The strongest antidepressants for social phobia are the top best. Treatment of phobias with antidepressants

This year I turn 30 years old. Exactly 22 years of them I live with panic attacks. Familiar? Even if your story does not repeat mine, I am sure that many, being in similar life situations will understand me. My story will be long, and I want to make a reservation in advance that I did not plan to bore anyone with it. It's just that for the first time, I feel like I can finally talk about it honestly and without fear.

Yesterday

My nightmare started at the age of 8. At this age, I underwent surgery to remove a hernia in the white line of the abdomen. I don't remember the pain and I don't remember the doctors who were nearby. But I remember the darkness and fear when you try to open your eyes for the first time after anesthesia, and black dreams drag you back against your will. Mom was not around. I grew up in an incomplete family and she had to work hard to support me and my sick parents. When I woke up, I heard only children's laughter. Then for the first time I learned how cruel children can be when you feel bad and don’t have the strength to answer. It was at that moment that I first felt an overwhelming lack of self-confidence. And also - that I am worse than others and I am not suitable for games, because I am not healthy.

It was difficult for me to come out of anesthesia. I could not eat or drink - everything immediately came out back. This caused laughter from those who did not experience such problems. And I closed myself even more. Finally I went home. My first panic attack happened right before going to school. The upcoming meeting with friends and classmates, whom I was embarrassed to tell about what had happened to me, plunged me into inexplicable horror. I was afraid that they would find out, and I convinced myself that I needed to do everything in my power to make a good impression on them. So I developed a clear social phobia.

Evie Hammond, the heroine of the film "V for Vendetta", conquers her fear of death by experiencing and accepting it. People suffering from social phobia must conquer their fear daily. This groundhog day turns into years and decades, becoming part of our terrifying reality and washing away ideas about a fulfilling life.

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I grew up and my fear grew with me. I began to stutter and had as little of myself as possible. All around seemed to me fine people without problems. I communicated only with a circle of close friends, most often preferring books to them. If there was a need to communicate with strangers or go somewhere, I refused food and water - nausea rolled from fear and I was sure that if I had to eat, I would definitely become ill in the presence of others, and thus I would expose myself to ridicule. I was shaking with fear. Not only in the very moments of communication, but also at night. I woke up with cramps and couldn't sleep.

At the age of 12, I was diagnosed with ADHD. It is the one that is often given to most people with completely different degrees of severity of symptoms and without explaining at all how to treat it and how to live on. I continued to complain of nausea and cramps, and the doctors did nothing but treat me for hundreds of diseases that I did not have. I spent months on examinations in the hospital, treating either the gastrointestinal tract, or allergies, or scoliosis .... Each specialist saw the cause of my ailment precisely in their industry. And not a single doctor even hinted that it would be nice to go to a child psychologist.

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Meanwhile, the years went by. I graduated from high school with a red medal. Then she entered the university on a budget, received two higher educations (both with honors). I weighed 36 kilograms, but the thought of studying occupied me, and I paid less attention to fears. I overcame stuttering by memorizing poems and songs with a clear rhythm, and then reciting/singing them in front of a mirror with expression.

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While studying at the university, fate brought me to interesting person, a psychologist by education, who first opened my eyes to what was happening. "It's not VSD," he said. "It's panic attacks. You're afraid to show your own fear of others. It's brave, but you don't understand it and you destroy yourself." He showed me the techniques of proper breathing and acupuncture points, which can be massaged with PA. And he also advised me to drink Phenibut. I quickly forgot about the techniques (but in vain), but Phenibut settled in my first aid kit for a long time. I was not fully treated by him, but I took one tablet situationally before leaving the house. Thanks to the medicine, I felt more confident, sometimes I could even afford to have a snack with friends in a cafe. He did not save from night cramps, but during the day it became much easier to be among people.

Before the onset of neurosis and depression, Phenibut helped me cope with panic attacks.

When I was in my fifth year, I met Him. A man with whom I wanted to spend, if not eternity, then at least life. Very soon we began to live together (God only knows how much strength it cost me). And at 23, I got pregnant. For the first time, I felt completely happy. And for a while this crazy happiness blocked all my fears. I began to eat normally, because I understood that if people become ill, I can refer to my interesting position and no one will judge. Caring for my daughter, who was born soon, also took a lot of time and thought, but I still (apparently out of habit) avoided going out to people. From the moment of conception until the end of breastfeeding, I refused Phenibut, only occasionally used motherwort tablets, but as you understand, the effect of it was more like a placebo. After the end of feeding, I again returned to the periodic intake of Phenibut for almost 5 years. This was no less facilitated by a change of work and a busy schedule.

