# Why is Nardil the best med for social phobia?



## jakeforpresident (Sep 27, 2009)

Hey all,
here with an important question. I am thinking of taking either parnate or nardil but want to know just why it works.

This article is one of several that find a link between REDUCED MAO activity and low social status (a possible cause of Social Phobia):
http://www.ncbi.nlm.nih.gov/pubmed/12450967

Whereas this article says that higher levels of MAO are a measure of dominance and sociability:
http://books.google.com/books?id=lB...en#v=onepage&q=mao platelet dominance&f=false

I was wondering if there is a spectrum of MAO activity, and Social Phobics just have really high levels of MAO or what?

Finally, is Nardil really the best drug for social phobia??


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## euphoria (Jan 21, 2009)

I think it's because Nardil boosts GABA, serotonin and dopamine, but also "trace amines" including octopamine which opposes [nor]adrenaline and probably helps reduce anxiety & physical symptoms. Other trace amines include tryptamine and PEA. Nardil seems one of the best "all in one" meds to target exactly the right neurotransmitters for SA; it gets the balance just right for us. There are very few other ways to target dopamine without increasing [nor]adrenaline and hence anxiety, at least by prescription (e.g. stimulants). Realistically you would have to be on quite an extensive combination therapy to get the same effects as Nardil.

Yeah, if SSRI + mirtazapine doesn't work for me, I'll probably beg for Nardil (which I have taken before without problems and LOVED it, though it's hard to obtain). Even if you encounter side-effects, you tend to do so with a smile .


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## jakeforpresident (Sep 27, 2009)

Freesix88 said:


> Because Nardil is the med that increases most neurotransmitters in the brain and therefore the most side effects (and good effects). I do think it is very sloppy way to target SA but we don't much other choices (Legally) . I think Nardil is better because it also increases GABA and Parnate not.


You are probably right, the placebo effect works best when you actually feel different, and maois must make you feel way different.

Does anyone know if upregulation/desensitization or downregulation become an issue for MAOIs? I don't like the idea of it pooping out. Maybe an antipsychotic at night to counteract downregulation of DA receptors?


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## euphoria (Jan 21, 2009)

^ Tolerance / "poop out" is an issue with most meds, including Nardil. You could try supplementing magnesium to guard against this, at a safe dose of course.


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## jakeforpresident (Sep 27, 2009)

euphoria said:


> ^ Tolerance / "poop out" is an issue with most meds, including Nardil. You could try supplementing magnesium to guard against this, at a safe dose of course.


simple magnesium supplementation solves tolerance? How so?


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## arth67 (Aug 6, 2009)

nardil and parnate are, IMO too dangerous and should be a last resorrt only after many other antidepressants have been tried and failed


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## sssig (Mar 2, 2009)

OP , where are you at in Montana? I also live here.


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## euphoria (Jan 21, 2009)

jakeforpresident said:


> simple magnesium supplementation solves tolerance? How so?


I think it's something to do with magnesium's oppositional role to calcium, and NMDA receptors. Not really sure, but there's enough evidence to say magnesium works for tolerance, as do pharmaceutical NMDA receptor antagonists like ketamine. The jury's still out on whether tolerance builds to these agents themselves, safety of long-term usage, dose range, etc.

I used varying amounts of magnesium for a long time, usually about a gram a day, and after a while developed seizures along with probable hypothyroidism & hypocalcemia. A lot of things should be considered before deliberately altering electrolyte balance, take it from this hypocrite. Lower doses shouldn't be much to worry about though -- too many people are magnesium-deficient and/or calcium-overloaded. I plan to supplement about 400mg elemental magnesium a day when I start again, though will first consult with my doctor(s).


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## belfort (May 3, 2009)

what kind of side effects from nardil??i know its harmful to your liver but what other bad effects are there??

does nardil make you pro-social though or does it just eliminate SA??i need something pro-social...


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## euphoria (Jan 21, 2009)

Nardil was moderately pro-social for me, definitely more than purely serotonergic meds like SSRIs. Not as much as stimulants like Ritalin though.

Side effects? Sexual dysfunction was pretty bad, and I got some orthostatic hypotension & tiredness.


