Questions and Answers
I am a 31 year old professional male. I have taken Nardil for nearly ten years now, and its use has helped me a great deal to recover my confidence. The side effects however are extremely inconvenient. My panic symptoms have been minimized, but even diminished anxiety is intolerable at times. So, I often question Nardil's effectiveness versus newer medications.
I have seen doctors for many years and have routinely asked about alternative medications. Four or five years ago, I committed to changing medications. I tried several including Prozac, Lithium, Buspar, and another but found they were not effective for me. That sacrifice was so distressing, I have hesitated to attempt another change without gathering more conclusive advice.
Which new medications may have similar properties for pacifying anxiety and social phobias? Which have proven to help people formerly on Nardil? What is your position on St. John's extract?
I am very involved in business, and refuse to evade situations due to fear. However, I seemed to have reached my improvement threshhold. Is there any general advice you might offer for improving beyond to my full capability?
Hi Pete ... sorry to learn of your problems.
Typical pharmacotherapy for panic and anxiety attacks is the use of antidepressants or alternatively, a benzodiazepine. Of the two types of antidepressants generally accepted, you have used, and as I understand it, still use the MAO inhibitor phenelzine (Nardil). You don't mention any use/trial of the other, tricyclic antidepressants e.g. amitriptyline (Elavil). Also not mentioned is a benzodiazepine e.g. alprazolam (Xanax).
Of the other drugs you mention, fluoxetine (Prozac) is a serotonin re-uptake inhibitor, its use in the treatment of Panic Disorder is not an approved use; Lithium is effective in the treatment and control of manic-depression and not the disorder you describe; buspirone (Buspar) is used effectively to treat Generalized Anxiety Disorder, I'm not qualified to comment on its use in your case. Incidentally, all these have to be taken for at least 4 - 6 weeks before any effect can be appreciated.
St. John's Wort (God's wonderplant, Devil's scourge!) has anecdotal popularity , particularly in Europe, as a basis for healing ointments and for the treatment of bronchial and urinary tract conditions. I know of no basis for even contemplating its use in your particular case.
It would seem best to stick with proven remedies, with selection and proper use defined by a professional skilled in this condition; at the same time realizing that pharmacotherapy is only part of a general treatment plan including supportive psychotherapy, relaxing techniques, and so on.
Best wishes.