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Does Flomax help with shy bladder?

Alpha-adrenergic blockers (Hytrin, Flomax)- These drugs lower your blood pressure. They relax the smooth muscles of the prostate and bladder neck and may or may not help people with paruresis. They are commonly prescribed for BPH (benign prostatic hypertrophy).

paruresis.org - Drug Treatments for Paruresis Information

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Antidrepessants

Antidrepessants – The antidepressants cause profound and little-understood changes in brain chemistry. Their therapeutic benefits for depression are notoriously idiosyncratic: what works for one person may make another’s condition worse. This is a complex subject which cannot be properly covered here. IPA has reports from a number of contributors who say antidepressants have helped their BB, particularly the SSRI class of these drugs. Others say they have not helped at all. If you are tempted by this route (particularly if you suffer from depression as well as BB) you should discuss all your options in depth with a doctor, preferably a good psychiatrist.

The antidepressants fall into four main categories:

1. Tricyclic antidepressants: these medications are commonly referred to as TCAs, and represent the oldest class of antidepressants.Â As such, they have a number of side effects which need to be taken into account.Â These include low blood pressure (due to alpha blockade), anticholinergic effects (which could aggravate the symptoms of paruresis), sedation (though this does not apply to all), cardiac arrhythmias (it is recommended to obtain a baseline EKG before starting TCAs to rule out a prolonged QT interval, which could predispose to arrhythmias), in addition to others.

Examples: amitriptyline, doxepin, clomipramine, protriptyline, nortriptyline.

2. Monoamine oxidase inhibitors (“MAOIs” or “MAO inhibitors”): Dangerous, even lethal, especially in combination with other drugs (particularly other antidepressants which act to increase levels of serotonin, a combination which could lead to a very dangerous clinical picture called serotonin syndrome) and even certain foodstuffs (there is a very long list of foods which, in combination with MAOIs, can lead to a hypertensive crisis due to their tyramine content). It is rarer to see physicians prescribe these medications nowadays due to the potential dangers. Antidepressants in this category are thought by one or two contributors to have helped their paruresis. Be aware, however, that these dangerous drugs to be used ONLY with active medical supervision. Some drugs in this class been clinically proven to reduce social anxiety for some people. Nardil is interesting though. It has been helpful for some social phobias, like test taking and public speaking and there are some mixed reports in the scientific literature with mixed claims concerning paruresis. There is one report that a related drug, moclobomide, a reversible monoamine oxidase inhibitor (Nardil is not reversible) has been reported to help paruresis. 3. Selective serotonin reuptake inhibitors (SSRIs): Prozac is the most famous example. SSRIs function by interfering with the availability in the brain of a fundamental neurotransmitter, serotonin. They are all the rage these days and are thought to have fewer hazards and side-effects than the other antidepressants. However, the full list of side effects and contraindications for Prozac alone runs to 12 pages. Some SSRIs have been clinically proven to reduce social anxiety for some people. One SSRI that many people with paruresis report good results with is Paxil (though it must be emphasized that there are differences in receptor profiles between the different SSRIs, and Paxil has actually been found to be the most anticholinergic of the class; thus, while potentially decreasing anxiety, it may promote urinary retention). Trade names: Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline), Lexapro (escitalopram), Celexa (citalopram), Luvox (fluvoxamine) (incomplete list)

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Advantages: Despite many possible side effects, most are minimal or can be addressed by changes in dosage or medication. For most people, SSRI’s are not habit-forming. It is possible to stop using these drugs after a long-term dosage schedule, especially if treatment includes cognitive-behavior therapy, support group work, or other forms of self-help work. There is no consensus regarding the optimal time of use for these medications, and usage should always be coordinated with a physician. Disadvantages: Side effects can be significant for some people. Cost of long-term use can be significant. Some have a genetic makeup that renders these drugs ineffective. Getting off of the drug can be difficult – one should not abruptly discontinue these medications, as some of them can lead to very uncomfortable withdrawal symptoms. Side effects: Major ones include: suicidal thoughts or behavior, especially at the start of treatment or when dosage is changed; stomach or intestinal bleeding; an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); irregular heartbeat; low blood pressure (dizziness, weakness); high blood pressure (severe headache, blurred vision); unusual bleeding or bruising; fever or chills; headache; tremor, nervousness, or anxiety; nausea, diarrhea, dry mouth, or changes in appetite or weight (gastrointestinal side effects are the most frequently experienced); sleepiness or insomnia; sexual side effects (these can occur in around 40% of patients). This is an incomplete list; check each drug’s product insert for more information. SSRIs must be used with caution in children and adolescents. Below is an example of the “black box” warning that appears on the Effexor XR (an SNRI) product insert. Similar warnings appear on all SSRI’s: Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of Effexor XR or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Effexor XR is not approved for use in pediatric patients. (See WARNINGS and PRECAUTIONS, Pediatric Use.) Pooled analyses of short-term (4 to 16 weeks) placebo-controlled trials of 9 antidepressant drugs (SSRIs and others) in children and adolescents with major depressive disorder (MDD), obsessive compulsive disorder (OCD), or other psychiatric disorders (a total of 24 trials involving over 4400 patients) have revealed a greater risk of adverse events representing suicidal thinking or behavior (suicidality) during the first few months of treatment in those receiving antidepressants. The average risk of such events in patients receiving antidepressants was 4%, twice the placebo risk of 2%. No suicides occurred in these trials. For several SSRIs, hyponatremia (low sodium level) has been reported (this is due to a syndrome termed SIADH â€“ syndrome of inappropriate antidiuretic hormone secretion); this is usually observed in elderly patients, though it can occur at any age. A person with paruresis doing fluid loading for graduated exposure treatment needs to be particularly careful to include enough sodium in their fluid intake to avoid dangerously low sodium levels which could lead to a life-threatening condition.

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4. Serotonin and norepinephrine reuptake inhibitors (SNRIs): the 2 prototypes of this class are duloxetine (Cymbalta) and venlafaxine (Effexor). They have dual action on increasing the levels of norepinephrine and serotonin (and, at higher levels, of dopamine). They have similar efficacy to the other classes of antidepressants and usually exert their anxiolytic effect at higher doses (as the other classes do). Advantages: Cymbalta has been recognized as an effective adjunct in patients who experience concomitant neuropathic pain in addition to their psychiatric symptoms. These drugs are usually well tolerated and are becoming more popular. Disadvantages: the side effect profile does not differ significantly from the list outlined above for the SSRIs. Since there is an increase in norepinephrine levels, a dose-related increase in diastolic blood pressure has been observed, and should be monitored. Also, a withdrawal syndrome from venlafaxine has been described which can be very unpleasant. Physiologically, norepinephrine can act to increase contraction of the smooth urethral sphincter, therefore there is some risk associated with using these medications in terms of aggravating paruresis.

paruresis.org - Drug Treatments for Paruresis Information

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