In May of this year, the person with whom I had hoped to meet old age left us. The day he ran away, I thought I heard my heart shatter into pieces. I never received an answer as to why this happened. She blamed herself for everything. Then the daughter broke her arm in kindergarten, and we spent a month and a half on sick leave. I was tormented by the conscience that they were waiting at work, that I had to spend money left for a rainy day ... How to pay for food and an apartment when the money runs out? But there was nowhere to wait for support ... And I broke down.

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Stopped eating and drinking. I couldn't sleep, nothing helped. I was shaking day and night. I have earned a full-fledged neurosis with depression. She lay all day, staring at one point, there was no strength and desire to clean, cook ... It became unbearable even to go to the grocery store. I lost 10 kilograms in three months, my weight was approaching 40 kg with a height of 160 cm. I was enslaved by the fear that I would go crazy and die of exhaustion, and my daughter would be left all alone. I hated myself. But she couldn't help it. I didn't want to live.

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At work, I took a vacation at my own expense, the management did not mind. On the Internet, I read that it would be nice to consult a psychotherapist. And signed up at random to one of the local doctors. It turned out to be an elderly woman who (as I now understand) was not my doctor at all. Giving a minimum of information in an urgent and indifferent form, she prescribed the antidepressant "Azafen" for me, and when, after a month of taking it, I complained of severe headaches, I replaced it with the antidepressant "Fevarin". The drug cost almost one and a half thousand rubles. And as bad as after taking it, I never felt myself in my life. Having decided that I did not want to be a guinea pig, I did not visit this psychotherapist again.

I tried several antidepressants, but personally Siozam (citalopram) was the best for me.

I have addressed to the paid neuropathologist. She prescribed me a course of maintenance therapy:

Taking B vitamins (I used Pentovit and then Doppelherz Magnesium + B vitamins)

Injections "Mexidol" and "Elkar"

Massage of the cervical-collar zone using the Kuznetsov applicator

The course of taking "Phenibut"

As long as possible walks in the fresh air (to the point of physical exhaustion!) And the obligatory intake of a relaxing hot bath in the evening.

I started treatment and really felt a little relief. Went to work. In the mornings, I forced myself to walk to the office, but since my body was suffering from exhaustion (I ate very little once a day - in the evening, when I felt that I was safe and did not have to go anywhere else), I soon abandoned these exhausting walks. I still slept for 3-4 hours, and the load at work required a lot of attention and energy. I felt my intellect weaken. The simplest calculations and operations that I used to click like nuts were given with difficulty. I scoured the forums up and down until I finally came to terms with the idea that a key link was missing from my treatment regimen.

My daughter needs a healthy mother, she has no one else. And I again decided to try my luck by signing up with another psychotherapist. This time I got lucky. I met "my" doctor. From her, I not only received participation and words of support, but most importantly, hope. She explained to me that the panic attacks that haunt me are treatable and are the result of insufficient production of serotonin, or simply put, the hormone of happiness. The onset of depression is also a typical symptom of this. As you understand, I had already read this information earlier on the Internet, so the question was a kind of test for compatibility with a doctor, because, having learned from the bitter experience of communicating with a previous psychotherapist, I was looking for a doctor who could really find me proper treatment. So I was assigned Siozam.

Antidepressant "Siozam" review

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The active substance of the drug is citalopram. There are other antidepressants based on it on the Russian market, but Siozam is one of the most inexpensive. Now a pack of 20 tablets costs me 320-370 rubles (depending on the pharmacy). I want to warn you that all drugs based on citalopram are dispensed only by prescription. You can apply them only if you received a direct appointment from the doctor, no amateur performance! An excess of serotonin in a healthy body can cause so-called hypomania. In simple terms, this is the same feeling when the sea is knee-deep. Hyperactivity and reckless behavior caused by it, as a rule, lead to rather disastrous consequences.

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My diagnosis: anxiety-depressive disorder with panic attacks. The psychotherapist prescribed me the minimum therapeutic dose - 1 tablet of Siozam per day. I want to note that it is necessary to go out to take the whole pill slowly, gradually increasing the dose. The fact is that during the period of adaptation to the antidepressant, the state of health can deteriorate greatly and the disease worsens. Therefore, many people quit treatment at the initial stages, afraid of side effects. In my case, anxiety just went through the roof. But even before I started taking the drug, I lived in hell, so I didn’t see a way back for myself. It is very important not to give up, even if the hope for recovery at these moments is weaker than ever, and you want to send everything to hell. Very soon, the condition will normalize, and you will again feel like a man. And it's worth it.

For cover, I was prescribed minimal doses of the daytime tranquilizer Atarax and the neuroleptic Teraligen at night. The doctor recommended that I start taking Siozam with ¼ tablets, but bearing in mind the experience with Fevarin, in the first week I drank 1/8. As soon as my health stabilized, I again added 1/8, gradually reaching the dose I needed in a whole tablet. No one stood over my soul and did not drive me with sticks, I minimally increased the doses in a calm mode for myself, having spent 1.5 months to reach the therapeutic dose. Every week I visited a psychotherapist, reporting on my well-being.