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## Medline (Sep 23, 2008)

arth67 said:


> nardil and parnate are, IMO too dangerous and should be a last resorrt only after many other antidepressants have been tried and failed


Of course they should not be used as first line treatment, but regarding the dangers:



> An approximation of the risk to benefit ratio of NSAIDs compared with MAOIs will place things in perspective. This is especially topical and pertinent in view of the recently recognised association between SSRIs and GI bleeding. NSAIDs are mostly used for arthritis which rarely has a fatal outcome. In major depression there is a 10-15% life-time risk of suicide as well as a greatly increased standardised mortality ratio (SMR). Consider the number of deaths from GI bleeds associated with NSAIDs (the figure is 1,200 deaths every year in the United Kingdom (2), not to mention cases of Stevens-Johnson syndrome/toxic epidermal necrolysis (3). Most doctors will have seen quite a few cases. Compare that to the rarity of cerebral bleeds from MAOIs. Most doctors will never ever see, or even hear of, a single case in their entire career. Deaths from MAOI induced hypertension are very rare. It is hard to find many reported in the last 50 years. A search of the whole Pubmed data base returns 67 hits for the keywords 'fatal' + 'monoamine oxidase inhibitor'. Many of these relate to serotonin toxicity, older reports to hepatic toxicity, but not one single report of intra-cranial bleeding. Another possible perspective is to note that fatal cerebral bleeds are documented as a result of the increase in arterial blood pressure secondary to weight lifting (4), which can elevate BP to 480 mm Hg. So, although exact figures for cerebral bleeds are imprecise this comparison puts the matter into perspective. It is abundantly clear that to regard MAOIs as dangerous is not just an over-reaction but also an egregious example of the unscientific and ill informed opinions not uncommon in the psychiatric fraternity.


http://www.psychotropical.com/maois_full.shtml

Nardil is so great vs. anxiety because it not only acts as a MAOI, but also as a GABA transaminase inhibitor therefor raising brain GABA levels. This might also be the reason it has in general more side effects than Parnate (weight gain, sedation...)


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## KurtG85 (Sep 19, 2008)

jakeforpresident said:


> Hey all,
> here with an important question. I am thinking of taking either parnate or nardil but want to know just why it works.
> 
> This article is one of several that find a link between REDUCED MAO activity and low social status (a possible cause of Social Phobia):
> ...


No. There is not one specific scientifically defined reason for social phobia and therefore there is not one scientifically determined best med therapy. Nardil also has a crap load of side effects for most users which render the whole therapeutic effects moot for many people.

However I wouldn't be surprised and would support the theory, based on my limited knowledge, that low 'MAO activity' did play some role in social phobia though.

I also think you meant to say: "and Social Phobics just have really [LOW] levels of MAO or what?"


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## jakeforpresident (Sep 27, 2009)

KurtG85 said:


> No. There is not one specific scientifically defined reason for social phobia and therefore there is not one scientifically determined best med therapy. Nardil also has a crap load of side effects for most users which render the whole therapeutic effects moot for many people.
> 
> However I wouldn't be surprised and would support the theory, based on my limited knowledge, that low 'MAO activity' did play some role in social phobia though.
> 
> I also think you meant to say: "and Social Phobics just have really [LOW] levels of MAO or what?"


My thinking is that since Monoamine Oxidase Inhibitors INHIBIT MAO activity and also help social phobia, depression, and anxiety that MAO activity must be higher than normal people without phobias or depression.

However, some studies support lower MAO activity in social phobics. The studies really are all over the place.
Dopamine D2 receptors being underactive in SA and higher than normal norepinephrine levels may be the problems MAOIs fix. But lower social status may be a consequence, unless Social Phobics are tweaked to such super-dominance that socializing becomes difficult/awkward which actually makes a lot of sense.


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## jakeforpresident (Sep 27, 2009)

sssig said:


> OP , where are you at in Montana? I also live here.


I live in Laurel, how about yourself?


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## db0255 (Jul 20, 2009)

jakeforpresident said:


> I live in Laurel, how about yourself?


