Psycho-Babble Medication Thread 996279

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Nadril

Posted by selection10 on September 9, 2011, at 13:34:45

Nardil is not currently available in my country and I've tried every other possible combination of meds to no avail.

I'm considering pulling out the big guns and trying out Nardil, but this would require ordering from out of country.

Can anyone with experience with ordering online give me an e-mail and help me out? It would be forever appreciated.

You can contact me at selection10@gmail.com

Cheers.

 

Re: Nadril

Posted by selection10 on September 9, 2011, at 13:35:46

In reply to Nadril, posted by selection10 on September 9, 2011, at 13:34:45

This is very promising...

-----------------------------
A combination of the monoamine oxidase inhibitor phenelzine sulfate and cognitive behavioral group therapy (CBGT) is superior to either treatment alone and placebo for the treatment of social anxiety disorder (SAD), according to the results of a new study.

These findings, say investigators, suggest that combined therapy offers an additive of synergistic effect in patients with SAD.

"The main message of the paper, and something which has a lot of appeal both for patients and physicians, is that combined treatment is better than just one of the treatments separately and that combination therapy is probably the best choice for most people," lead study author Carlos Blanco, MD, associate professor of clinical psychiatry, Columbia University, New York City, told Medscape Psychiatry.

The study is published in the March issue of Archives of General Psychiatry.

According to the study, medication and cognitive behavioral treatment are the best-established therapies for SAD. However, only two-thirds of patients are considered responders and only half are considered remitters. Most patients, the investigators note, remain symptomatic after initial treatment.

The goal of the study, the study authors write, "was to determine whether a combination of 2 partially efficacious treatments with different mechanisms of action pharmacotherapy and CBGT would be superior to each monotherapy in the treatment of SAD."

Effect Significantly Greater in Combination Group

Investigators at the New York State Psychiatric Institute/Columbia University and the Adult Anxiety Clinic at Temple University in Philadelphia, Pennsylvania, randomized 128 adult patients with a Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) diagnosis of SAD to phenelzine (n = 35), CBGT (n = 34), combined CBGT plus phenelzine (n = 32), or pill placebo (n = 27).

The current analysis included findings of the 12-week initial acute phase and the second 12-week intensive continuation phase of a 4-phase study.

Those in the phenelzine sulfate group were prescribed 15 mg/day, but this could be titrated up to a maximum of 90 mg during the study. Patients in this group were instructed to expose themselves to anxiety-provoking situations.

The CBGT sessions took place weekly and were administered by 2 therapists in 2.5-hour sessions to groups of 4 to 6 participants. Subjects learned to confront increasingly difficult feared situations, practiced cognitive skills while completing behavioral tasks, and completed assignments for exposures between sessions.

Patients in the combination treatment group received both phenelzine and CBGT. None of the therapists were informed as to whether a specific patient was receiving another treatment, and patients were coached not to reveal that they were in the combined therapy group.

Assessments were conducted at baseline and at weeks 6, 12, and 24. The primary outcome measures were the Liebowitz Social Anxiety Scale (LSAS), a 24-item scale that assesses fear and avoidance, and the modified Clinical Global Impression (CGI) scale. Researchers also used the Anxiety Disorders Interview Schedule for DSM-IV Clinicians Severity Ratings, the Hamilton Rating Scale for Depression, and patient-rated symptom measurements.

The researchers found that the slope of the LSAS score was significantly greater in the combined treatment and the phenelzine groups than in the placebo group, whereas there was no significant difference between the slopes of the CBGT and placebo groups.

Additive or Synergistic Effect

CGI response rates at week 12 were 33.3% for those taking placebo, 47.1% in the CBGT group, 54.3% in the phenelzine group, and 71.9% for patients receiving combined treatment. Using the CGI definition of remission, the rates at 12 weeks were 7.4% for placebo, 8.8% for CBGT, 22.9% for phenelzine, and 46.9% for patients receiving combined treatment.

At week 24, response rates were 33.3%, 52.9%, 48.6%, and 78.1% and remission rates were 14.8%, 23.5%, 25.7%, and 53.1%, respectively.