While there was no appetite, the doctor recommended that I use the Nutrison Nutridrink enteral mixture. I mixed it with baby applesauce or cottage cheese and washed it down with chamomile tea. Thanks to this, I began to have strength, and internally it was calmer that I was not drinking drugs on an empty stomach. Soon I was surprised to find that the nagging feeling of anxiety in my chest disappeared, and after another month I began to sleep.

Today

Now I continue to take 1 tablet of Siozam daily, at the same time. I try to do this with meals, or drink a mini-bottle of Aktimel / Immunel. I have an appetite, and I myself go shopping, I calmly ride public transport. I visit the doctor once every two weeks, now this amount of therapy is enough for me. Along the way, I use the Supradin vitamins and situationally take Atarax and Teraligen in mini-doses at night. Yes, there are kickbacks. In the first months of treatment, there were days when it seemed to me that I had not been treated at all. Just imagine: everything seems to be fine, and then - BAM! - and rolled over. Again in the eyes of horror, and in the thoughts of blackness. Especially strong attacks were during PMS, unaccountable fear went off scale. I did breathing exercises (short inhalation - long exhalation; short inhalation - breath holding - long exhalation), convincing myself that everything is fine, I am healthy and this is only a temporary deterioration in well-being. I am being treated, which means that tomorrow I will definitely feel better.

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Yesterday I laughed for the first time. Sincerely, as before. Do you understand how great it is? Feel real pure joy, sonorous and filling you from the inside. Now I know for sure that, albeit with small, but confident steps, I am moving towards the intended goal. It only takes time.

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I am not advocating anyone to be treated with this particular drug or antidepressants in general. Yes, and I want to warn you that it will not be possible to defeat a phobia with pills alone. You need to change the way you think, and this can take years. But if you come to an abyss, don't look down. Turn back and fight, if not for yourself, then for those who need you. One day you too will wake up and realize that fear and pain no longer have power over the heart. They have turned into Christmas decorations, a fleeting ringing reminder of their presence when the wind blows.

If my story was useful and gave hope to at least one person, then everything was not in vain. I am writing this wishing health and strength to everyone who reads my lines. Happy New Year, friends!

Phobias are quite widely represented among patients, they have their own boundaries and clinical variations. Along with such recognized variants of phobias as social phobias, nosophobias, specific or isolated phobias, panic disorder, which is classified in both ICD-10 and DSM-4 as anxiety disorders, should also be included in the phobic circle disorders.

Firstly, both the psychopathological and content features of the experiences of patients during a panic attack are more typical for phobias than for anxiety: paroxysmal thanatophobia, cardiophobia, lyssophobia occur, and not anxiety, tension, devoid of a specific content. Nevertheless, the fear in the structure is not obsessive. It's more of an overwhelming fear. But other phobias, traditionally classified as obsessions, are largely, if not for the most part, fears that are not obsessive, but overvalued.

Secondly, they become a source of social phobias and other phobias much more often than the basis of generalized and other protracted anxiety disorders. At the same time, panic attacks lose their independence and act as one of the components of the phobic syndrome.

Modern treatment of phobias

Currently, the methods of treating phobias are quite diverse. The leading place in the treatment of phobias is actually occupied by psychopharmacotherapy. Of the classes of psychotropic drugs, they are in the first position, according to the results of most studies and established therapeutic practice. Followed by and . Application, psychotherapy are methods of treatment of phobias of the first order, which in some cases can be used independently, as monotherapy. This is followed by beta-blockers, which usually play a supportive role in complex treatment, excluding some cases of social and isolated phobias. Practically significant are general vegetostabilizing measures, especially in the earlier stages of phobic disorders.

There are also methods of treatment with limited or controversial effectiveness (laser therapy, acupuncture, the use of thymostabilizers) used as additional in complex therapy, as well as methods of treatment with relatively high efficiency, but rarely used at present, for example, subshock methods.

It is also worth noting that with the advent of their intensive use in the treatment of phobias, including the parenteral administration of high doses of Relanium, began. However, a certain disappointment set in relatively quickly, after which such treatment practically ceased. The effectiveness of tranquilizers was not as high as expected. In addition, the use of tranquilizers has a time limit due to the risk of addiction (the duration of a course of treatment should not exceed four, and sometimes two weeks, according to some studies. The abolition of tranquilizers in most cases is accompanied by an exacerbation or resumption of phobias. As a result, tranquilizers, while maintaining a noticeable place in the treatment of phobias, have lost their dominant positions.Currently, in the treatment of phobias, especially panic disorder, alprazolam, clonazepam, Relanium, phenazepam are mainly used.The latter is very promising due to the lower risk of addiction, according to a number of narcologists, and the emergence of injection forms.

