The question concerns a man with a diagnosis of therapy-resistant social phobia. His medication unt

Fråga: The question concerns a man with a diagnosis of therapy-resistant social phobia. His medication until now has been diazepam (Stesolid) 80 mg qd, a dose which has been decreased to 40 mg with the addition of clonazepam (Iktovril) 8 mg qd. The therapy has had no effect. The questioner plans to add phenelzine (Nardil) to this regimen, and asks whether there are any potential negative effects for the patient concerned. The licence to use phenelzine has been approved.

Sammanfattning: There is no clear evidence ofany direct interactions between MAO inhibitors and benzodiazepines. Considering the adverse effects of the old generation of MAO inhibitors, the use of moclobemide might be preferrable.

Svar: Regarding the question of interactions between benzodiazepines and MAO inhibitors, there are only two case reports suggesting that there might be a connection between the development of oedema and the use of the drugs mentioned (1,2). These suggestions are based on single cases, both with patients subject to treatment with several other psychotropic drugs. The mode of action is, however, unknown.

Concerning the more general question of therapy of social phobia, there is evidence (3) that moclobemide (Aurorix) is nearly as effective as phenelzine, and is tolerated better by the patients.