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Dr. Bob is Robert Hsiung, MD,
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Posted by ace on January 16, 2005, at 22:15:53
In reply to Which neurostransmitters affect social phobia?, posted by Iansf on January 16, 2005, at 13:31:04
> Which neurotransmitters are the ones most critically involved with social phobia - and in what way do they affect it? thanks.
>
> John McGood question...Social phobia exists, like all psychiatric diagnoses, along a continuum....it is not really something you have or don't have.
Everyone to a degree has social phobia -- if we didn't people would defecate and urinate in public and not be embarresed at all.
On the other hand, some folk (like myself until nardil saved me) can't eat in public, feel self-conscious to an extreme degree, can't make love with the lights on etc etc
So, to answer your qstn, many neurotransmitters are involved in social phobia. Everyone goes on about serotonin -- DON'T believe them!!!
We have little evidence that serotnin has effect on affective states except for postmortem studies of cerebrospinal fluid....other than that, the effect that some SSRI's have on some folk...but a LOT fail on SSRI's, which, obviously tells me that serotonin isn't the be all and end all neurontransmitter in psychiatric illneses, as some naive psychiatrists would like to think...
All psychopathologies, to my way of thinking, represent unspecified changes in brain chemistry due to many factors. Also, they are not all-encompassing. By that, I mean that two people who have "OCD" might have very different aetiologies (causes) -- one might have an excess of dopamine, the other an excess of serotonin and too little norepinephrine...same goes for "social phobia"....focus on SYMPTOMS not DIAGNOSES -- diagnostic systems (DSM) are greatly flawed.
anyway, hope that helps!
ace
Posted by King Vultan on January 16, 2005, at 22:38:52
In reply to Which neurostransmitters affect social phobia?, posted by Iansf on January 16, 2005, at 13:31:04
> Which neurotransmitters are the ones most critically involved with social phobia - and in what way do they affect it? thanks.
>
> John Mc
My own observations and experience:Increasing serotonin reduces anxiety.
Increasing norepinephrine reduces panic attack symptoms, if present.
Increasing dopamine tends to make one bolder and more self confident.
IMO (and experience), the MAOIs are still superior to all other antidepressants for social phobia. Whether Nardil or Parnate is the better choice seems to depend on the particular individual.
Todd
Posted by Iansf on January 17, 2005, at 0:36:13
In reply to Re: Which neurostransmitters affect social phobia?, posted by King Vultan on January 16, 2005, at 22:38:52
> IMO (and experience), the MAOIs are still superior to all other antidepressants for social phobia. Whether Nardil or Parnate is the better choice seems to depend on the particular individual.
>
> ToddThe first time I took Parnate, it worked very well. Unfortunately I had to stop because I couldn't get rid of a chronic sinus condition and needed to take decongestants. I tried Parnate again a couple years ago and it had almost no effect whatsoever. I'd be willing to give Nardil a try, but my current doctor is not willing to prescribe it. Maybe when Emsam comes out, he'll consider that, though I've seen little evidence of selegiline being effective to treat social phobia.
Posted by SLS on January 17, 2005, at 0:55:34
In reply to Which neurostransmitters affect social phobia?, posted by Iansf on January 16, 2005, at 13:31:04
> Which neurotransmitters are the ones most critically involved with social phobia - and in what way do they affect it? thanks.
>
> John Mc
Don't forget about GABA (gamma amino butyric acid).
- Scott
Posted by TheOutsider on January 17, 2005, at 6:44:22
In reply to Re: Which neurostransmitters affect social phobia?, posted by SLS on January 17, 2005, at 0:55:34
Personaly I suspect that Dopamine and GABA are the principal neuro transmitters which are disfunctional in Social Phobia.
GHB worked very well for my social phobia and it deffinetly works on GABA and Dopamine receptors, as well as having some effect on seratonin
Here is an Abstract that you might find interesting.
Low dopamine D(2) receptor binding potential in social phobia.
Schneier FR, Liebowitz MR, Abi-Dargham A, Zea-Ponce Y, Lin SH, Laruelle M.
Anxiety Disorders Clinic and the Brain Imaging Division, New York State Psychiatric Institute, New York 10032, USA. frs1@columbia.edu
OBJECTIVE: This study compared dopamine D(2) receptor binding potential in patients with social phobia and healthy comparison subjects. METHOD: Dopamine D(2) receptor binding potential was assessed in 10 unmedicated subjects with generalized social phobia and no significant lifetime psychiatric comorbidity and 10 healthy comparison subjects matched for age and sex. Binding potential was measured in the striatum by using single photon emission computerized tomography and constant infusion of the D(2) receptor radiotracer [(123)I]iodobenzamide ([(123)I]IBZM). RESULTS: Mean D(2) receptor binding potential was significantly lower in the subjects with social phobia than in the comparison subjects. Within the social phobia group, there was a nonsignificant correlation of binding potential with the Liebowitz Social Anxiety Scale score. CONCLUSIONS: Generalized social phobia may be associated with low binding of [(123)I]IBZM to D(2) receptors in the striatum.
