Posted by zeugma on April 13, 2004, at 8:05:55
In reply to Re: Nardil, Parnate, NE, Social Phobia » Geoffrey Ruch, posted by King Vultan on April 12, 2004, at 20:22:22
> My understanding is that Nardil is better for social phobia than Parnate for two reasons: 1) Nardil is skewed much more towards serotonin than is Parnate and 2) Nardil also works on GABA, while Parnate does not. Serotonin seems to be the neurotransmitter most identified with social phobia. Paxil, which is FDA approved for social anxiety disorder, is obviously a very powerful SSRI. Nardil's actions on GABA likely have further anti-anxiety effects, which it would have in common with the benzodiazepines.
It's my understanding that serotonin is involved in stable bodily self-perception somehow. Social phobia for me is a very visceral feeling of being physically inadequate, and even repulsive. this causes tremendous self-consciousness and anxiety when interacting with others. Clonazepam calms me down, but does not eliminate this feeling (similar effect to a little alcohol). Definitely, GABA is involved, but it's not the whole story, at least for me.
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> As for norepinephrine and depression/panic/anxiety, I think this is a complex topic. While it's true that people who suffer from panic attacks are thought to perhaps have overactive norepinephrine systems, this is really a separate issue from that of depression and social anxiety. My own experience (which may be somewhat atypical), and as someone who mainly suffers from depression and social phobia is that I found NE reuptake inhibitors actually quite helpful for both conditions despite moderately increasing my overall anxiety levels. Blocking NE reuptake gave me both an antidepressant lift and an increase in self confidence, self esteem, and assertiveness.NE reuptake inhibitors help my ADD, which in itself has caused an increase in confidence, and have alleviated my depression to a great degree. They have done absolutely nothing for social anxiety, although I have only had one panic attack since starting an NE reuptake inhibitor, leading me to believe that panic is noradrenergically mediated, while social anxiety is not (at least in my case).
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> I've also gotten an antidepressant lift from SSRIs and some relief from my social phobia, but for me, anyway, the NE reuptake inhibitors were more effective on the latter. I don't know if I am unique in this respect or if I necessarily have a good explanation for this. As far as Nardil's effects on social phobia, I think it's worth pointing out that if Nardil is highly serotonergic, it follows that it should have a similarly powerful effect on norepinephrine because both neurotransmitters are metabolized by MAO-A. Also, Paxil has the greatest affinity in absolute terms for the NE reuptake transporter of any of the SSRIs (it also has the greatest affinity for the serotonin reuptake transporter). I don't know if these effects on NE actually confer any real ability on social phobia, but I thought I would share the observation.
>I suspect that my social anxiety is more serotonin- than dopamine-mediated. The thoughts that come to mind when experiencing social anxiety are related to distorted body image (this may not be everyone's experience of course). the way to test this hypothesis would be to try a little clomipramine in lieu of nortriptyline. But given the relative success of Paxil when treating social anxiety, and the fact that SSRI's treat Body Dymorphic Disorder, i would guess that serotonin would be intimately involved in many cases of social anxiety.
Making this all the more complicated is the fact that serotonin and dopamine also seem to be in competitive balance. The consensus I've gotten from people is that SSRi's elicit a 'don't care' attitude in response to imagined flaws, which is consistent with the self-perception hypothesis, but that this attitude generalized causes demotivation and anhedonia. Maybe clomipramine, because of its powerful NE effects (many times more powerful than Paxil) causes less problems with this. And maybe, if you're less preoccupied with imagined flaws, you need less motivation to get by. Anyway, it will be a little clomipramine mixed in with my TCA in a month, if things don't improve.
> Todd
poster:zeugma
thread:205134
URL: http://www.dr-bob.org/babble/20040412/msgs/335868.html