is far from perfect.All the
psychiatrists here seem to like the idea of my wasting endless hours in talk therapy which doesn't help but seems to make things worse. I've been doing this for seven years now and its
very frustrating.Any chance you could give me the address of your doctor or a similar good one as I am quite willing to travel to the US to get some decent help.Sorry if this seems a
strange request but I am beginning to feel desperate as I am sure their are things that will help, for all the "no quick fix" talk of doctors here.

Thanks anyway,
Chris

 

Re: My newly prescribed "social phobia" meds - fyi

Posted by Rick on November 21, 1999, at 2:01:34

In reply to My newly prescribed "social phobia" meds - fyi, posted by JohnB on November 17, 1999, at 8:41:52

JohnB -

Interesting that you ended up with BuSpar in addition to the Klonopin + Pindolol, because that's exactly what I was on for about six weeks, although at lower doses of all three meds. Even though I'm doing just great on the two-med combo (significantly better than Klonopin alone), I felt even more "up" and confident with the BuSpar in the mix. But the BuSpar side effects were difficult for me at night, so I dropped it.
I'm surprised I never mentioned that combo to you during our e-mail exchanges, but that's probably because you seemed so focused on Selegiline as a possible third component of the cocktail. And you know that I also found the Selegiline to add a nice, motivating and cognitively stimulating dimension to the Klonopin/Pindolol combo (not that I'm having the least bit of cognitive difficulty on the two meds alone -- but again, I'm taking a little less than you). For other readers I should mention that I reluctantly dropped the Selegiline from the combo because it was causing sexual over-stimulation and even premature ejaculation (probably because I'm one of the minority of people who's libido is stimulated by Klonopin, and the Selegiline magnified that effect with its own widely-experienced aphrodisiac effect).

As I've told you I'd love to take > 5mg Pindolol, but for some reason anything greater than this very small dose shoots me from mildly hypertensive to hypotensive -- at least when taken with Klonopin.

Anyways, I'm looking forward to hearing how things go. Since our particular Social Phobia challenges and symptoms seem to have so much in common, I'm very optimistic that you'll do well. Just remain patient and experiment with the timing and dosages, if necessary, until you find the optimal regimen. And I'm sorry to belabor the point, but please resist any temptation to take MORE Klonopin. Everyone reacts differently, but...As I told you, I actually showed significant improvement on already-decent results when I LOWERED the amount of Klonopin I take by about 1 mg (to 1.5-2.0 tid in descending amounts), even though it remains the key med in the mix.