PMID: 10698826 [PubMed - indexed for MEDLINE]
Posted by King Vultan on January 17, 2005, at 7:59:40
In reply to Re: Which neurostransmitters affect social phobia?, posted by SLS on January 17, 2005, at 0:55:34
> > Which neurotransmitters are the ones most critically involved with social phobia - and in what way do they affect it? thanks.
> >
> > John Mc
>
>
> Don't forget about GABA (gamma amino butyric acid).
>
>
> - Scott
Right, Nardil and the benzos also work on GABA, which is obviously another neurotransmitter that is involved with anxiety. This could have been one of the reasons I felt so sociable on Nardil. I find the dopaminergic effects of Parnate more useful in my particular situation but suspect many people might have more luck with Nardil, given how heavily benzos are used by members of this group (alcohol also has a detrimental effect on my own social phobia, the opposite of what most people's experience seems to be).Todd
Posted by ed_uk on January 17, 2005, at 8:58:43
In reply to Re: Which neurostransmitters affect social phobia?, posted by King Vultan on January 17, 2005, at 7:59:40
Hello Todd!
What effect does alcohol have on you??
How are you doing on Parnate? What dose are you on these days?
Regards,
Ed.
Posted by Optimist on January 17, 2005, at 9:24:55
In reply to Re: Which neurostransmitters affect social phobia?, posted by King Vultan on January 17, 2005, at 7:59:40
> Right, Nardil and the benzos also work on GABA, which is obviously another neurotransmitter that is involved with anxiety. This could have been one of the reasons I felt so sociable on Nardil. I find the dopaminergic effects of Parnate more useful in my particular situation but suspect many people might have more luck with Nardil, given how heavily benzos are used by members of this group (alcohol also has a detrimental effect on my own social phobia, the opposite of what most people's experience seems to be).
>
> ToddI find alcohol also makes my social anxiety worse. I'm thinking it may be driving down my blood sugar causing hypoglycemia. Interestingly when I was taking Prozac when I drank I didn't feel anxious at all. Prozac seemed to greatly help my hypoglycemia. I could tolerate a lot of other foods that I couldn't usually handle as well when on it.
Brian
Posted by King Vultan on January 17, 2005, at 11:10:32
In reply to Re: Which neurostransmitters affect social phobia? » King Vultan, posted by ed_uk on January 17, 2005, at 8:58:43
> Hello Todd!
>
> What effect does alcohol have on you??
>
> How are you doing on Parnate? What dose are you on these days?
>
> Regards,
> Ed.
>
>My social phobia is very situational and involves profuse sweating. Social settings involving alcohol are an example of a situation where I have experienced this problem in the past, and I believe it is one I have become rather phobic about. Alcohol in itself also seems to make the sweating worse, perhaps by making me feel warmer or some other darned thing.
I'm still on 60 mg Parnate and am doing relatively well. I am currently augmenting it with 0.375 mg Risperdal, going up to 0.5 mg in a few days, and I am finding this very helpful in a number of ways. However, I tend to think my pdoc is correct in his assessment that ziprasidone might be a better choice for me. I will likely discuss this with him at my next appointment.
Todd
Posted by lunesta on January 17, 2005, at 12:21:02
In reply to Which neurostransmitters affect social phobia?, posted by Iansf on January 16, 2005, at 13:31:04
A lot. Many we still dont understand at all,
here are just some :
gaba
dopamine
serotonin
norepinephrine
neuropeptide-y
oxytocin
CRH (indirectly) - the entire adrenal system hormones....lunesta
Posted by Iansf on January 17, 2005, at 12:21:54
In reply to Re: Which neurostransmitters affect social phobia? » King Vultan, posted by Optimist on January 17, 2005, at 9:24:55
> I find alcohol also makes my social anxiety worse. I'm thinking it may be driving down my blood sugar causing hypoglycemia. Interestingly when I was taking Prozac when I drank I didn't feel anxious at all. Prozac seemed to greatly help my hypoglycemia. I could tolerate a lot of other foods that I couldn't usually handle as well when on it.
