Posted by Kon on December 16, 2003, at 23:12:13
In reply to Parnate vs SSRIs for social anxiety, posted by Zabadoo on December 16, 2003, at 7:00:08
>I know that Nardil is the "gold standard" but it is not available in my backward country... And after I mentioned the word "klonopin" he started looking at me funny.
Two fairly recent meta-analysis done comparing the effectiveness of different meds on SAD suggest that benzos particularly clonazepam (Klonopin) may be the most effective medication:
From Blanco (2003),"Our analysis found that clonazepam, based on a single study, had the largest mean effect size of all medications. The effect sizes of SSRIs and phenelzine (Nardil) were similar to each other and numerically (but not statistically) smaller than those of clonazepam"
"Until relatively recently, phenelzine (Nardil)was considered the gold standard in the treatment of SAD. However, results from the meta-analysis suggest that its efficacy is not superior to that ofthe SSRIs or clonazepam, although it has never been directly compared to those medications."
Effect size based on Liebowitz Social Anxiety Scale:
Benzos (clonazepam)-1.54
Nardil (Phenelzine)-1.02
SSRIs -0.65Effect size based on Clinical Global Impression Scale:
Benzos (i.e. Clonazepam)-16.61
Phenelzine (Nardil) -5.53
SSRIs -4.1
Similarily from Federoff et al. (2001)meta-analysis:Effect size based from self-report:
Benzos-2.095
SSRIs -1.697
MAOIs -1.078Effect size based on Clinician-rated measures:
Benzos-3.150
SSRIs -1.540
MAOIs -1.235
Despite these impressive values for benzos both these authors go on to still favour SSRIs because of fewer side effects and less addiction potential. Their evidence for this argument, however, was not given. In fact if one looks at WHO data and UK yellow-card reports the SSRIs are significantly worse than benzos both wrt withdrawl and dependence-related problems. See:
poster:Kon
thread:290411
URL: http://www.dr-bob.org/babble/20031213/msgs/290789.html