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Question
Posted by: Jayxer | 2007/04/25

Social and Performance Anxiety medicatio

Hello,

Could someone please shed some light on 2 things please: firstly, the best medication available for this problem and, secondly, the combinationsof different types of medication.

With the first issue, from my research and from my Psychiatrist, it seems that Parnate (an MAOI) is the best available medicine although Nardil (also MAOI) is far better but only available in the USA for some strange reason. I haven't triedParnate even though I have a prescription because of it's dangerous side effects and low efficacy. I would be prepared to try Nardil because of it's high efficacy. How can I get this?

I am trying Rivotril (Clonazepam), a benzodiazepine, which has helped but is sedating. I think this combined with Inderal (beta blocker) may be a good option. Any better medications?

Secondly, I know it's safe to have a benzo with a beta blocker but is it safe to have a MAOI (perhaps Moclobemide such as Aurorix/Clorix) with a benzo or a SSRI with a benzo? What other combinations may be effective?

Thank you.

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Our expert says:
Expert ImageCyberShrink

Importing Narduil from the USa would be a very stupid idea, and I'm surprised any competent shrink would even talk about it. It is NOT magically effective in Social Aniety Disorder, and it's a poor shrink who thinks drugs alone are the answer. ANY MAOI including the much much safer and more convenient Aurorix, the closely related but safer RIMA ( which reversibly inhibits the same chemical as the older MAOI's. ( see elsewhere in H24 00 http://www.health24.com/mind/Anxiety/1284-1295,13086.asp )
SSRI antidepressants are just as effective in treating it, and CBT counselling is BRILLIANT at treating this disorder effectively, rapidly and well, and the best available treatment would be to combine an SSRI with CBT.
Rivotril is rubbish in this condition and I am suspicious of how many doctors seem to use this drug for almost anything, while there's no good evidence that it's especially useful for ANYTHING. Its very sedating and that is unhelpful. I would never use any benzo in treating this condition except in rare and unusual circumstances. A beta blocker can be temporarily useful as part of the larger treatment plan, but it only relieves the purely physical symptoms and has no useful impact whatsoever on the psychological / emotional symptoms.

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