The beginning of the use of ov in anxiety-phobic disorders dates back to the 60s of the last century, when positive results were obtained in the treatment of panic attacks with om. In fact, all or almost all antidepressants, both long known and relatively recent, have been used or are being used for phobias at the present time. Tricyclic antidepressants (TCAs) and irreversible monoamine oxidase inhibitors (MAOIs) were the first to be introduced into the treatment of phobias. The latter, however, are almost never used to correct phobias. The main TCAs (, imipramine and especially clomipramine) are still widely used. With the advent of new groups of antidepressants, selective serotonin reuptake inhibitors (SSRIs), reversible monoamine oxidase inhibitors (RIMAOs), intensive use of these drugs in the treatment of phobic disorders began.

The most significant advantages of imipramine include the availability, reasonable cost of outpatient therapy, the availability of injectable forms, and the possibility of use in children. Disadvantages: the need to use high doses, lower efficiency compared to SSRIs (although the results of the comparison are not entirely unambiguous), insufficient certainty of ideas about the mechanisms of their action in phobias, the frequency and severity of side effects, including anticholinergic ones (tachycardia, extrasystole, arterial hypertension, tremor), which correspond to the somatovegetative manifestations of panic attacks, other phobias and, in some cases, contribute to the strengthening of phobic disorders. it is known that anticholinergic effects occur in every fifth patient with phobias receiving amitriptyline or imipramine.

Clomipramine favorably differs from amitriptyline and imipramine in higher efficiency associated with its pronounced serotonergic activity. The disadvantages inherent in classical TCAs do not apply to tianeptine, a member of the SSOZR group, which is used in a standard daily dose, is well tolerated and seems to be a very promising drug. long-term treatment phobic disorders.

Significant advantages of SSRIs in comparison with classical TCAs:

• higher efficiency;
• the presence of pathogenetic grounds for their appointment;
• lower frequency and severity side effects;
• great potential for long-term use.

However, SSRIs are inferior to TCAs in some respects. First of all, this is a lack of non-medical nature:

• lower current affordability;
• problems of long-term outpatient therapy;
• lack of injectable forms for most drugs;
• inability to use in children and adolescents under 15 years of age (with the exception of).

Daily doses of TCAs used for phobias are quite high and approach those used in the treatment of major depressive episodes. At the same time, the analysis of relevant data on SSRIs only partially confirms the well-known position on the advisability of using low doses of SSRIs in phobias, which are significantly lower than the doses used in severe depression. This is true for fluoxetine, citalopram, fluvoxamine and, to some extent, paroxetine. Daily doses of a and RIMAO (moclobemide), especially often and most successfully used in phobic circle disorders, are close or correspond to the maximum.

To date, the insufficiency of central serotonergic structures in phobias can be considered established, which is usually considered as their main pathogenetic mechanism. This explains the significant efficacy found in many studies in phobias of clomipramine and SSRIs, which increase the concentration of serotonin in intersynaptic spaces.

It is more difficult to explain the effectiveness of amitriptyline and imipramine in relation to phobic symptoms. There is a point of view that if many TCAs can be successfully used in panic disorders, then only clomipramine and SSRIs can be used with obsessions. However, various TCAs began to be used for phobias long before the advent of SSRIs. Amitriptyline and imipramine have a fairly high serotonin reuptake inhibitory ability, not inferior or slightly inferior in this respect to fluvoxamine and paroxetine. In addition, the effectiveness of TCAs may be partly due to their positive effect on associated depressive symptoms associated with phobias. The concept of the essential unity of phobias and depressions should also be taken into account. However, reduce pathogenetic mechanisms phobias to insufficiency of functions of serotonergic structures prematurely. Most likely, the pathogenesis of phobias is more complex, and not all of its links have been established.

The effectiveness of monotherapy for phobias in all groups of antidepressants is relatively high. Compared with amitriptyline and imipramine, the efficacy rates of clomipramine and SSRIs are slightly higher. Pay more attention low rates efficacy of moclobemide. However, when evaluating them, it should be taken into account that moclobemide was tested mainly for social phobias, which are characterized by a special therapeutic resistance. As a result, given the better tolerability of SSRIs, the possibility of using relatively low doses, they show noticeable advantages compared to TCAs. It should be noted that when evaluating the direct effectiveness of antidepressants, the proportion of patients with an improvement in their condition is most often determined. Significant improvement is rarely singled out. Long-term results of treatment of non-psychotic disorders, including phobias, are generally successful when the immediate results of therapy reach a level of significant improvement. Otherwise, the risk of exacerbations and relapses is high. According to various sources, with phobias, it is 30-70%.