Laurel, MD????


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## sssig (Mar 2, 2009)

jakeforpresident said:


> I live in Laurel, how about yourself?


Missoula.


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## jim_morrison (Aug 17, 2008)

My pdocs willing to prescribe me nardil, but i don't particularly want it unless all else fails.


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## db0255 (Jul 20, 2009)

I feel like Nardil is the equivalent of a great-responder to Prozac.


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## db0255 (Jul 20, 2009)

rocknroll714 said:


> When monoamine oxidase levels are lower during early development it paradoxically ****s things up, hence the discrepancy. Provided you're older than a fetus, lowering monoamine oxidase levels will be nothing but antidepressant and anxiolytic.
> 
> As for what Nardil does, as some here have already mentioned, it inhibits two enzymes: 1) monoamine oxidase (MAO) -> 80-90%; 2) GABA transaminase (GABA-T) -> 30-40%. This results in a lower rate of breakdown of the neurotransmitters serotonin, melatonin, dopamine, norepinephrine (noradrenaline), epinephrine (adrenaline), trace amines like phenethylamine, tyramine, octopamine, and tryptamine, and GABA. Specifically, elevation of serotonin, dopamine, norepinephrine, and epinephrine is antidepressant, and the former two anxiolytic, and elevation of GABA is anxiolytic as well. Paradoxically, however, Nardil actually decreases norepinephrine and epinephrine levels through a complicated (I won't bother explaining it) interaction with octopamine, resulting in a lower though still significant therapeutic response, and side effects like orthostatic hypotension.
> 
> The combination of targeting several major systems involved in mood and anxiety in a positive manner is what makes Nardil the [in my opinion as well as that of many others] most powerful prescription anxiolytic available. Unfortunately, having such a nonselective action also results in ruthless side effects, and I myself couldn't tolerate them despite the literally incredible anxiety relief; hence, I quit and I'm never taking another MAOI again.


We have a winner for copying off wikipedia!


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## jakeforpresident (Sep 27, 2009)

rocknroll714,

what side effects did you experience???


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## Medline (Sep 23, 2008)

jakeforpresident said:


> rocknroll714,
> 
> what side effects did you experience???


The worst side effect I experienced while HE was on the drug was worrying about his experimental drug (combos) and it's effects on his body & brain.


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## 3y2l (Sep 29, 2009)

*Nardil*

I have been on Nardil on two occasions, and both times I had to quit due to side effects. The worst side effect being extremely slow metabolism that was resulting in 10-15 lbs a month weight gain despite eating a 1000 calorie diet and exercising rigorously twice a day. Normally, I can eat anything I want without gaining weight. Unfortunately, I have tried everything to get the same positive effect as Nardil but just can't get it - even with a combo therapy of Celexa, Wellbutrin, Ritalin, and Xanax (in an effort to get major NTs). Anybody have thoughts on why the Nardil stops my metabolism so badly? Anything I can do to counter this? I was trying a low fat diet last time. Maybe a low carb diet would be more effective since it might make my body utilize fat for energy? I really want to try Nardil again (and find myself again) but can't handle that kind of weight gain. I can figure something out for the rest of the side effects but that I can't tolerate. Thanks!


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## jakeforpresident (Sep 27, 2009)

3y2l said:


> I have been on Nardil on two occasions, and both times I had to quit due to side effects. The worst side effect being extremely slow metabolism that was resulting in 10-15 lbs a month weight gain despite eating a 1000 calorie diet and exercising rigorously twice a day. Normally, I can eat anything I want without gaining weight. Unfortunately, I have tried everything to get the same positive effect as Nardil but just can't get it - even with a combo therapy of Celexa, Wellbutrin, Ritalin, and Xanax (in an effort to get major NTs). Anybody have thoughts on why the Nardil stops my metabolism so badly? Anything I can do to counter this? I was trying a low fat diet last time. Maybe a low carb diet would be more effective since it might make my body utilize fat for energy? I really want to try Nardil again (and find myself again) but can't handle that kind of weight gain. I can figure something out for the rest of the side effects but that I can't tolerate. Thanks!


