Psycho-Babble Medication Thread 529220

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Re: SSRIs worsening Social Phobia? so

Posted by smith562 on July 18, 2005, at 4:49:24

In reply to Re: SSRIs worsening Social Phobia?, posted by so on July 17, 2005, at 20:45:03

Hey So,

Thank for the advise. I am interested ... what are some of the good reasons people might chose to lead a private life? Thank You.

Smith

>There are plenty of good reasons other than a mental disorder that a person might choose to live a reasonably private life.

 

Re: SSRIs worsening Social Phobia?

Posted by linkadge on July 18, 2005, at 6:36:14

In reply to Re: SSRIs worsening Social Phobia? so, posted by smith562 on July 18, 2005, at 4:49:24

It is fully concivable that SSRI's alter the way that human interaction transpires.

For starters, they lower dopamine, a chemical inticately involved in socaial interaction, secondarily, they potently activate the 5-ht2a and 5-ht3 receptors, which are bad news for people with social anxiety. Activating the 5-ht2c receptor can also make people socally agressive.

It's not that I don't think that certain socialphobes could use a little tweeking, but rather that SSRI's are just plain MESSY.


Linkadge

 

Re: SSRIs worsening Social Phobia?

Posted by SLS on July 18, 2005, at 7:17:53

In reply to Re: SSRIs worsening Social Phobia?, posted by linkadge on July 18, 2005, at 6:36:14

> It is fully concivable that SSRI's alter the way that human interaction transpires.
>
> For starters, they lower dopamine, a chemical inticately involved in socaial interaction, secondarily, they potently activate the 5-ht2a and 5-ht3 receptors, which are bad news for people with social anxiety. Activating the 5-ht2c receptor can also make people socally agressive.
>
> It's not that I don't think that certain socialphobes could use a little tweeking, but rather that SSRI's are just plain MESSY.

Empirical evidence is usually more important than the theory that attempts to support or refute it. It is what it is. These drugs are what they are. If they work - and for many people, they work well and without the appearance of apathy - then they must be considered seriously as effective therapy.

Are they messy? Yes. So are just about all psychotropic medications, but they are the best we have to work with at the moment. I have an observational advantage over most people posting here as I volunteer at an adult partial hospital program for the mentally ill. I've seen the results of both pharmacotherapy and psychotherapy and combinations of both. I believe in magic. I have seen recovery from mental illness occur through the use of modern psychiatry.

I believe the regular participants at Psycho-Babble are predominantly treatment-resistant. However, many of these folks are resistant only to what they have yet tried. I hope we can see more success stories in the future as these individuals progress through treatments that are to them, novel.

Alas, the same people always seem to be faced with failure after failure. What are we to do with them?


- Scott

 

Re: SSRIs worsening Social Phobia? SLS

Posted by Kon on July 18, 2005, at 11:12:25

In reply to Re: SSRIs worsening Social Phobia?, posted by SLS on July 18, 2005, at 7:17:53

I agree with using empirical evidence but that's what is confusing. I honestly don't find the evidence too compelling. Consider the use of SSRIs in children and adolescents. Clinical data appear to show little to no benefit beyond placebo:

http://www.cmaj.ca/cgi/content/full/170/5/783

And even in adults on closer inspection evidence appears to be lacking or at the least is pretty weak:

http://www.journals.apa.org/prevention/volume5/pre0050023a.html

http://bjp.rcpsych.org/cgi/content/full/183/2/102

Given such weak evidence why are these drugs so popular with prescribers?

 

Re: SSRIs worsening Social Phobia?

Posted by crazychickuk on July 18, 2005, at 11:25:03

In reply to Re: SSRIs worsening Social Phobia? SLS, posted by Kon on July 18, 2005, at 11:12:25

Ive just been reading through my phycosologists books she left here for me to read on ( as i want to become one myself)

and in them it states america did some tests on 100 people doing cbt, 100 people taking placabo and 100 people taking antidepressants over a year!!


turnt out the ppl on antidepressants showed sagnificent improvement on their mental health within the first 8 weeks, placabo within 12 weeks and cbt within 20 weeks, the ppl on antidepressants showed worsening or their symptoms coming back within 8 mnths plus placabo within 6 mnths but those on cbt or a combo of cbt and antidperesants were showed to be 95% better..

conclusion those who do cbt are much likely to become better than those taking ad's or placabo as its all mind control (not in al so many words)

 

Re: SSRIs worsening Social Phobia?