The antiphobic activity of specific antidepressants from the SSRI group is usually recognized as the same, which raises some doubts. To clarify this issue, comparative clinical trials of drugs are needed. The effectiveness of various methods of treating phobias has been repeatedly compared: monotherapy, tranquilizers, one psychotherapy and their combinations, with mixed results. However, the complex therapy of phobias has the largest number of supporters. Monotherapy of phobias with antidepressants is becoming increasingly popular; long-term monotherapy with tranquilizers should not be carried out at all due to the high risk of addiction. Psychotherapy as the only way to correct phobias is used relatively often.

Indications for monotherapy with antidepressants are very limited. These are isolated phobias, monosymptomatic variants of agoraphobia, nosophobia, social phobia, and those cases of agoraphobia, social phobia, when the degree of generalization of pathological fears and the degree of avoidant behavior are low and phobias do not show a tendency to progress. In addition, antidepressant monotherapy can be used as a long-term maintenance treatment after a successful course of active complex therapy. For social phobias and isolated phobias that occur in a single, relatively rare and predictable situation, single doses of beta-blockers or alprazolam may be sufficient before the occurrence of such a situation.

With a combination of different phobias, the presence of several frightening situations with incomplete avoidance, a combination of antidepressants and psychotherapeutic measures is indicated. With generalized phobias with complete avoidance, maladaptive personality, frequent and pronounced panic attacks, chronic or recurrent course of phobic disorders, the presence of a tendency to their progression, the endogenous nature of phobic symptoms, the most active complex therapy, which is advisable to start with the appointment of tranquilizers, including parenterally. Further, antidepressants, psychotherapy, vegetative stabilizing measures are included in the treatment. A month later, tranquilizers are replaced with antipsychotic behavior correctors or small or moderate doses of neuroleptic antipsychotics.

I.I. Sergeev
Department of Psychiatry and Medical Psychology
Russian State Medical University,
Moscow

Before discussing the role of antidepressants in the treatment of phobias, it is advisable to dwell on the boundaries of phobic disorders and their clinical options(table).

From our point of view, along with such recognized variants of phobias as agoraphobia, social phobias, nosophobia, specific (isolated) phobias, panic disorder, which is classified both in ICD-10 and B5M-4 as anxiety disorders, should also be included in the phobic circle disorders. disorders.

Firstly, both the psychopathological and content features of the experiences of patients during a panic attack are more typical for phobias than for anxiety: paroxysmal thanatophobia, cardiophobia, lyssophobia occur, and not anxiety, tension, devoid of a specific content. True, fear in the structure of panic attacks is not obsessive. It's more of an overwhelming fear. But other phobias, traditionally classified as obsessions, to a large extent, if not for the most part, according to the data of our team (L.G. Borodina, 1996; A.A. Shmilovich, 1999), are fears that are not obsessive, but overvalued.

Secondly, panic attacks become a source of agoraphobia, social phobias and other phobias much more often than the basis of generalized and other protracted anxiety disorders. At the same time, panic attacks lose their independence and act as one of the components of the phobic syndrome.

Means and methods of treatment of phobias are diverse. In table. they are, if possible, arranged in descending order of their importance at the present time.

The leading place in the treatment of phobias is actually occupied by psychopharmacotherapy. Of the classes of psychotropic drugs, antidepressants are in the first position (considering the results of most studies and established therapeutic practice). This is followed by tranquilizers and antipsychotics.

Psychotherapy could claim a leading position if there were a sufficient number of qualified psychotherapists, as evidenced by comparative studies (for example, A. B. Smulevich et al., 1998).

The use of antidepressants, psychotherapy are methods of treating first-order phobias, which in some cases can be used independently, as monotherapy.

Practically significant are general vegetostabilizing measures, especially in the earlier stages of phobic disorders.

At the end of the table lists the methods of treatment with limited or controversial effectiveness (laser therapy, acupuncture, the use of thymostabilizers) used as additional in complex therapy, as well as methods of treatment with relatively high efficiency, but rarely used at present (subshock methods).

Without delving too deeply into the history of the issue, it should be noted that with the advent of tranquilizers, their intensive use in the treatment of phobias began, including the parenteral administration of high doses of Relanium. However, a certain disappointment set in relatively quickly (Table 1).

The effectiveness of tranquilizers was not as high as expected. In addition, the use of tranquilizers has time limits due to the risk of addiction (the duration of course treatment with tranquilizers should not exceed 4 or even 2 weeks, according to foreign data). The abolition of tranquilizers in most cases is accompanied by an exacerbation or resumption of phobias. As a result, tranquilizers, having retained a prominent place in the treatment of phobias, have lost their dominant position. Currently, in the treatment of phobias, especially panic disorder, alprazolam, clonazepam, Relanium, phenazepam are mainly used. The latter is very promising due to the lower risk of addiction, according to a number of narcologists, and the emergence of an injectable form.