Rick

> hi, thought it might be worth sharing with you my visit yesterday to my pschiatrist/psychopharmacologist. He has previous experience with a large university-based anxiety disorder's program and is a true psychopharmacologist. That is, we don't have much talk therapy, but focus on fine-tuning the neurotransmitter imbalance which causes my social phobia. I've tried to become very informed of individual meds, results of open-label and closed-label studies, augmentation therapies, etc. I've also been treated for social phobia about the last 7 years, and have tried Nardil, Parnate, Buspar (low dose), Gabapentin (low dose), Celexa, Remeron, Effexor, and Klonopin. As Rick (another psychobabbler) say's, "I'm always looking for the 100% solution, with no negative side effects."
>
> Regardign my appointment with my psychopharmacologist, first, I discussed numerous possibilities, based upon PubMed research, Medscape research, and contact with various psychdocs who have previously communicated with me regarding new meds. Alternatives I mentioned included:
> (1) Pindolol 5mg bid, plus Klonopin 1 mg tid, plus Buspar 15 mg bid. Pindolol, although a beta-blocker, exerts significant activity at the 5HT1 receptor, as does Buspar. Pindolol has been found to potentiate buspar and, possibly, potentiate or augment Klonopin, by exerting a similar anxiolytic effect. This would also keep me off the SSRI's or SNRI's or MAOI's, which have all caused either some degree of sexual function, weight gain, dry mouth,or insomnia. Further, Pindolol is often use to reverse/eliminate the cognitive side effects caused by SSRI's, SNRI's, and benzodiazepines.
>
> - this was my doctors preferred route, and what he ended up prescribing. Rick armed me with some information regarding his experience with Pindolol and Klonopin, and that helped a lot. If I experience any sexual side effects, we will augment with selegiline.
>
>
> (2) Buspar monotherapy, 15 mg qid (equals 60 mg/day). Recent studies suggest Buspar at 60 to 90 mg/day may be efficacious for treating social phobia. Previous "guidance" of 15 to 30 mg/day, as monotherapy, was found to have been subtherapeutic.
>
> - although some recent studies seem convincing, this isn't too different from alternative one, yet alternative one allows me to stay on the Klonopin, which is very effective, until I'm sure the Pindolol or Buspar polytherapy is effective. I'd like to eventually stop taking a benzodiazepine due to amnestic and cognitive effects, which are common with all CNS depressants.
>
>
> (3) Zoloft (sertraline) and Buspar combination. One psychdoc in "Pscychopharmacology Tips" referred to this combination as "magical." I e-mailed him a question about what he meant by magical. He responded by saying that sertraline was no longer available in New Zealand. When I questioned him a second time about the "magical" effect, he ignored my e-mail. I understand from some postings that, while this combo is quite activating and good for drive deficient states, there's still an issue of significant weight gain.
>
> - bottom line, we scratched this alternative
>
> (4) Gabapentin (Neurontin) monotherapy. Although recent studies "imply" the efficacy of gabapentin for social phobia in the 3600mg/day to 4800 mg/day range, there have been no fixed-dose closed-label, placebo-controlled large scale studies. Parke-Davis is expected to conduct a follow-up study using high fixed dose buspar for social phobia, based upon promising results of this past summer's study.
>
> - I was a little more reluctant to try this than was my psychdoc. He had been prescribing 1800 - 2400 mg/day, and had not gone as high as 3600 mg/day. As with many psychotropic medications, benefits do not "kick-in" until higher dosages are used. For that reason, there's typically not a linear relationship between dosage and benefit. That is, you may not receive any benefit until 3600mg/day plus. My bottom line, here, was to wait and see the results of the follow-up high fixed dose study.
>
>
> So, to conclude, I'm just starting the Pindolol (5mg twice a day), Buspar (15 mg, twice a day), and Klonopin (1 mg, three times a day). Will let you know in several weeks how this is working.
>
> Hope this helps someone.
>
> JohnB.

 

To Scott re: MAOI sexual dysfunction

Posted by Rick on November 21, 1999, at 2:33:18

In reply to Re: Adam - counteracting MAOI sexual dysfunction, posted by Scott L. Schofield on November 20, 1999, at 9:45:05

When I was on Nardil, I had no problems whatsoever with desire or erection, and no lack of pleasurable physical sensations. Yet orgasm was impossible. This stuck me as very odd. Is this typical? (BTW, Nardil is the only AD I've ever been on, unless you count low-dose Selegiline or BuSpar.)

>As I've written in other posts, it has been my >experience with MAOIs that these changes in >orgasm disappear over time. I sometimes get the >feeling, however, that such may not be the case >with SSRIs.

 

To Chris

Posted by Rick on November 21, 1999, at 4:15:06

In reply to Re: My newly prescribed "social phobia" meds - fyi, posted by Chris on November 20, 1999, at 14:50:20


> I suffer from quite severe social phobia and atypical depression.I live in the UK, and have managed to persuade my doctor to try moclobemide which helps but is far from perfect.All the
> psychiatrists here seem to like the idea of my wasting endless hours in talk therapy which doesn't help but seems to make things worse. I've been doing this for seven years now and its
> very frustrating.Any chance you could give me the address of your doctor or a similar good one as I am quite willing to travel to the US to get some decent help.Sorry if this seems a
> strange request but I am beginning to feel desperate as I am sure their are things that will help, for all the "no quick fix" talk of doctors here.
>
> Thanks anyway,
> Chris


Chris -

Have you tried looking for a psychiatrist at a large university? Perhaps the situation is different in the United States, but University pdocs seem to be the most open to experimentation and less-conventional treatment options.

My pdoc here in the Chicago area (NOT at a university) is a longtime proponent of MAOI's. He believes the dangers are far overstated, and he prescribed Nardil+Xanax as my first attempt at alleviating Social Phobia. This is despite the fact that, even in the U.S., MAOI's are rarely prescribed as first-line therapy for Social Phobia, largely because reversible formulations are not marketed here (my pdoc says they're theraputically inferior, anyways). We have also tried Tranxene (clorazepate), Selegiline, BuSpar, Lithium, Klonopin, and Pindolol, finally settling on the latter two with great success for non-depressive Social Phobia. He also considered Neurontin, Effexor, Serzone, and Wellbutrin. If you'd have any interest in coming all the way to Chicago, e-mail me and I'll send you his telephone number.