Posted by so on July 18, 2005, at 12:32:47

In reply to Re: SSRIs worsening Social Phobia?, posted by SLS on July 18, 2005, at 7:17:53


> Are they messy? Yes. So are just about all psychotropic medications, but they are the best we have to work with at the moment.

But as suggested in the post below
http://www.dr-bob.org/babble/20050718/msgs/529505.html
they are not all we have to work with. What we work with is effected by economic constraints of our culture. Cognitive behavioral therapy is seldom as profitable as is the manufacture of chemicals. Our culture is organized so as to capitalize most profitable economic endeavors.

At the same time, we have seen an erosion of community institions that would offer the sort of wisdom that can be achieved in therapuetic settings. Extended families isolate individuals from more experienced family members. Mobility isolates individuals from more experienced community members.

And as community institutions erode, we have a new set of social stressors. Role expectations are less well defined. Technology exposes us to unfamiliar and powerful stimuli. Evolving cultural expectations can lead to confusion about what is important in life.

If the current pharmacopea is all we have to work with, it is worth considering what we have excluded from our available set of tools.

 

Re: SSRIs worsening Social Phobia? smith562

Posted by so on July 18, 2005, at 12:39:41

In reply to Re: SSRIs worsening Social Phobia? so, posted by smith562 on July 18, 2005, at 4:49:24

> Hey So,
>
> Thank for the advise. I am interested ... what are some of the good reasons people might chose to lead a private life? Thank You.
>
> Smith
>
> >There are plenty of good reasons other than a mental disorder that a person might choose to live a reasonably private life.
>
>


Mental stability might be one reason. Social groups create undue performance pressures on a person, which can be avoided by a carefully chosen and somewhat limited social circle.

I would approach the question from the opposite direction, though. What does a person need from social contact? How much social contact does a person require to fulfill those needs? Beyond those requirements, what are the benefits of social contact? What are the risks? What needs might we be attempting to fulfil with social contact that just might not be satisfied by social contact? At what point does social contact become an addiction, in which we try to satisfy a basic hedonic drive, but in which an increased tolerance leads to an ever increasing need for more social contact?

 

Re: SSRIs worsening Social Phobia?

Posted by linkadge on July 18, 2005, at 17:30:16

In reply to Re: SSRIs worsening Social Phobia?, posted by SLS on July 18, 2005, at 7:17:53

I guess I am just saying that they are not the ideal treatment for social phobia, and that they *may* make it worse.

I would think that ritalin + clonazepam might hit inballences of a social-phobe more accurately.


Linkadge

 

Re: SSRIs worsening Social Phobia?

Posted by linkadge on July 18, 2005, at 17:41:21

In reply to Re: SSRIs worsening Social Phobia? smith562, posted by so on July 18, 2005, at 12:39:41

Social contact is probably the best way to maintain cognitive abilities. Deprived of this basic level of social contact because of a heightened fear is unacceptable.

"Its all we have" is not true. When sertaline went head to head with SJW, and placebo, both failed but SJW came out superior to sertraline.

The study claimed "SJW no better than placebo"!

It is one thing to remove fear from the social setting, and another thing to remove inscentive.

My friend was on paxil for SP. He said that he didn't get anxious around people anymore, but that he totally lost interest in social contact.

Linkadge

 

Re: SSRIs worsening Social Phobia? linkadge

Posted by so on July 18, 2005, at 17:44:12

In reply to Re: SSRIs worsening Social Phobia?, posted by linkadge on July 18, 2005, at 17:30:16


>
> I would think that ritalin + clonazepam might hit inballences of a social-phobe more accurately.
>
>
> Linkadge

yes. Similarly cocaine and ethyl alcohol is often quite effective. For those on a budget, methamphetamine and alcohol is more affordable. Benzos such as clonoazepam, but more often common valium, often find their way into the popular pharmacopea used to treat social anxienty. When benzo's are out of reach, speed-balls, or coca-opiod combinations are often used.

 

Please be civil so

Posted by gardenergirl on July 18, 2005, at 18:51:11

In reply to Re: SSRIs worsening Social Phobia? linkadge, posted by so on July 18, 2005, at 17:44:12

Please refrain from promoting the use of illegal drugs as a way to cope with a mental disorder.

gg

 

Re: Please be civil

Posted by linkadge on July 18, 2005, at 19:01:11

In reply to Please be civil so, posted by gardenergirl on July 18, 2005, at 18:51:11

I don't really know what you're trying to say. Personally, I have been on and off clonazepam so many times, yet I am still withdrawing from SSRI's. So, barring this, I'd rather use clonazepam, as it is more effective for me.