>
> BrianI don't know that alcohol makes my social phobia worse, but it definitely doesn't make it better. It takes very little to make me drunk, and if I drink enough to loosen up at all socially, it's also enough to make me unstable and noticeably ill-coordinated. and slur my speech. So by the time I'm looser socially, I look, sound and act drunk, which is hardly what I'm looking for. I'm careful to limit myself to two drinks at most
Actually, I sometimes wonder if there's a connection. People I know who are outgoing can drink a lot more than I can. Sometimes a lot more. And it's not that they become outgoing by drinking - they start out extroverted and remain, externally, unchanged till they've had what to me is an amazingly large number of drinks.
By the way, thanks, everyone, for the responses.
John
Posted by lunesta on January 17, 2005, at 12:30:50
In reply to Re: Which neurostransmitters affect social phobia? » Optimist, posted by Iansf on January 17, 2005, at 12:21:54
alcohol effects your brainm through formadahyde "overload" basically and the transmitters involved in this are : gaba and dopamine and to some extended, glutamate and the NMDA receptors.
gaba is the benzo is alcohol, while dopamine is the high you get from a lot of alcohol..
whats interesting is certain benzos do the same thing, albiet, a little more selective. triazolobenzodizepines(sp) are xanax, halicon, midizolam, and all those really short acting ones that can make you happy, and benzo-high, very similar to being drunk without drinking.
Now, if you take klonopin or valium or most normal benzos, youll only get the gaba part of the drunk. Its true, though, that they somehow effect the other neurotransmitters somewhere along the line, but not in the same way as above.
lunesta
lunesta
Posted by banga on January 17, 2005, at 14:45:14
In reply to Re: Which neurostransmitters affect social phobia?, posted by lunesta on January 17, 2005, at 12:30:50
Do you mean formaldehyde? If yes, that would be interesting--I am allergic to formaldehyde and it is hypothesized that my alcoholism stems from an allerg/chemical sensitivity.
Posted by Michael Bell on January 18, 2005, at 2:03:34
In reply to Which neurostransmitters affect social phobia?, posted by Iansf on January 16, 2005, at 13:31:04
Primarily GABA disfunction, but there is probably inefficient dopamine transmission as well. Serotonin's involvement is dubious, except that highly sensitive 5HT receptors increase fear, anxiety, rejection sensitivity and harm avoidance.
Posted by sabre on January 18, 2005, at 3:03:40
In reply to Re: GABA and dopamine » Iansf, posted by Michael Bell on January 18, 2005, at 2:03:34
If dopamine and noradrenaline deficiencies/dysfunction are implicated in social anxiety for some people why doesn't wellbutrin seem to be very useful for sufferers?
I find alcohol useful for only v brief time spans and one glass leaves me legless so I can't keep topping up.
sabre
Posted by lars1 on January 18, 2005, at 4:29:55
In reply to Re: Which neurostransmitters affect social phobia? » lunesta, posted by banga on January 17, 2005, at 14:45:14
> Do you mean formaldehyde? If yes, that would be interesting--I am allergic to formaldehyde and it is hypothesized that my alcoholism stems from an allerg/chemical sensitivity.
Yes. Alcoholic beverages contain trace amounts of methanol, which gets metabolized to formaldehyde. Dark liquors (whiskey, dark rum, red wine) contain more methanol than light ones (vodka, gin) and therefore result in more formaldehyde. This may explain why they are also more likely to cause a hangover.
I don't think formaldehyde has much to do with alcohol's psychoactive effects (other than hangovers). Ethanol gets preferentially metabolized before methanol, so formaldehyde doesn't start getting produced until you are sobering up.
Lars
Posted by djmmm on January 18, 2005, at 10:29:50
In reply to Which neurostransmitters affect social phobia?, posted by Iansf on January 16, 2005, at 13:31:04
> Which neurotransmitters are the ones most critically involved with social phobia - and in what way do they affect it? thanks.
>
> John McWell, If you look at the Most effective meds for social anxiety (MAOIs and Benzos) I would have to say:
Serotonin
Dopamine--> PEA
GABAEach drug effects social anxiety symptoms differently..
The serotonin medications work at higher doses, probably because they cause apathy.
GABA drugs like the Benzos work effectivly.
MAOIs cause a general increase in all monoamines, indolamines and trace amines, including PEA...
I think drugs like Nardil are VERY effective because of the increase in PEA, and GABA, along with serotonin. They seem to cause a "pleasent relaxed stimulation" as opposed to the more conventional "harsh" stimulation of traditional stimulants.
