Finally! The results!

[tecknohed]

Hi all. I took part in a study 10yrs ago. Looking at dopamine's role in social anxiety. Was never given the results, but I've just found them.

http://jop.sagepub.com/content/24/5/709

Abstract

Serotonergic antidepressants (SSRIs) are first-line treatments for social anxiety disorder [SAnD], though there is evidence of dopaminergic system dysfunction. Twenty subjects with DSM-IV SAnD, untreated (n = 10) and SSRI-remitted DSM-IV SAnD (n = 10), were administered a single dose of 1) a dopamine agonist (pramipexole 0.5 mg) and 2) a dopamine antagonist (sulpiride 400 mg), followed by anxiogenic challenges (verbal tasks and autobiographical scripts) in a double-blind crossover design, the two test days being one week apart. Anxiety symptoms were measured by self-reported changes in Visual Analogue Scales, specific SAnD scales and anxiety questionnaires. Plasma levels of prolactin were obtained. Untreated SAnD subjects experienced significant increases in anxiety symptoms following behavioral challenges after either sulpiride or pramipexole. Following remission with SSRIs, the socially anxiogenic effect of behavioral provocation was significantly attenuated under pramipexole, whereas under sulpiride effects remained significantly elevated. There appears to be instability of the dopamine system under behavioural stress in social anxiety subjects that is only partly rectified by successful treatment with an SSRI, which may induce a desensitization of post-synaptic dopamine D3 receptors.


Kinda explains why SSRIs, on their own are NOT necessarily the best 1st line approach for treating SA. In my experience they usually make matters a lot worse. In fact, it was because I had tried all SSRIs that after a short trial on Nuerontin, I was given Phenelzine. Then I started to live.

[ArkoN]

Originally Posted by tecknohed

Hi all. I took part in a study 10yrs ago. Looking at dopamine's role in social anxiety. Was never given the results, but I've just found them.

http://jop.sagepub.com/content/24/5/709

Abstract

Serotonergic antidepressants (SSRIs) are first-line treatments for social anxiety disorder [SAnD], though there is evidence of dopaminergic system dysfunction. Twenty subjects with DSM-IV SAnD, untreated (n = 10) and SSRI-remitted DSM-IV SAnD (n = 10), were administered a single dose of 1) a dopamine agonist (pramipexole 0.5 mg) and 2) a dopamine antagonist (sulpiride 400 mg), followed by anxiogenic challenges (verbal tasks and autobiographical scripts) in a double-blind crossover design, the two test days being one week apart. Anxiety symptoms were measured by self-reported changes in Visual Analogue Scales, specific SAnD scales and anxiety questionnaires. Plasma levels of prolactin were obtained. Untreated SAnD subjects experienced significant increases in anxiety symptoms following behavioral challenges after either sulpiride or pramipexole. Following remission with SSRIs, the socially anxiogenic effect of behavioral provocation was significantly attenuated under pramipexole, whereas under sulpiride effects remained significantly elevated. There appears to be instability of the dopamine system under behavioural stress in social anxiety subjects that is only partly rectified by successful treatment with an SSRI, which may induce a desensitization of post-synaptic dopamine D3 receptors.


Kinda explains why SSRIs, on their own are NOT necessarily the best 1st line approach for treating SA. In my experience they usually make matters a lot worse. In fact, it was because I had tried all SSRIs that after a short trial on Nuerontin, I was given Phenelzine. Then I started to live.

so in english, what are the best meds and the ones to avoid? lol

[incommunicado]

Hi tecknohed, i believed dopamine was at the root of my sa not the seretonin bullshit so participated in this study to proove it.

November 5th got wired up and kitted out then the fire alarm went off so had to go outside with doc holding bits of equipment lol. A short while after taking the amilsulpride i got really bad nausea, threw up and collapsed(transpired later that me heart had gone spazzo, so had to see cardiologist and have load of tests). Felt really shit during the tests and nearly fell asleep driving home, jumped straight into bed and then the fireworks started going off!

Following week had the pramipexol, felt good and "normal" for the day, got put straight on moclobemide for 9 years, kept attending Bristol until Dec 05.

Started searching for results in 06, found them in several places which were much more accessable back then as well as PubMed where only the abstract was freely available. Can't find the original now, but they were revised by some Brazilian in Dec 06:

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

http://www.scielo.br/scielo.php?pid=...pt=sci_arttext

[tecknohed]

Originally Posted by defiance21

so in english, what are the best meds and the ones to avoid? lol

Off the top of my head...

Def worth a go: Full MAOIs, SSRI + bupropion, SNRI or TCA + low-dose AP (eg.quetiapine). Low dose long-term benzo, with clonazepam being most effective, to add to your AD(s) if they don't help the anxiety enough themselves. Although Phenelzine, a full irriversable MAOI boosts SE, NA & DA & also GABA via one of it's metabolites. Saves needing a benzo. With SA it appears that, unlike GAD & Panic Disorder, clonazepam does not become addictive in a 'morish' kinda way. You cannot just stop it dead coz you'll get DTs. But once you reach your most effective dose it seems SA sufferers can stay on that dose indefinitely without needing to increase dose due to tolerance. Finally buspirone may be added to any non-SE AD as its an anxiolitic that works on SE and DA too but to a lesser degree.

Do not bother with the following as mono-therapy: after trying 2 diff SSRIs without success then dump them. Also avoid Reboxetine & all NRIs which includes many TCAs. The TCA clomipramine is basically an SRI TCA, whereas amitriptyline is equal SRI & NRI.

Its not that difficult to find this stuff out if you bother to search the net.

SE = serotonin NA = noradrenalin DA = dopamine TCA = tricyclic AD = antidepressant AP = anti-psychotic NRI = noradrenalin re-uptake inhibitor DRI = dopamine re-uptake inhibitor, SSRI = selective serotonin re-uptake inhibitor SRI = serotonin re-uptake inhibitor without selectivity, hitting all/most serotonin receptors. The SSRIs target specific types of serotonin receptors. Hence why there are many SSRIs which all work differently. SNRI = serotonin & noradrenalin re-uptake inhibitor MAOI = mono-amine-oxidase-inhibitor (enzym which breaks down mono amines [SE, NA, DA & many more] is inhibited).

[tecknohed]

@incommunicado
Thanks for the links. cant seem to find anything from the 1st link tho. Yes there was alot more free info on the net till several years ago. Are we going back in time or something?