Linkadge

 

Re: Please be linkadge

Posted by gardenergirl on July 18, 2005, at 19:22:43

In reply to Re: Please be civil, posted by linkadge on July 18, 2005, at 19:01:11

> I don't really know what you're trying to say. Personally, I have been on and off clonazepam so many times, yet I am still withdrawing from SSRI's. So, barring this, I'd rather use clonazepam, as it is more effective for me.
>
>
> Linkadge

Hi link,
I was referring to so's post about illegal drugs and alcohol.

gg

 

Re: Please be

Posted by linkadge on July 18, 2005, at 19:59:22

In reply to Re: Please be linkadge, posted by gardenergirl on July 18, 2005, at 19:22:43

Sorry, I was under the impression that he was making fun of my ritalin + clonazepam suggestion for social phobia. I was simply defending it by saying that SSRI's can be addicting too.

Sorry, I'm not making a lot of sence :)


Linkadge

 

Re: Happened again!

Posted by smith562 on July 18, 2005, at 21:30:11

In reply to Re: Please be, posted by linkadge on July 18, 2005, at 19:59:22

I must be ignorant, but I wanted to test my reaction again to zoloft. I increased from 75 to 112.5 mgs this morning .... wow! I felt like molasses ... was very quiet, unsociable and lethargic! Maybe I will try titrating down to 50 mgs to see if my energy improves.

To be fair ... I have a diagnosis of panic disorder and depression with a family h/o of depression, panic disorder and bipolar II. I have found this combo to be best for me ... zoloft 75, klonopin 1, selegiline 10, lithium 450 and lamcital 50. Because of all my meds, I don't know what zoloft is doing exactly.

Smith

 

Re: Please be linkadge

Posted by gardenergirl on July 18, 2005, at 23:26:25

In reply to Re: Please be, posted by linkadge on July 18, 2005, at 19:59:22

Aha, that was my misunderstanding. I thought your post was to me.

:)

gg

 

Re: SSRIs worsening Social Phobia?

Posted by SLS on July 19, 2005, at 10:14:09

In reply to Re: SSRIs worsening Social Phobia? SLS, posted by Kon on July 18, 2005, at 11:12:25

Hi.

Have you ever experienced a robust antidepressant response from a medication?

I have. These drugs work. That's my bias.

I can't review the citations you provided, but I think it is great that you were able to find them. The Internet is a great place to find differences of opinion.

I am not a statistician, but I think biases are probably seen on both sides of a debate over the efficacy of antidepressants.

Approximately 30% of people will "respond" to placebo. Of course, they are not really responding to nothing, they are simply recovering spontaneously, whether it be the natural course of their illness or a psychological effect from belief that they will get well. I don't have the energy to get into a discussion of the selection criteria used for most antidepressant trials, but 30% is too high for these studies to have much meaning. I don't think many of these people belong in these studies to begin with. If you exclude the placebo responders, things look different. Most antidepressant studies report rates of response close to 65-70%. That is an excellent rate of response no matter how you look at it. Many "failed" and "weak" studies report placebo responses significantly higher than 30%. Something is wrong here. Placebo controls don't work when evaluating depression when using the current inclusion criteria.

> Given such weak evidence,

I don't agree that the evidence is weak, as I have indicated above.

why are these drugs so popular with prescribers?

They work.


- Scott

 

Re: SSRIs worsening Social Phobia?

Posted by SLS on July 19, 2005, at 15:56:19

In reply to Re: SSRIs worsening Social Phobia?, posted by SLS on July 19, 2005, at 10:14:09

I wish I could come up with stronger citations than this, but this is a good start to begin to understand the problems with using placebo controls in studies involving depression.

http://www.srmhp.org/0201/media-watch.html

Notice that it takes into consideration the literature and authors that are cited in the link you provided. Unfortunately, there is not as much interest in elucidating the placebo effect in depression studies as might be desired. Know, however, that those people claiming improvement in the placebo arm of a study demonstrate different brain activity than is evidenced by those who respond to either medication or psychotherapy. In addition, this placebo response tends to disappear at approximately week 10 when subjects are studied longitudinally. Many of these people ask to be placed on the active compound once they learn they were given placebo.