I'd give parnate a try, or selegiline with an SSRI or SNRI combo. Have you gained weight on any other psychiatric drugs?? You could isolate what nuerotransmitter is responsible and create a regimen that mimicks nardil w/out the SE of weightgain.


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## db0255 (Jul 20, 2009)

rocknroll714 said:


> I wrote the Nardil article on Wikipedia smart ***.


Well you did a damn good job.


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## Medline (Sep 23, 2008)

Really great article. Just one thing:



> Phenelzine and the other MAOIs are typically considered to be significantly more effective against clinical depression in comparison to more mainstream antidepressants like the selective serotonin reuptake inhibitors (SSRIs)...


This might be true, but 1) MAOIs have never actually been compared to SSRIs in randomized, controlled, double-blind trials for clinical depression AFAIK and 2) Maybe MAOIs are just especially useful in treatment resistant cases, but not significantly more effective than eg. SSRIs for clinical depression in general.


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## TiMeZuP (Sep 30, 2009)

Many claim that nardil is the gold standard for treating SA. Alot of SAers' feel better from the treatment. But in my opinion Nardil is a sloppy way of treating SA


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## Medline (Sep 23, 2008)

TiMeZuP said:


> Many claim that nardil is the gold standard for treating SA. Alot of SAers' feel better from the treatment. But in my opinion Nardil is a sloppy way of treating SA


And what is a "non-sloppy" way in your opinion?


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## db0255 (Jul 20, 2009)

Question: Does Nardil relieve social inhibition or improve social status/skills?


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## TiMeZuP (Sep 30, 2009)

Medline said:


> And what is a "non-sloppy" way in your opinion?


Well there is no med available that would be non sloppy. But many people seem to get a benefit from stims. I am assuming the dopamine receptors are providing the relief and minimising the SA symptoms. Possibly D2? It just would nice to see some actual drugs selective of there target for the treatment of SA; there focus could be on dopamine targeting D2 (social pleasure) and maybe oxytocin (reduce anxiety...)....I am sure there are more targets that would be relevant to SAD

I dont mean to sound disgruntled, but current SA meds just sedate us; treating only the anxiety. Ignoring what could be actually causing the anxiety in the first place. I wonder how many SAS'er have SA because they dont feel social pleasure. For example; Socialising to me feels like a job it's mental draining and often unrewarding. Since I am not getting pleasure from socializing ......anxiety kicks in if I socialize to long.

Benzo/stim help my SA alot but like I previously said about nardil. Thats a sloppy way to treat SA. The stims are giving us some things SAers need (dopamine) but also giving us what we dont need more of. Norepinephrin


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## Medline (Sep 23, 2008)

TiMeZuP said:


> Well there is no med available that would be non sloppy. But many people seem to get a benefit from stims. I am assuming the dopamine receptors are providing the relief and minimising the SA symptoms. Possibly D2? It just would nice to see some actual drugs selective of there target for the treatment of SA; there focus could be on dopamine targeting D2 (social pleasure) and maybe oxytocin (reduce anxiety...)....I am sure there are more targets that would be relevant to SAD
> 
> I dont mean to sound disgruntled, but current SA meds just sedate us; treating only the anxiety. Ignoring what could be actually causing the anxiety in the first place. I wonder how many SAS'er have SA because they dont feel social pleasure. For example; Socialising to me feels like a job it's mental draining and often unrewarding. Since I am not getting pleasure from socializing ......anxiety kicks in if I socialize to long.
> 
> Benzo/stim help my SA alot but like I previously said about nardil. Thats a sloppy way to treat SA. The stims are giving us some things SAers need (dopamine) but also giving us what we dont need more of. Norepinephrin


It's hard to get potent stimulants + benzos for SA.


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## TiMeZuP (Sep 30, 2009)

True.....But I managed getting it. Adderall helps alot. But it also does alot of other stuff we really don't need for SA treatment.


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## Medline (Sep 23, 2008)

Have you thought about adding clonidine or carvedilol to the stimulant.


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## TiMeZuP (Sep 30, 2009)

Medline said:


> Have you thought about adding clonidine or carvedilol to the stimulant.


