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Depression

Question
Posted by: | 2019/06/20

Q.

MAOIs for social phobia

Is the MAOI Phenelzine effective for depression? I have been told it helps atypical depression, whatever than means, but not endogenous depression. I need something that can help both sets of symptoms because my problem is very complicated. I think I have avoidant personality disorder, a severe variant of social phobia. Because I like cheese, I do not want to take an MAOI. Are other drugs, like SSRIs and tricyclics just as therapeutic? And where does Flupentixol come into the equation? Is that one less effective, or do psychiatrists split hairs too much? Put all the doctors and the patients together in the world and we know nothing about the human mind!

Expert's Reply

A.

Depression expert
- 2019/06/22

Any MAOI, including Phenelzine, sounds like a bizarre choice for treating social phobia.  You don't mention whether a wide range of alternative antidepressants have been tied and failed, before this decision was made. MAOI's are uncommonly used these days, except when safer drugs have failed, because they usually don't have compelling advantages, and the older forms can cause serious problems when combined with some other drugs or with some foods.  There is one member of that family, Aurorix ( Moclobemide) which appears to be safer and less likely to cause such problems, and is classified as a RIMA, a Reversible Mono Amine Inhibitor, which I would have thought a more likely choice if other antidepressants, properly tried, had failed, and an MAOI was considered worth trying.
Drugs are not considered useful in managing personality disorders or any variety, whereas skilled psychotherapy from an experienced psychologist can be really useful.  And CBT style psychotherapy can be as effective in treating depression as drugs.
Yes, all other varieties of antidepressant, including SSRI's are overall as effective as MAOI's. ( why would they still be on the market, let alone used FAR more often than MAOI's, unless they were at least similarly effective ? )
Flupenthixol is an interesting and special case. I remember way back, when it was introduced for schizophrenia, I noticed that the studies showed it also seemed to improve mood, and asked the Danish parent company if they were doing studies of its use in Depression.  The possibility seemed to be set aside for some years as it's value in psychotic illness was explored.  Now I see increasing studies showing it's potential as a treatment for depression, though it is not, technically, an antidepressant.  It's availability in a long-acting injectable form is also interesting.
Though the field may look confusing, I don't agree that we know nothing about the human mind. The issue is that it is immensely complex, and each new discovery requires us to revise the whole set of concepts we have ; each reveals new issues needing explanation.  This does get annoying and disappointing at times, but compared to the phase in each field of knowledge when it stagnates, with nothing new, and nothing really getting anywhere,  this state of flux is preferable.
Maybe we should put doctors and patients together more often, to enhance all of our understandings.  Put all the philosophers in the world end to end, and they'd reach no conclusion ;  put all the lawyers in the world end to and, and that'd be a jolly good idea !

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