The beginning of the use of antidepressants for phobic anxiety disorders dates back to 1962, when D.E. Klein reported on positive results treatment of panic attacks with imipramine.

In fact, all or almost all antidepressants, both long known and relatively recent, have been used or are being used for phobias at the present time.

Tricyclic antidepressants (TCAs) and irreversible monoamine oxidase inhibitors (MAOIs) were the first to be introduced into the treatment of phobias. The latter, as well as four-cyclic antidepressants, in Table. are not presented, since at present they are almost not used for the correction of phobias. The main TCAs (amitriptyline, imipramine, and especially clomipramine) are still widely used.

With the advent of new groups of antidepressants - selective serotonin reuptake inhibitors (SSRIs), reversible monoamine oxidase inhibitors (RIMAOs) - intensive use of these drugs in the treatment of phobic disorders began. A kind of competition has emerged between TCAs and newer antidepressants. Each group of antidepressants has its own advantages and disadvantages in terms of the treatment of phobias (Table ).

The most significant advantages of amitriptyline and imipramine include the availability, reasonable cost of outpatient therapy, the availability of injectable forms, and the possibility of use in children. Disadvantages: the need to use high doses, lower efficiency compared to SSRIs (although the results of the comparison are not entirely unambiguous), insufficient certainty of ideas about the mechanisms of their action in phobias, the frequency and severity of side effects, including anticholinergic ones (tachycardia, extrasystole, arterial hypertension, tremor), which correspond to the somatovegetative manifestations of panic attacks, other phobias and, in some cases, contribute to the strengthening of phobic disorders. According to our data, anticholinergic effects occur in every fifth patient with phobias receiving amitriptyline or imipramine (L.G. Borodina, 1996).

Clomipramine favorably differs from amitriptyline and imipramine in higher efficiency associated with its pronounced serotonergic activity.

The disadvantages inherent in classical TCAs do not apply to tianeptine, a member of the SSOZS group, which is used in a standard daily dose, is well tolerated and seems to be a very promising long-term treatment for phobic disorders. We have a number of observations in which tianeptine has been successfully used for a long time in agoraphobia.

Significant advantages of SSRIs in comparison with classical TCAs are higher efficiency, the presence of pathogenetic grounds for their appointment, lower frequency and severity of side effects and, accordingly, greater possibilities for long-term use. However, SSRIs are inferior to TCAs in some respects. First of all, this is a disadvantage of a non-medical nature - the current lower economic availability and the associated problems of long-term outpatient therapy, the absence of injectable forms for most drugs and the inability to use in children and adolescents under 15 years of age (with the exception of sertraline).

The advantages and disadvantages of RIMAOs (moclobemide) are generally consistent with those noted for SSRIs.

In table. presents the most used or optimal, according to those who compared the effectiveness of different dosages, daily doses of antidepressants used in the monotherapy of phobias, in comparison with the average and maximum doses used in depression (from the literature and partly our own data).

Daily doses of TCAs used for phobias are quite high and approach those used in the treatment of major depressive episodes.

At the same time, the analysis of relevant data on SSRIs only partially confirms the well-known position on the advisability of using low doses of SSRIs for phobias, which are significantly lower than the doses used for severe depression. This is true for fluoxetine, citalopram, fluvoxamine and, to some extent, paroxetine. Daily doses of sertraline and RIMAO (moclobemide), especially often and most successfully used in phobic circle disorders, are close or correspond to the maximum.

To date, the insufficiency of central serotonergic structures in phobias can be considered established, which is usually considered as their main pathogenetic mechanism. This explains the significant efficacy found in many studies in phobias of clomipramine and SSRIs, which increase the concentration of serotonin in the intersynaptic spaces.

It is more difficult to explain the effectiveness of amitriptyline and imipramine in relation to phobic symptoms. There is a point of view that if many TCAs can be successfully used in panic disorders, then only clomipramine and SSRIs can be used with obsessions. However, various TCAs began to be used for phobias long before the advent of SSRIs. The results of their application, according to most publications and their own data, are generally positive, which becomes, at least in part, understandable given the data of M.Kh. Leider (1994) on the inhibitory ability of some antidepressants at the experimental level (Table).

From these data it follows that amitriptyline and imipramine have a sufficiently high inhibitory ability of serotonin reuptake, not inferior or slightly inferior in this respect to fluvoxamine and paroxetine.

In addition, the effectiveness of TCAs may be partly due to their positive effect on associated depressive symptoms associated with phobias. One should also take into account the concept of the essential unity of phobias and depressions, which is actively developed in Russian psychiatry by O.P. Vertrogradova (1998), who considers phobias as "a special equivalent of depression."

In our opinion, today it is premature to reduce the pathogenetic mechanisms of phobias to the insufficiency of the functions of serotonergic structures. Most likely, the pathogenesis of phobias is more complex, and not all of its links have been established.