No I barely take the stim because the sideffects are rough. No anxiety. But damn does it help treat some of the symptoms of SA.

I am not familiar with those meds....what would they do to the stim?


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## jakeforpresident (Sep 27, 2009)

TiMeZuP said:


> Well there is no med available that would be non sloppy. But many people seem to get a benefit from stims. I am assuming the dopamine receptors are providing the relief and minimising the SA symptoms. Possibly D2? It just would nice to see some actual drugs selective of there target for the treatment of SA; there focus could be on dopamine targeting D2 (social pleasure) and maybe oxytocin (reduce anxiety...)....I am sure there are more targets that would be relevant to SAD
> 
> I dont mean to sound disgruntled, but current SA meds just sedate us; treating only the anxiety. Ignoring what could be actually causing the anxiety in the first place. I wonder how many SAS'er have SA because they dont feel social pleasure. For example; Socialising to me feels like a job it's mental draining and often unrewarding. Since I am not getting pleasure from socializing ......anxiety kicks in if I socialize to long.
> 
> Benzo/stim help my SA alot but like I previously said about nardil. Thats a sloppy way to treat SA. The stims are giving us some things SAers need (dopamine) but also giving us what we dont need more of. Norepinephrin


It should be noted that although there are physical abnormalities in "SAers" brains that no correlation between any genetic predisposition for the dopamine system (any specific allele.)
It is likely that a host of specific alleles in the SA system make one have a "Low risk, low gain" predisposition in life, which makes one vulnerable for phobias and atypical depression.
The brain adapts to the low social status (a symptom and/or cause of social phobia) in a host of ways, affecting the amygdala, hippocampus, and other mood regulatory centers.
Medication helps, but ultimately cognitive aspects of the disease are very important, which is why some people respond well to a drug then poop out after three days, lol.

A non-sloppy way of treating SA is exposure therapy, then, as well as Thought Control (resisting self-depreciating/socially-avoidant thoughts). Taking a pill will never turn you into a social robot... at least not yet, sigh!



db0255 said:


> Question: Does Nardil relieve social inhibition or improve social status/skills?


According to this article, yes, then with time, yes and yes.
http://books.google.com/books?id=lB...=6#v=onepage&q=mao b social dominance&f=false


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## Medline (Sep 23, 2008)

TiMeZuP said:


> No I barely take the stim because the sideffects are rough. No anxiety. But damn does it help treat some of the symptoms of SA.
> 
> I am not familiar with those meds....what would they do to they stim?


Reduce side effects like restlessness and anxiety caused by the stimulants.


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## TiMeZuP (Sep 30, 2009)

Jake: Im glad your giving yourself another approach. But life is nothing more then one big CBT. I do it every day. Besides.....CBT may teach you how to reduce anxiety and relax yourself. Will it teach one how to gain pleasure from socializing? To be able to enjoy talking with friends? Will it teach me how to FEEL pro social? Sure CBT did an excellent job teaching me how to ACT prosocial......but I want to feel the part. I'm sorry if this sounds harsh. But I just dont have much faith in CBT. I have social skills but I am tired of isolating from people because socializing seems so unrewarding and mentally draining. 1 night of hanging out for me === 4 days down time I need just to recharge my mentally drained head. And that "one night" wasn't fun. It felt like a PIA. I sit watching people enjoy themselves and think WTF. I'm yacking with these people. Why dont I feel the pleasure from this. Ohhhh I guess ill go home and get "rewarded" watching TV. I begining to think alot of SAer's have a FCC'up Dopamine system. 

Medline: Do you feel pleasure interacting with people off meds? Do you find it to be mentally draining and tiring as well? Do you lack pro-social drive? Doesn't it seem possible that lack of social pleasure is WHAT is causing anxiety in the first place?


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## Medline (Sep 23, 2008)

Medline: Do you feel pleasure interacting with people off meds? Do you find it to be mentally draining and tiring as well? Do you lack pro-social drive? Doesn't it seem possible that lack of social pleasure is WHAT is causing anxiety in the first place?[/QUOTE]
1) yes 2) no 3) yes

4) In general people with 'just' social phobia don't have a lack of social pleasure. Schizoid people have that, but this personality disorder is rare.


