Expert: Dr Alan Galbraith - 9/27/2009

Question
In response to your previous comment on litigation re: Nardil, there is the Mt. Zion case in NYC. Another question re: Nardil. Does it seem to potentiate the effects of nicotine, or reduce the effects. The literature on smoking and MAO seems confusing to me.

Another question. The esteemed Australian (and Tennessean) Dr. Barry Nurcombe has documented some effects of childhood sexual abuse including later dysfunction. What might be the best short term anxiolytic or other medication which would be best for women (or men) suffering disruptive emotionality in intimate situations, yet who desire to proceed onward with sexual activity (perhaps while dealing with the issue more substantively in therapy).

Damon LaBarbera, PhD
Psychologist

Answer
Dear Damon

I have done a Medline search for possible interactions between nicotine and phenelzine and basically have come up with nothing of any relevance. I very much doubt if there is a significant interaction as it would have been noticed years ago when smoking was much more common and phenelzine was much more frequently prescribed. Theoretically, I suppose there could be a potential for an interaction since nicotine has some sympathomimetic properties. However, a drop in blood pressure is an immediate effect of smoking rather than an increase so they would tend to cancel each other out here. In my opinion the longterm effect of smoking causing an increase in BP would not be a factor worth considering in any potential interaction.  (Hope this makes sense to you?)

Re your second question, a psychiatrist (including Prof Nurcombe) would perhaps be best consulted but I would think some of the newer antidepressants with anxiolytic properties eg duloxetine would be best. I tend to be anti the use of benzos for most purposes even short term and the main other anxiolytic, buspirone is of doubtful value in most instances. I am very much in agreement with Prof Nurcombe and your suggestion in parenthesis.

Regards

Alan Galbraith