The difference between 12 and 24 weeks was not huge but may have built on benefits generated during the initial phase of treatment, said Dr. Blanco. "Its like going to the gym, you gain a little bit more over time but the main gains are in the first 12 weeks."

Combination therapy may work better than either monotherapy because some patients may respond to psychotherapy and others to medication, and so if patients receive both therapies, the probability of response is higher, said Dr. Blanco.

The other, more likely, explanation is that the 2 treatments have an additive or synergistic effect, he said. "The average improvement in the combined treatment is better than the average improvement in one of the therapies, so its not just a matter of probability responding to one or the other; its actually that the effect of one adds to the effect of the other."

Similar Effect Likely With Other Agents

The study authors speculate that the benefit of the combined treatment may be due to the separate treatments facilitating the effect of the other. "For example, phenelzine may reduce anxiety and increase the chances of successful exposures to feared situations, whereas the skills learned through CBGT may help those taking phenelzine profit more from their exposures."

Although the combined treatment approach appears to be superior to monotherapy, it might not always be possible to achieve, said Dr. Blanco. "There are times when it may be difficult to get because there may not be experts in psychotherapy close to where a patient lives or a patient cant or doesnt want to take medication. In those cases, a patient can take a monotherapy that is a little bit less effective but is still effective."

The researchers chose phenelzine as the study medication because it was the best-established medication for treating social anxiety at the time the study began in 1995. However, combining CBGT with another approved medication would likely have similar results, said Dr. Blanco.

"My best guess is that the use of another medication that is approved for social phobia, like sertraline or paroxetine, combined with therapy would also be more effective than either medication or [cognitive behavioral] therapy alone."

Although the study used just 1 nondrug therapy, Dr. Blanco said that combining drugs with other therapies, for example, individual CBT or interpersonal psychotherapy would likely produce similar results.

The investigators found that CBGT was not as effective as in previous studies. "The lower efficacy of CBGT in this study is surprising to us and may be due to sample differences, although other more recent studies found CBT highly efficacious," the study authors note.

Combination Therapy for All May Not Be Possible or Necessary

Commenting on the study for Medscape Psychiatry, Mark H. Pollack, MD, director, Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, and professor of psychiatry, Harvard Medical School, Boston, Massachusetts, said that although the current study shows some incremental benefit for the combined treatment strategy, other studies have shown no appreciable difference for combined treatment over monotherapy.

Given the logistical complexities and costs associated with the combination approach, it may not be possible to offer this therapy to all patients, and it may not even be necessary, said Dr. Pollack.

"Critical issues for the field to address going forward will be to identify what patients might need combined treatment from the start, who might do just as well beginning with monotherapy, and how to optimally combine these treatments in practice for example, sequentially or concomitantly."

Dr. Pollack also wondered whether there may be minimal "doses" of CBT that can be provided in the context of brief pharmacotherapy sessions that would provide added benefit
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Re: Nadril

Posted by jono_in_adelaide on September 10, 2011, at 4:14:12

In reply to Nadril, posted by selection10 on September 9, 2011, at 13:34:45

http://www.internationalpharmacy.com/en/products/search/phenelzine/1


these guys are the real deal, have brought from them many times - they are based in America, and are legitimate

 

Re: Nadril jono_in_adelaide

Posted by Phillipa on September 10, 2011, at 12:21:11

In reply to Re: Nadril, posted by jono_in_adelaide on September 10, 2011, at 4:14:12

Jono no nardil in Australia why is that? Deemed too many dangerous possible side effects? Or is it another country? Phillipa

 

Re: Nadril selection10

Posted by europerep on September 11, 2011, at 11:48:22

In reply to Nadril, posted by selection10 on September 9, 2011, at 13:34:45

what country are you in?

 

Re: Nadril

Posted by JONO_IN_ADELAIDE on September 11, 2011, at 20:22:35

In reply to Re: Nadril jono_in_adelaide, posted by Phillipa on September 10, 2011, at 12:21:11

Oh, we have Nardil in Australia, was just trying to help out the poster.

I brought some Atarax off of that site to see if it would help my anxiety (Atarax was withdrawn here some years ago, not for safety reasons, it was just not very commonly used, and Pfizer decided it wasnt worth bothering to market it)

Not sure what country the OP is in that doesnt have Nardil


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