This "pleasent" stimulation seems more conducive to social interaction via increased self confidence, combined with and internal sense of peace (for lack of a better word)
Posted by chemist on January 18, 2005, at 11:43:03
In reply to Re: Which neurostransmitters affect social phobia? » banga, posted by lars1 on January 18, 2005, at 4:29:55
hello there, chemist here...i could not help but notice that oxytocin - which is summoned from the posterior pituitary to induce a contractile event in smooth muscle enveloping an expanding uterus - was indicated as a target of alcohols (ethanol in particular). the other choice is to aid in breast feeding biomechanics.
i seem to recall that a rare few males of the human variety (no jokes, please) have been known to lactate, yet i am foggy on whether this is true or if it is a ``recovered non-memory.'' in any event, it is the other hormone - not neurotransmitter - that is suitable prey for an alcohol (and other suspects): anti-diuretic hormone (a.k.a. vasopressin), useful for keeping the fluids topped-off.
underexpression of this little number in the early, early developmental stages of life (or preexisting kidney problems) does set the stage for type I diabetes (insipidus)....and alcohol and pregnancy do not mix, that is for certain....
the methanol is not present in amounts in commercial ``adult beverages'' to make a difference in re: addiction or hangover. both remain mysteries, yet not entirely: the hangover is a combination of dehydration, loss of vitamins and minerals (especially thiamine), acidosis (more a problem with methanol and ethylene glycol), widening the anion gap (more a problem with ethylene glycol), off-balance blood sugar, and the very short half-life of the drug. hence, the hangover ``cure'' that contains alcohol is satisfying the craving the morning after.
the dark vs. light coloration is most attributed to congeners and lack of adequate distillation/filtration (mostly the former). think of congeners as patchwork molecules containing various functional groups that may impart an aroma/taste/color you find desireable.
your body will not be as pleased in that many of the congeners are not easily and painlessly decomposed by your system (the natural analog(s) might be humic and fulvic acids and tannins).
if one should imbibe methanol, alcohol dehydrogenase (a bit in the gut but the heft in the liver and a smidgeon in the retina) will oxidize it to formaldehyde, but ethanol competitively binds with methanol for the active site in ADH (and wins) and thus any methanol is sent out with the liquid waste. the citric acid cycle, muscle function (skeletal), electron transfer, pyruvate/lactate balance, and many other things i have long forgotten or never knew are involved.
my 44 year-old reference (biochemist's handbook) opines that ADH is present in the retina to oxidize vitimin A to retinal, and cannot do so if methanol arrives there first (the blindness/coma/etc. does tend to set in tens of hours later); a newer text asserts that formic acid damages the optic nerve. not a good idea to drink the stuff in any case.
the allergy you reference could arise from sulfite salts used as antioxidants in wines, some natural product your body does not ``like,'' or any number of things a more enlightened enologist than i can impart.
being allergic to formaldehyde sounds like a good thing, as presumably you are aware if it is present and can thus avoid being around a carcinogen for long - but please do not take my comment to making light of your allergy (i have almost collected the complete set, myself), it is usually sulfite-laden red wine that is the culprit.
cheers, chemist
> > Do you mean formaldehyde? If yes, that would be interesting--I am allergic to formaldehyde and it is hypothesized that my alcoholism stems from an allerg/chemical sensitivity.
>
> Yes. Alcoholic beverages contain trace amounts of methanol, which gets metabolized to formaldehyde. Dark liquors (whiskey, dark rum, red wine) contain more methanol than light ones (vodka, gin) and therefore result in more formaldehyde. This may explain why they are also more likely to cause a hangover.
>
> I don't think formaldehyde has much to do with alcohol's psychoactive effects (other than hangovers). Ethanol gets preferentially metabolized before methanol, so formaldehyde doesn't start getting produced until you are sobering up.
>
> Lars
Posted by Iansf on January 19, 2005, at 0:04:16
In reply to Re: GABA and dopamine, posted by sabre on January 18, 2005, at 3:03:40
> If dopamine and noradrenaline deficiencies/dysfunction are implicated in social anxiety for some people why doesn't wellbutrin seem to be very useful for sufferers?
>
> sabreThat's a good question, because I've never found Wellbutrin helpful for social phobia, which is too bad because for me it has the best side effect profile of any of the antidepressants. I do, however, have a friend who finds it very helpful with general anxiety disorder.
John
Posted by Iansf on January 19, 2005, at 0:10:47
In reply to Re: Which neurostransmitters affect social phobia?, posted by djmmm on January 18, 2005, at 10:29:50
> > Which neurotransmitters are the ones most critically involved with social phobia - and in what way do they affect it? thanks.