I've read many people on this board testifying to their own pdocs' expertise and willingness to take advantage of the full spectrum of meds and off-label uses. I'd wager you'd get a flood of responses if you started a separate thread...maybe even from someone in the U.K.! It's worth a try, don't you think?

Rick

 

Re: To Scott re: MAOI sexual dysfunction

Posted by Scott L. Schofield on November 21, 1999, at 8:24:50

In reply to To Scott re: MAOI sexual dysfunction, posted by Rick on November 21, 1999, at 2:33:18

> When I was on Nardil, I had no problems whatsoever with desire or erection, and no lack of pleasurable physical sensations. Yet orgasm was impossible. This stuck me as very odd. Is this typical?

That's a real good question.

HEY out there! Has anyone else had problems reaching orgasm while taking an MAO-inhibitor? (males and females)

Speaking for myself, I have had problems achieving orgasm with both Parnate (tranylcypromine) and Nardil (phenelzine). This side-effect appeared within the first two weeks, but disappeared after a few months. I'm not sure that this is such good news to the ladies.

I do hope others respond to this post. A study of one individual is hardly enough to observe a trend.

Good Luck!


- Scott

 

Re: MAOI sexual dysfunction

Posted by Elizabeth on November 21, 1999, at 14:24:56

In reply to Re: To Scott re: MAOI sexual dysfunction, posted by Scott L. Schofield on November 21, 1999, at 8:24:50

> HEY out there! Has anyone else had problems reaching orgasm while taking an MAO-inhibitor? (males and females)

This problem -- being able to get aroused but not to reach orgasm -- is frequently reported with SSRIs (I've dated a couple people who had it on Prozac, in fact). I've definitely heard of some people having it with MAOIs too; Nardil seems to be worse than Parnate.

I did not have this problem with Parnate. It may have taken slightly longer to have orgasms with Nardil, but it was far from impossible. I've only been on Marplan for a day, but so far I can report no difficulties.

 

Re: To Scott re: MAOI sexual dysfunction

Posted by Judy on November 21, 1999, at 14:31:09

In reply to Re: To Scott re: MAOI sexual dysfunction, posted by Scott L. Schofield on November 21, 1999, at 8:24:50

> HEY out there! Has anyone else had problems reaching orgasm while taking an MAO-inhibitor? (males and females)
>

Hey Scott et al! Oh yeah! No such thing as reaching orgasm for me when taking Nardil (or Marplan, I recently found out) even though my libido is ready and willing. I've taken Nardil four or five times over the past fifteen years - it's my miracle drug for depression/anxiety but the side effects (including severe edema and almost total inability to urinate) don't allow me to take it for more than six to eight weeks max.

I've been told anorgasmia is a long-term side effect of MAOI, for me at least, evidenced by the fact that it takes almost exactly four weeks to resume normal orgasmic ability after ingesting my last pill. Thus, there's no possibility of stopping my meds for a few days and expecting a 'second honeymoon' before resuming meds.

An ironic twist is that none of the other AD's I've tried caused anorgasmia - BUT I never had the libido to enjoy it while taking any other AD! Seems I'm damned if I do and damned if I don't, huh?

I've just begun a second trial of Selegiline, at higher doses than I originally took. It's been almost three weeks and I'm currently taking 40 mg/day (and intending to go higher). I'm very curious to see if the touted 'magical' sexual properties of Selegiline work for me!

Good luck with your 'study'!

Judy

 

Re: MAOI sexual dysfunction

Posted by Elizabeth - LOL on November 21, 1999, at 14:51:32

In reply to Re: MAOI sexual dysfunction, posted by Elizabeth on November 21, 1999, at 14:24:56

>It may have taken slightly longer to have orgasms with Nardil, but it was far from impossible. I've only been on Marplan for a day, but so far I can report no difficulties.


I swear I was thinking of you as I was typing my response to Scott's post. Little did I know that you were typing at the same time!

You probably don't remember, but we had this discussion months ago when I expressed my awe and envy at your being able to achieve orgasm while taking Nardil. I am one of those for whom it is *totally* impossible!