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## TiMeZuP (Sep 30, 2009)

Then what explains why people claim (myself included) how well Stims help treat there SA symptoms?

When on adderall I find that I am actually paying attention to what the other person says......after 1 hour of talking Im like "WOW time just flew by". The conversation felt easier, enjoyable, and somewhat pleasurable. Without Adderall I would have anxiety needing to bail out of the conversation within 10 min.

Again Adderall is far from a good SA treatment. I don't even take it. The side effects are rough. 

Im lucky to have an open pdoc. I was prescribed Adderall and DXed as having an Anxiety Disorder. Though my only anxiety disorder is socially related.


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## euphoria (Jan 21, 2009)

I don't think it's accurate to use official figures for SPD prevalence when you consider schizoids' detachment from society (including those contributing the statistics). It's going to be very under-estimated unless they find a way of reaching every 'loner' out there.

TiMeZuP: I'm similar, the dopaminergic component of stimulants seems to be the part that helps. For my brain, I consider the adrenergic bit just to contribute side-effects like anxiety. I don't suffer from low energy, just anhedonia (causing other symptoms like no motivation, no social drive, etc.), anxiety & depression. I can say for sure the only drugs/meds to ever touch my core symptoms were dopaminergics like selegiline, methylphenidate & opioids. It's not because everything seems fine when you are 'high', they did actually seem to fix something and make me normal / finally understanding life. This was at pretty low doses, not recreational; the aim is not to achieve euphoria.

If "chemical imbalances" are truly behind depression, anxiety, personality disorders and so on, I don't see why dopamine is any less deserving of attention than serotonin. Maybe it's because it makes our resident rule-makers uncomfortable that society's balance of power / social status isn't set in stone as they'd like to think. IMO current treatment of SPD and some other PDs is a downright scandal, and you're not likely to get very far unless you have something else considered 'treatable' by the medical community. No wonder so many SPD people self-medicate.

Medline's idea of selegiline + low-dose methylphenidate sounds like one of the best pro-social regimens you can find, but tolerance would be a major worry.


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## Medline (Sep 23, 2008)

euphoria said:


> I don't think it's accurate to use official figures for SPD prevalence when you consider schizoids' detachment from society (including those contributing the statistics). It's going to be very under-estimated unless they find a way of reaching every 'loner' out there.


I didn't took the official figures - I added you twice just for the heck of it. :yes Seriously: You are right, the real number is for sure higher.



> Medline's idea of selegiline + low-dose methylphenidate sounds like one of the best pro-social regimens you can find, but tolerance would be a major worry.


I thougt of adding caroverine. What do you think about that? The cool thing is even when tolerance becomes a bigger issue, you still need not that much Methylphenidate because of the Selegiline: http://www.mindandmuscle.net/forum/index.php?showtopic=31342&pid=439093


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## db0255 (Jul 20, 2009)

euphoria said:


> I don't think it's accurate to use official figures for SPD prevalence when you consider schizoids' detachment from society (including those contributing the statistics). It's going to be very under-estimated unless they find a way of reaching every 'loner' out there.
> 
> TiMeZuP: I'm similar, the dopaminergic component of stimulants seems to be the part that helps. For my brain, I consider the adrenergic bit just to contribute side-effects like anxiety. I don't suffer from low energy, just anhedonia (causing other symptoms like no motivation, no social drive, etc.), anxiety & depression. I can say for sure the only drugs/meds to ever touch my core symptoms were dopaminergics like selegiline, methylphenidate & opioids. It's not because everything seems fine when you are 'high', they did actually seem to fix something and make me normal / finally understanding life. This was at pretty low doses, not recreational; the aim is not to achieve euphoria.
> 
> ...


I def asked this in another thread, but you probably didn't see it. Euphoria, how are you avoidant and schizoid at the same time?


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## jakeforpresident (Sep 27, 2009)

I agree that dopamine is a key nuerotransmitter that is off in SA people, studies obviously prove this.