- Scott

 

Re: SSRIs worsening Social Phobia?

Posted by linkadge on July 19, 2005, at 17:40:27

In reply to Re: SSRIs worsening Social Phobia?, posted by SLS on July 19, 2005, at 15:56:19

"In addition, this placebo response tends to disappear at approximately week 10"


Wow, that seems to correspond nicely to the timeframe for antidepressant poop out.


Linkadge

 

As An Added Note

Posted by Phillipa on July 19, 2005, at 18:14:45

In reply to Re: SSRIs worsening Social Phobia?, posted by linkadge on July 19, 2005, at 17:40:27

I can remember when an IM injection of a pain med was used. That was for the people who always wanted something for pain. And at times it worked. But pain is considered a serious thing. As it interfers with the healing process. So no longer are placebos allowed in a hospital. Fondly, Phillipa

 

Re: SSRIs worsening Social Phobia? smith562

Posted by Chairman_MAO on July 20, 2005, at 20:44:47

In reply to SSRIs worsening Social Phobia?, posted by smith562 on July 17, 2005, at 18:50:59

No, as a matter of fact, SSRIs do not help social phobia at all. Studies--or rather, only the ones that are published--show that SSRIs differ from placebo in SP by the barest of margins. Phenelzine 1mg/kg gives conservatively a 75% response rate.

 

Re: SSRIs worsening Social Phobia? Chairman_MAO

Posted by linkadge on July 21, 2005, at 15:24:14

In reply to Re: SSRIs worsening Social Phobia? smith562, posted by Chairman_MAO on July 20, 2005, at 20:44:47

I totally agree with you. SSRI's are not good for social phobia. Its not one chemical that is probably out of ballence with them.

If any one chemical was to be implicated, I'd say GABA, or PEA, before serotonin.

Linkadge

 

= Chairman Mao - A question regarding Nardil

Posted by johnb11 on July 24, 2005, at 21:54:03

In reply to Re: SSRIs worsening Social Phobia? smith562, posted by Chairman_MAO on July 20, 2005, at 20:44:47

Think I read a post where you augmented Nardil to help with sexual dysfunction. Could you share with me what worked?

2nd question - Do you have any knowledge about high dosage deprenyl (60 mg/day) being effective for SP. I believe it loses is MAO-B selectivity above 10-20 mg/day.

Oh, one more question. Do you know anything about combining Moclobemide with Deprenyl? My pdoc thinks that could be a strong possibility, without the weight gain and sexual dysfunction of Nardil. Would only mean that my Moclobemide prescription wouldn't be picked up by insurance. I'd have to order from Canada. By the way, there was a study done by Leibowitz et al, combining clorgyline (MAO-B) with Deprenyl. Found it as effective as Nardil. Too bad clorgyline can no longer be had outside of the laboratory.

Thanks, in advance, for your help!

JohnB11

 

Deprenyl + Nardil ?? johnb11

Posted by Declan on July 24, 2005, at 22:47:08

In reply to = Chairman Mao - A question regarding Nardil, posted by johnb11 on July 24, 2005, at 21:54:03

What do you think of the idea of deprenyl (5mg/d ?) and Nardil (30mg/d?)?
Maybe you'd just have desire and no ability. Someone must have tried the two together.

I found moclobemide OK as far as sex went.

Declan

 

Deprenyl + Nardil-- willyee have you tried? Declan

Posted by Questionmark on July 25, 2005, at 18:24:49

In reply to Deprenyl + Nardil ?? johnb11, posted by Declan on July 24, 2005, at 22:47:08

willyee, in a post in an above thread you mentioned that you've "used deprenyl and moclobemide [spelling changed] with maois to fight the fatigue syndrome and give a added kick." This is very interesting. Do you know what dose of MAOI, and which one, you used? And do you remember what dose of deprenyl you used? ...with or without moclobemide? Was this a daily or a once-in-awhile practice? Please also share the effects and your experiences. Thanks very much.

Anyone else with any experiences or thoughts on the matter please chime in as well.

Declan, good question. i've been wondering this myself for quite awhile.


> What do you think of the idea of deprenyl (5mg/d ?) and Nardil (30mg/d?)?
> Maybe you'd just have desire and no ability. Someone must have tried the two together.
>
> I found moclobemide OK as far as sex went.
>
> Declan


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