In table. the literature data and partially the data of our team are presented in a generalized form on the results of short-term and long-term monotherapy of phobias with various groups of antidepressants. The lowest and highest performance scores are excluded.

The effectiveness of monotherapy for phobias in all groups of antidepressants is relatively high. Compared with amitriptyline and imipramine, the efficacy rates of clomipramine and SSRIs are slightly higher. Pay attention to the lower efficacy of moclobemide. However, when evaluating them, it should be taken into account that moclobemide was tested mainly for social phobias, which are characterized by a special therapeutic resistance.

As a result, given the better tolerability of SSRIs, the possibility of using relatively low doses, they show noticeable advantages compared to TCAs. It should be noted that when evaluating the direct effectiveness of antidepressants, most often, as follows from Table. , the proportion of patients with improvement is determined. Significant improvement is rarely singled out. According to our own observations, the long-term results of the treatment of non-psychotic disorders, including phobias, are generally successful in cases where the immediate results of therapy reach a level of significant improvement. Otherwise, the risk of exacerbations and relapses is high. According to various sources, with phobias, it is 30-70%.

The antiphobic activity of specific antidepressants from the SSRI group is usually recognized as the same, which raises some doubts. To clarify this issue, comparative clinical trials of drugs are needed.

The effectiveness of various methods of treating phobias has been repeatedly compared: monotherapy with antidepressants, tranquilizers, one psychotherapy and their combinations, with mixed results. However, the complex therapy of phobias has the largest number of supporters.

Monotherapy of phobias with antidepressants is becoming increasingly popular, but in practice in our country it is carried out less often and mainly on an outpatient basis. Long-term monotherapy with tranquilizers should not be carried out at all due to the high risk of addiction. Psychotherapy as the only way to correct phobias is used relatively often.

Indications for the use of antidepressants in the framework of monotherapy and complex therapy of phobias (according to our own data) are presented in Table. .

Indications for monotherapy with antidepressants are very limited. These are isolated phobias, monosymptomatic variants of agoraphobia, nosophobia, social phobia, and those cases of agoraphobia, social phobia, when the degree of generalization of pathological fears and the degree of avoidant behavior are low and phobias do not show a tendency to progress. In addition, antidepressant monotherapy can be used as a long-term maintenance treatment after a successful course of active complex therapy. For social phobias and isolated phobias that occur in a single, relatively rare and predictable situation, single doses of beta-blockers or alprazolam may be sufficient before the occurrence of such a situation.

With a combination of different phobias, the presence of several confusing situations with incomplete avoidance, a combination of antidepressants and psychotherapeutic measures is indicated.

With generalized phobias with complete avoidance, maladaptive personality, frequent and severe panic attacks, chronic or recurrent course of phobic disorders, the presence of a tendency to their progression, the endogenous nature of phobic symptoms, the most active complex therapy is shown, which is advisable to start with the appointment of tranquilizers, including parenterally . Further, antidepressants, psychotherapy, vegetative stabilizing measures are included in the treatment. A month later, tranquilizers are replaced with antipsychotic behavior correctors or small or moderate doses of neuroleptic antipsychotics.

Panic attacks often have a specific biological basis, being essentially vegetative crises with a phobic component (due to cerebro-organic, endocrine, infectious-allergic or other visceral pathology). In such cases, the correction of the somatic basis of vegetative paroxysms is of particular importance.

Phobic disorders in most cases require long-term (at least 6-12 months) treatment with very slow drug withdrawal.

As a result, antidepressants today occupy a leading position in the treatment of phobias, either in the form of monotherapy or as the main component of complex treatment.

Please note that this article is for informational purposes only. There is no specific information on which pills to take and which not to take. Perhaps it will appear in the future. If you don’t want to miss it, you can subscribe to updates in any convenient way (by mail, by entering VKontakte group, as well as via RSS or via Twitter). Now let's move on to the article itself.

There are several various types pills for social phobia. The main ones include:

• benzodiazepines
• monoamine oxidase inhibitors (MAOIs)
• beta blockers
• selective serotonin reuptake inhibitors (SSRIs)
• selective serotonin and norepinephrine reuptake inhibitors (SSRIs)

Each type of social anxiety pill has its own advantages and disadvantages, depending on your specific situation.

Benzodiazepines

Description

Benzodiazepines relieve symptoms of anxiety, which is achieved by influencing the central nervous system. Benzodiazepines can be sedating and addictive, so they are preferred not to be used as the primary drug for treatment.

List of drugs

• Ativan (lorazepam)
• Valium (diazepam)
• Xanax (alprazolam)
• Klonopin (clonazepam)

Beta blockers

Description

Beta-blockers for social phobia are usually taken some time before events that may cause anxiety. Beta-blockers are useful in situations requiring mental sharpness, as they do not have adverse effects on cognition, which is also true for benzodiazepines.