However there is no correlation between genetic polymorphisms of the DA system and socially anxious people.
People with SA such as myself do seem to have trouble paying attention to conversations because we are so busy looking at ourselves and curling up with our feelings of isolation and alienation. These are cognitive aspects of the disorder.

Meds do help, but i've never met anyone cured by them for a period longer than a few days to a few years. Look at these very forums to see my point.
You have to do some work yourself... that should be obvious.


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## euphoria (Jan 21, 2009)

db0255 said:


> I def asked this in another thread, but you probably didn't see it. Euphoria, how are you avoidant and schizoid at the same time?


Heh, time for another life story. Here's my analysis:

In the beginning I was just extremely shy/introverted, along with a lack of assertiveness & sociability, but still had a normal life. Oh and I had pretty severe OCD as a child; anxiety has always been a running theme.

As I grew into a teenager I wasn't able to handle the increased social demands, so lost the few friends that remained and developed a lot of social anxiety & dysthymia / minor depression. It was a constant ordeal, and I think around this time I lost the ability to enjoy life or have any interests 'cause the problems always dominated. How can you when you're humiliated on a daily basis?

I was very embarrassed by it all so didn't tell anyone. I started avoiding things [<-- avoidant?] at school I feared (the list progressively growing), with such highlights as walking to a nearby town (~12km return trip, many blisters, several days in a row), and pouring a cup of scalding hot water over my hand to get off school. It was usually class presentations 'n stuff like that.

Having no teenage life whatsoever (age 12-16), I just became increasingly shut off [<-- schizoid?] with a cross between apathy & pessimism, and eventually said "f*** it" and started taking the mighty Xanax. After this it was just a blurry 2 years of too many drugs and failure at school/college. I still didn't have a life 'cept for getting wasted with a few people. This was probably the most depressing time of all.

So yeah, I think I have both those PDs but maybe it's not too late to change that. I have always been a bit schizoid and don't think it's necessarily a bad thing, but the avoidant-ness needs to be gone. Recently, I quit college on the first day because of the old problems, and am waiting for a new script for some SSRI. I don't have a job / purpose or any friends really, and currently am avoiding just about every part of life. I don't leave the house very often, but am not at all agoraphobic...



> However there is no correlation between genetic polymorphisms of the DA system and socially anxious people.
> People with SA such as myself do seem to have trouble paying attention to conversations because we are so busy looking at ourselves and curling up with our feelings of isolation and alienation. These are cognitive aspects of the disorder.


I think for those who'd be perfectly normal without anxiety, therapy and/or simple anxiolytics like SSRIs or benzos would be a good choice. Dopamine is implicated for SPD/APD though, which can occur alongside SA:

http://www.ncbi.nlm.nih.gov/pubmed/9152988

For me, therapy and anxiolytic meds were all focused on getting over anxiety, not solving the thing that caused it.


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## db0255 (Jul 20, 2009)

euphoria said:


> Heh, time for another life story. Here's my analysis:
> 
> In the beginning I was just extremely shy/introverted, along with a lack of assertiveness & sociability, but still had a normal life. Oh and I had pretty severe OCD as a child; anxiety has always been a running theme.
> 
> ...


Those personality disorders are mutually exclusive, you're either one or the other. Perhaps you just have bad social anxiety and depression?


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## meyaj (Sep 5, 2009)

If you're on a social anxiety support board, it's unlikely you're schizoid. People with schizoid personality have no interest in being social, don't really feel that the isolation is affecting them in a bad way, are emotionally cold, and generally don't care about rejection or criticism.

People with avoidant personalities DO generally wish to be social, realize their isolation isn't really a good thing, are EXTREMELY sensitive to rejection and/or criticism, and, although they may appear to be emotionally cold because they might feel embarrassed displaying emotion, they have the potential to be affected by emotion more strongly than even you average person.

So... which one sounds more like you? I suppose it's not impossible that you used to be one, and are now the other, but that is EXTREMELY unlikely.