> >
> > John Mc
>
> Well, If you look at the Most effective meds for social anxiety (MAOIs and Benzos) I would have to say:
>
> Serotonin
> Dopamine--> PEA
> GABA
>
> Each drug effects social anxiety symptoms differently..
>
> The serotonin medications work at higher doses, probably because they cause apathy.
>
>
While I did find Prozac created a certain level of what I would term "emotional apathy," my activity level and interest both increased while I was taking it. With Luvox and now with Cymbalta I also find an increased activity level ( or at any rate I'm more productive.) but I don't experience emotional apathy.
John Mc
Posted by sabre on January 20, 2005, at 2:11:57
In reply to Re: Which neurostransmitters affect social phobia?, posted by Iansf on January 19, 2005, at 0:10:47
>While I did find Prozac created a certain level of what I would term "emotional apathy," my activity level and interest both increased while I was taking it. With Luvox and now with Cymbalta I also find an increased activity level ( or at any rate I'm more productive.) but I don't experience emotional apathy.
John McJohn, did you take Prozac, Cymbalta and Luvox specifically for social anxiety or for fatigue and a lack of motivation? How would you rate them for social anxiety?
sabre
Posted by Iansf on January 20, 2005, at 18:02:10
In reply to Re: Which neurostransmitters affect social phobia?, posted by sabre on January 20, 2005, at 2:11:57
> John, did you take Prozac, Cymbalta and Luvox specifically for social anxiety or for fatigue and a lack of motivation? How would you rate them for social anxiety?
>
> sabreI took them for a combination of depression and social phobia, though frankly I think the social phobia is the more critical issue. Prozac and Luvox both worked well in that regard. I felt more confident around strangers, was able to initiate conversations, deal with people in authority, etc. And just as important, people would approach me, seek me out even, where they had rarely done that before. But the most interesting aspect was what I call the "magic" quality--good things just seemed to happen, even things at a distance where my personality didn't come into play. Nothing spectacular, just small things like winning a drawing, being offered an assignment (I'm a journalist) by someone I'd never met who had never talked to anyone I'd ever worked with, dialing the number for an apartment I wanted at exactly the right moment. Life just flowed better. It's odd, but it did.
The reasons I quit Prozac and Luvox were the usual ones. With Prozac I couldn't stay awake past 10 and had to sleep at least 9 or 10 hours to not be too groggy to function, my sex life was greatly diminished and I didn't like the emotional apathy--I was content, but I felt kind of heartless. With Luvox, I had no sexual feelings whatsoever--no ability, no desire, not even phsycial sensation. In fact, the idea of sex was almost abhorrent. Given that one of my goals in overcoming social phobia was to try to meet someone to have a relationship with, it was somewhat self-defeating. I could relate better and meet people, but who wants to get involved with someone who not only can't have sex but actively dislikes it?
Cymbalta, unfortunately, isn't helping with social phobia., after a bit more than two months. It seemed to be helping for a brief period, then nothing. It cheers me up some and makes it easier to focus, but I'm still as shy as ever with strangers.
John
Posted by sabre on January 21, 2005, at 0:28:42
In reply to Re: Which neurostransmitters affect social phobia? » sabre, posted by Iansf on January 20, 2005, at 18:02:10
Thanks John
I have a mental list of drugs to try for social anxiety and after reading posts and research I keep rearranging the list.The research abstracts all seem to sing the same song, i.e. that social anxiety can be treated effectively by safe and tolerable drugs such as SSRIs. It is not the message I hear on Babble. It is depressing.
sabre
Posted by lars1 on January 21, 2005, at 4:20:24
In reply to Re: Which neurostransmitters affect social phobia?, posted by sabre on January 21, 2005, at 0:28:42
> The research abstracts all seem to sing the same song, i.e. that social anxiety can be treated effectively by safe and tolerable drugs such as SSRIs. It is not the message I hear on Babble. It is depressing.
I wonder if a workable approach would be to use an SSRI to effectively treat the social anxiety, together with a dopaminergic (Wellbutrin or methylphenidate) to counteract the SSRI-induced apathy and libidolessness? Has anybody tried this?
Lars
Posted by kellym on January 21, 2005, at 15:32:42
In reply to Re: SSRI + dopaminergic for social phobia?, posted by lars1 on January 21, 2005, at 4:20:24
I can't comment on methylphenidate, but I have taken Wellbutrin with SSRI's on a couple of occasions. In my case the Wellbutrin didn't do much, if anything, in regards to apathy or libido-although we all know YMMV. I hate the apathy that SSRI's produce. I guess in a sense it may reduce anxiety-but doesn't help the situation if all I do is sit on the sofa.
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