List of drugs

• Anaprilin (propranolol)
• Tenormin (atenolol)

Monoamine oxidase inhibitors (MAOIs)

Description

MAOIs were once considered the most effective pills for social anxiety, however, they carry the risk of serious side effects. At present, MAOIs are not commonly used unless there is reason to believe that they will be more effective than other drugs.

List of drugs

• Nardil (phenelzine)
• Transamine (tranylcypromine)
• Marplan (isocarboxazid)

Selective serotonin reuptake inhibitors (SSRIs)

Description

SSRIs are by far the main weapon in the fight against social phobia (thanks to insignificant side effects and high efficiency)

List of drugs

• Citalopram (Cipramil)
• Escitalopram (Cipralex)
• Fluoxetine (Prozac)
• fluvoxamine (fevarin)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

Selective serotonin and norepinephrine reuptake inhibitors (SSRIs)

SNRIs are antidepressants used to treat anxiety.

List of drugs

• Velafax MV (venlafaxine)
• Duloxetine

Other anti-anxiety pills

List of drugs

• Atarax (hydroxyzine)
• Buspirone (buspirone hydrochloride)

The article was prepared with the help of the book "Clinical Handbook of Psychotropic Drugs"

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This article will help you understand whether medications can help get rid of social phobia and when to take them. You will learn about the benefits and harms pharmacological preparations in the treatment of social phobia. In addition, I will describe an effective technique for dealing with social fears.

What does it take to make medication really justified?

Social phobia manifests itself in some typical physiological and psychological reactions: trembling in the body, excessive sweating, reddening of the face, anxiety, depression, apathy, etc. Just for fast elimination similar undesirable consequences of social phobia and drugs are used.

At the same time, there is one important clarification: in order for medication to be truly effective, it must be accompanied by non-pharmacological methods of treatment (cognitive-behavioral therapy, NLP, Gestalt therapy ...). This is true in all 100% cases when it comes to the treatment of social phobia.

Without a successful psychological study of fears, taking medication is absolutely unjustified. In this case, a person taking, for example, antidepressants, will be like a person who is trying to drown his grief in alcohol: while alcohol is working, the person is “well” - he forgets about his problems and “has fun”.

When the action of alcohol ends, the person returns to reality, and often finds himself even more unhappy than initially.

Of course, you can not equate alcohol with drugs, but, nevertheless, they have one thing in common: if a person taking antidepressants does not work to learn, along with their use, to stop running away from situations that frighten him - after finishing the course of taking antidepressants, he, as in the case of alcohol intoxication, will return to where he started.

The biggest disadvantage of drugs in the treatment of social phobia?

Imagine that you are a gardener, and your trees are sick with some kind of filth, because of which all their leaves have turned yellow. You call a specialist and ask him to cure the trees. And he, instead of understanding the causes of the disease and eliminating them, simply takes and paints the yellowed leaves in green color... “Voila!”, he says to you ... But time passes, the paint comes off the leaves, and appearance trees again begins to correspond to their internal state ...

This analogy illustrates well what happens in most of the cases I know of when psychotherapists prescribed drugs to patients ... doctors, just like our unfortunate tree specialist, followed the path of least resistance.

Their logic is this: if there are no symptoms, there is no disease. They attribute to a person drugs that remove the physiological and psychological manifestations of social phobia, and do not particularly deal with the real study of the problem. Naturally, we are not talking now about 100% of psychotherapists. I'm just sharing the experience of the guys with whom I worked personally.

What is needed for a real study of social phobia?

For a real study of social phobia, it is necessary first of all to work out the “root” - the negative beliefs of a person. This study should be accompanied by exercises aimed at developing a calm and confident behavior in situations that cause fear (panic). In conclusion, in order to build warm relationships with people, you need to learn the main principles of attraction between them and the rules of communication, which, unfortunately, most people do not realize (which is why there are so many scandals, quarrels and misunderstandings between people).

Unfortunately, for some reason, not every therapist is willing (or able) to offer such deep processing. Therefore, before you start working with any specialist, if he wants to attribute you to taking medications, you should ask in what direction your further work will be built.

If a specialist does not offer a comprehensive study of fears and recommends limiting himself to drugs (or does not give a clear description of further work), it is better to think three times before dealing with him.

Do not forget that drug therapy can only be an addition, and not the basis of the treatment of social phobia.

basis effective treatment there was and still is a therapy aimed at working through fears, flawed beliefs, and acquiring the necessary social skills.

By the way, in most cases drug therapy not needed at all (and maybe even harmful, given the presence of side effects) ...

My mailing list, which you can subscribe to at the top of this page, is dedicated to working out flawed beliefs and acquiring the necessary skills.