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## meyaj (Sep 5, 2009)

rocknroll714 said:


> The MAOIs were compared to TCAs in an interesting study I saw the other day. In typical depressives (those with more anxiety, stress, and negativity-related symptoms), the TCAs were actually superior (not too surprising really based on some of their other varying effects like 5-HT receptor antagonism), but in atypical depressives (those experiencing symptoms of apathy and anhedonia), the MAOIs were superior.
> 
> Anyway, regarding SRIs, besides essentially encompassing their effects, the MAOIs also elevate dopamine of course. Though dopamine may not be as effective as an antidepressant as serotonin in typical depressives, it does have typical antidepressant qualities that go beyond relieving atypical symptoms like apathy and anhedonia. I mean dopaminergics like pramipexole show efficacy in the forced swim test (FST) for example. Not to mention serotonin suppresses dopamine and therefore likely inhibits some of its antidepressant potential, of which MAOIs but not SRIs would reverse to some degree or completely. Hence, people don't usually report experiencing emotional blunting while on MAOIs.
> 
> In any case, I think it's pretty well-established that MAOIs are significantly more effective in comparison to SRIs. Ask anyone who's taken both and see what they have to say about the matter.


I don't quite think you have an understanding of typical vs atypical depression. The typical (aka melancholic) is much more likely to be anhedonic and apathetic, and they tend to undereat and undersleep.

Atypical depression (which is actually a misnomer - it's the most common type) is characterized by a few things like overeating, and oversleeping, as well as a hypersensitivity to rejection (making it have a lot in common with SAD), but one of the absolute defining characteristics of atypical depression is mood reactivity - that is, the mood of people with atypical depression can brighten following positive events. They are neither apathetic or anhedonic, unless they're having a melancholic depressive episode, in which case it wouldn't be called atypical.

However, you are absolutely right in that MAOIs are considered far superior in cases of atypical depression. TCAs are considered nearly useful. And when you consider how much overlap there is between social anxiety disorder and atypical depression, it's no surprise that MAOIs are also often considered the most effective for SAD.

Nardil in particular inhibits GABA transaminase, the enzyme that breaks down GABA. GABA is an inhibitory neurotransmitter, targeted by drugs like the benzos to achieve an anxiolytic effect.

One of the metabolites is phenethylamine, a monoamine naturally present in the body that acts a lot like amphetamine. Nardil, by its own action, prevents the breakdown of its own metabolite, boosting the PEA levels significantly. I believe this can also account for some of the extra anti-depressant effects and motivation that Nardil can often cause.


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## meyaj (Sep 5, 2009)

meyaj said:


> TCAs are considered nearly useful.


Sorry, I meant to say USELESS, not useful.


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## jakeforpresident (Sep 27, 2009)

So its official, I will be starting Nardil this coming Tuesday.

Hopefully it works! otherwise ill try Gabapentin with Modafinil and if those don't work say screw it all and just tough it lol


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## db0255 (Jul 20, 2009)

meyaj said:


> I don't quite think you have an understanding of typical vs atypical depression. The typical (aka melancholic) is much more likely to be anhedonic and apathetic, and they tend to undereat and undersleep.


Atypical depression is characterized by apathy and anhedonia also. They're common in both depressions....


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## meyaj (Sep 5, 2009)

db0255 said:


> Atypical depression is characterized by apathy and anhedonia also. They're common in both depressions....


Atypical depression is characterized by a reactive mood, which kind of precludes anhedonia... It's definitely possible for people that normally have atypical depression to have melancholic episodes, in which they become anhedonic, but at that point it wouldn't really be called atypical depression...


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## db0255 (Jul 20, 2009)

meyaj said:


> Atypical depression is characterized by a reactive mood, which kind of precludes anhedonia... It's definitely possible for people that normally have atypical depression to have melancholic episodes, in which they become anhedonic, but at that point it wouldn't really be called atypical depression...


I think you're confusing mood with pleasure here. I can have a reactive mood, but still not feel pleasure.

For example, if you have atypical depression with anhedonia, you would be happy that friends are over and you're watching football, but it's not exactly pleasurable; that is, you're probably thinking in your head, what's all the fuss about, why are they enjoying this? However, you're not complaining because at least you don't feel despondent...Mood is more general, pleasure would be more acute.


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