![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by JohnB on December 7, 1999, at 22:02:55
Giving up on experimental drug combinations for Social Phobia. I've tried hypnosis, imipramine, buspar, nardil/klonopin, parnate/klonopin, nardil/klonopin, parnate/klonopin, buspar (30 mg/day), neurontin (1800 mg/day), celexa, remeron, fluoxetine, vigabatrin, klonopin/pindolol/buspar, and marplan/klonopin. There are other combinations out there which look promising, such as high dose buspar (60 mg/day), high dose gabapentin (3600 to 4800 mg/day), and moclobemide/selegiline (10-15 mg/day) combination. However, I'm very, very tired of continuing to switch to drugs other than nardil, for which I never find an acceptable level of efficacy. Sometimes, the side effects are as bad or even worse, as well. Waiting up to two months for efficacy is just as bad.
Today, after 2 months of Marplan 80 mg/day, with no efficacy for social phobia, I made up my mind to go back to my doc and stick with Nardil. It has been the most efficacious of all drugs I've taken, either as monotherapy or augmented, by a factor of 4 or 5. There's simply no comparison. What's new is that my psychopharmacologist and I are determined to work with antidotes to treat the side effects - weight gain and sexual dysfunction (erectile, libido, anorgasmy). Further, I'm continuing to augment with Klonopin, for days when I need 100% efficacy, instead of Nardil's 85-90% efficacy as monotherapy.
So, my prescriptions today:
Nardil, 15 mg tablets, 30 mg BID dosing, 60 mg/day total, 1 month quantity of 120 tablets
Klonopin, 1 mg tablets, 1 mg TID dosing, 3 mg/day max, 1 month quantity of 90 tablets
Amantadine 100 mg tablets, 100 mg TID dosing, 300 mg/day max, 1 month quantity of 90 tablets.Amantadine has been shown to reduce carbohydrate cravings and obesity. There is less evidence regarding its efficacy for sexual dysfunction, however, so I'll have to wait and see. Viloxazine (marketed in Europe) has been shown to be extremely effective for restoring SSRI and MAOI induced loss of libido, but it isn't marketed in the U.S. I'll have my psychdoc write a prescription and I'll obtain it by mail order if necessary. In the meatime, I'm determined to manage the effects of Nardil, as opposed to constantly switching drugs.
However, if I ever do switch, it will probably be for a combination Moclobemide (non-hydrazine, reversible, selective for MAO-A) and Selegiline (at 10-15 mg/day, it is reversible, selective for MAO-B). My psychdoc thinks he may be better able to adjust the total MAO-A and MAO-B inhibition through this cocktail approach. However, he understands the efficacy of Moclobemide, from the Medline research, is very, very mixed. Further, he understands there would be little effect upon GABA, which appears to be a significant component behind the efficacy of Nardil.
Oh, well - here's to successfully managing Nardil's side effects. Goodbye to those combinations which have not provided efficacy.
See you. JohnB :)
Posted by Noa on December 8, 1999, at 7:16:17
In reply to Bye Marplan; hello Nardil/Amantadine/Klononpin SP, posted by JohnB on December 7, 1999, at 22:02:55
John,
Different Dx, different cocktail ingredients, but boy can I relate to the battle fatigue from the quest for the right mix.
Good luck, and keep us posted.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.