Good luck with Marplan! I suspect you'll be fine on it sexually. I think you're 'gifted' in that department! LOL

Judy

 

Chris: RE: anxiety disorders psychopharmacologist

Posted by JohnB on November 21, 1999, at 14:51:49

In reply to Re: My newly prescribed "social phobia" meds - fyi, posted by Chris on November 20, 1999, at 14:50:20

I'd recommend you contact any top university based anxiety disorder's progam. Certainly, your psychdoc could do such and perhaps received up-to-date relevant meds info. However, I'm sure there are many very qualified psychopharmacologists in the U.K., the issue is just finding those people. I would, similarly, suggest you make an appointment with any high caliber university's anxiety disorder's program. They're very pharmacologically based. Have one appointment and discuss some of the info you've seen on the threads, etc., and get their reaction. If you feel comfortable, continue to visit them or get their recommendation of a non-university psychdoc who is similarly schooled in psychopharmacology.

Best of luck. John

 

Elizabeth - LOL

Posted by Judy on November 21, 1999, at 14:54:38

In reply to Re: MAOI sexual dysfunction, posted by Elizabeth - LOL on November 21, 1999, at 14:51:32

Sorry, Elizabeth - As soon as I hit the 'submit' button on the above post, I realized I'd screwed up the name and subject!

Judy

 

"TID for TAT", or Get It Right, Rick!!!

Posted by Rick on November 21, 1999, at 16:48:37

In reply to Re: My newly prescribed "social phobia" meds - fyi, posted by Rick on November 21, 1999, at 2:01:34

Here I am suggesting the theraputic downside of
taking TOO MUCH Klonopin, and I inadvertently end
up suggesting just the opposite!! I did NOT mean
to say "1.5 - 2.0 mg TID", I meant 1.5-2.0 DAILY.
For me this is usually .75 mg Klonopin (+ 2.5 mg
Pindolol) upon waking, then .5 mg about three
hours later, and then .25 mg. about four hours
after that. I've been taking the other 2.5 mg of
Pindolol at night. I'll sometimes fiddle with the
timing, but not the daily total, when big
challenges are coming up (e.g., a presentation).

ORIGINAL F'D-UP STATEMENT:
>I actually showed significant improvement on
already-decent results when I LOWERED the amount
of Klonopin I take by about 1 mg (to 1.5-2.0 tid
in descending amounts), even though it remains the
key med in the mix.

 

Re: MAOI sexual dysfunction, other stuff

Posted by Adam on November 22, 1999, at 10:38:36

In reply to Re: To Scott re: MAOI sexual dysfunction, posted by Judy on November 21, 1999, at 14:31:09


>I'm very curious to see if the touted 'magical' sexual properties of Selegiline work for me!

I'm not sure if magical is the word I would use, but selegiline has been, well,
pretty cool in that dept. Admittedly, sample size thus far has been small, but
I've been pleasantly suprised to say the least.

I've been reading up on the use of buspirone and pindolol for OCD. It would appear
that these have been tried by many (some combination + SSRI for refractory patients),
but there's little or no evidence I could find that they are of any benefit for that
problem.

Oh well. I really hope it works for your social phobia, JohnB!

 

Re: MAOI sexual dysfunction

Posted by Elizabeth on November 22, 1999, at 23:56:49

In reply to Re: MAOI sexual dysfunction, posted by Elizabeth - LOL on November 21, 1999, at 14:51:32

> Good luck with Marplan! I suspect you'll be fine on it sexually. I think you're 'gifted' in that department! LOL

Can I quote you on that?

 

Re: To Scott re: MAOI sexual dysfunction

Posted by Scott L. Schofield on November 25, 1999, at 11:06:12

In reply to Re: To Scott re: MAOI sexual dysfunction, posted by Judy on November 21, 1999, at 14:31:09

>> Hey Scott et al! Oh yeah! No such thing as reaching orgasm for me when taking Nardil (or Marplan, I recently found out) even though my libido is ready and willing. I've taken Nardil four or five times over the past fifteen years - it's my miracle drug for depression/anxiety but the side effects (including severe edema and almost total inability to urinate) don't allow me to take it for more than six to eight weeks max.
>>
>> I've been told anorgasmia is a long-term side effect of MAOI, for me at least, evidenced by the fact that it takes almost exactly four weeks to resume normal orgasmic ability after ingesting my last pill. Thus, there's no possibility of stopping my meds for a few days and expecting a 'second honeymoon' before resuming meds.


> I swear I was thinking of you as I was typing my response to Scott's post. Little did I know that you were typing at the same time!
>
> You probably don't remember, but we had this discussion months ago when I expressed my awe and envy at your being able to achieve orgasm while taking Nardil. I am one of those for whom it is *totally* impossible!


Sorry.

I guess it was just wishful thinking on my part. I was hoping it wasn't such a pervasive side-effect.


- Scott


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