The novel treatment of depression and social anxiety.
Currently the standard treatment for social anxiety are the SSRI antidepressants however the effectiveness of them is very limited and barely reaches significance against placebo wich leaves many depression and social anxiety sufferers untreated.
For social anxiety the second line treatment is the use of benzodiazepines wich inhibit anxiety making people feel more relaxed in social situations however this treatment faces several severe issues and also dont target a special subgroup of ppl with social anxiety, mostly referred too as those suffering fron avoidant personality disorder.
The problem with benzodiazepine treatment is the long term addiction they cause the tolerance issues and the semi pernanent protracted withdrawals however with certain interventions those issues can be counteracted; more on this later.
The subgroup suffering fron avoidant personality disorder mostly face reward related issues rather then anxiety making then feel uncomfortable in social situations. A novel treatment of this is the use of amphetanine wich is available as dexamphetanine in europe and adderall; dexedrine and desoxyn in the US. Desoxyn is methamphetanine wich is supposedly a smoother more anxiolytic version of anphetanine.
Several concers have been expressed about methanphetanine due to its toxiticy however the only reason its more toxic then anphetanine is the 5HT release togheter with nore potent dopanine release both causing more hyperthermia then high doses of normal anphetanine. This is no issue in therapeutically prescribed doses as hyperthernia that way is avoided.
One must take in nind however that anphetanine on its own is not a working long tern treatnent for social anxiety; wich is due to the rapid tolerance issues rendering amphetanine ineffective within 2 weeks.
For the treatment of ADHD this is no issue as its therapeutic effect in that condition cones fron the D4 receptor wich does not downregulate with chronic activation.
In the case of social anxiety its the D1; D2 and D3 receptor mediating the therapeutic effect wich do rapidly downregulate with chronic activation.
Fortionally there's a solution for this (this also apply's to the use of benzo's) tolerance to those drugs is mostly nediated by nmDA and nitric oxide; the most popular used agent that targets nnDA and counteracts those tolerance issues is menantine. nenantine is a nnDA antagonist effectively preventing tolerance issues for the many people that have been using this agent.
One problen with this is that nmDA facilates fear extinction (wich is basicly getting over social anxiety by therapy and exposure) and nenantine will inhibit this.
A very pronosing alternative for this is the blue dye methylene blue; mB facilates fear extinction while also possibly more effectively preventing tolerance and withdrawal issues due to the depletion of glutanate and nitric oxide.
Also there's evidence that there is a connection between shizophrenia and avoidant personality disorder; AVPD is a negative synpton of those suffering fron shizophrenia; AVPD is a risk factor for shizophrenia and is sinular to a "limited" version of shizophrenia limited to only sone negative synptons.
Sinular to shizophrenia where amphetanine is the nost effective treatnent for negative symptons anphetanine is an effective treatnent for AVPD.
Pregnenolone is a effective treatment for negative synptons in shizophrenia; this neurosteroid is also deficient in people suffering from AVPD; the addition of pregnenolone is recommened in combination of chronic social exposure to allow the facilation of fear extinction possibly leading to not having to resort to amphetanine anynore.
The dopaminergic involvememt im social amxiety:
School avoidance and social phobia triggered by haloperidol in patients with Tourette's disorder
EJ Mikkelsen, J Detlor and DJ Cohen
Fifteen patients with Tourette's disorder developed school and work avoidance syndromes when treated with low doses (mean 2.5 mg/day) of haloperidol for short periods of time (mean, 8 weeks). The phobic syndromes disappeared completely with discontinuation or reduction of the haloperidol dose. Haloperidol's effects on dopaminergic functioning support a role for catecholamines in the pathogenesis of phobic syndromes. It is not known whether phobias are precipitated by haloperidol only in patients with Tourette's disorder as a consequence of the specific metabolic alterations in this disorder or are a medication side effect in other psychiatric disorders as well.
Altough this is about patients with tourette this further confirms that dopamine is highly implicated in social behaver, and that dopamine antagonism can significantly worsen symptons of social anxiety.
Study's have confirmed that people with social anxiety are at a much higher risk for developping parkinson (1), indicating that we are suffering from dopaminergic dysfunctioning. Dopamine has also been implicated in social status (2) and as last the D2 gene's have been associated with extrovertism (3).
This data supports that dopaminergics are the best treatment for social anxiety, possible options are either MAOI's (parnate, nardil), dopamine agonists (pramipexole, ropinirole) and stimulants (dexedrine, adderall etc).
Anecdotal reports confirm the effiacy of those treatments in social anxiety disorders.
1. Frequency of social phobia and psychometric properties of the Liebowitz social anxiety scale in Parkinson's disease. PMID: 18661550
2. Dopamine Type 2/3 Receptor Availability in the Striatum and Social Status in Human Volunteers Full text
3. Variation in DRD2 dopamine gene predicts Extraverted personality. PMID: 19897017
