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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by tgo on April 13, 2006, at 15:15:44
Hi. I have social anxiety and hardly any energy or motivation and tiredness. Does anyone know of a good med combo for this condition? I take Klonopin as needed and prozac 20 mg, but that doesn't help the lack of energy and tiredness. Anyone else have these conditions and found something that works?
Posted by Phillipa on April 13, 2006, at 15:36:26
In reply to Social anxiety with no energy or motivation, posted by tgo on April 13, 2006, at 15:15:44
Is it helping the social anxiety part? Love Phillipa
Posted by tgo on April 13, 2006, at 19:17:32
In reply to Re: Social anxiety with no energy or motivation » tgo, posted by Phillipa on April 13, 2006, at 15:36:26
Yes, the klonopin helps the anxiety, though not as much as I would like. I'm wondering what I can do to help the lack of energy and lack of motivation.
Posted by MARTY on April 13, 2006, at 19:46:59
In reply to Social anxiety with no energy or motivation, posted by tgo on April 13, 2006, at 15:15:44
Hi Tgo --I have exactly the same symptoms as you: Social phobia, lack of energy/motivation and tiredness.
It has took me 10 years to finally find what fit best those symptoms: They are called MAOI's.
MAOI's is an old familly of antidepressants that would certainly help you. One of them is called NARDIL (Phenelzine sulfate) and is considered to be the all time best med for social phobia (very near is Klonopin/Clonazepam).
One thing that makes Nardil unique is that he doesn't make you sleepy and unmotivated like med that usually treat anxiety. In fact Nardil GIVES you energy and motivation!
Since I'm not an expert and there is a lot to say about MAOI's, I urge you to start a new thread with "Help: What are MAOIs ??" as subject. Many people on this forum are very knowledgeable in those kind of meds.
The details you would want to seeks are; personnal experiences, MAOIs diet restriction and how to 'sold' the MAOI idea to your Pdoc.
Good luck
Since MAOIs could change your life forever, I'm very happy to be the one to introduce them to you ;)Marty
> Hi. I have social anxiety and hardly any energy or motivation and tiredness. Does anyone know of a good med combo for this condition? I take Klonopin as needed and prozac 20 mg, but that doesn't help the lack of energy and tiredness. Anyone else have these conditions and found something that works?
Posted by mattw84 on April 14, 2006, at 0:02:08
In reply to Re: Social anxiety with no energy or motivation » tgo, posted by MARTY on April 13, 2006, at 19:46:59
Tgo,
In spite (and no offense intended!) MAOIs are a pretty drastic step as far as meds are concerned. You might have more luck with something like Xanax that has some dopamine agonist activity rather than the Klonopin.
But to give MAOIs fair credit, they are an amazingly effective AD and work very well with anxiety disorders and OCD. From what I have read here the side effects are minimal, but in the real world I have heard some less positive reviews. I think it depends on the person. It may be worth a try though, your mileage may vary.
Posted by Chairman_MAO on April 14, 2006, at 4:43:39
In reply to Social anxiety with no energy or motivation, posted by tgo on April 13, 2006, at 15:15:44
Nardil + Dexedrine turned literally and unequivocally turned my life around.
Posted by MARTY on April 14, 2006, at 8:51:16
In reply to Social anxiety with no energy or motivation, posted by tgo on April 13, 2006, at 15:15:44
The two best meds for Social phobia, as far as I'm concerned after 27 years of being social phobic myself, are Klonopin (far beyond Xanax), Nardil as the best AD MAOI and Paxil as the best AD SSRI (easier to take than Nardil).Keep in mind those facts:
Nardil as a restrictive Diet that is scary at the BEGINING. Can cause sexual disfonctions and make you gain weight. Some people loose the activation/energy effect of Nardil after a time.
Paxil can cause lethargy, unmotivation and sexual side effects. Paxil is known to be the hardest of all SSRI to withdraw from; so hard that their are some class action against GSK, maker of Paxil.
Klonopin cas cause lethargy, unmotivation AND DEPRESSION AFTER A WHILE. Klonopin is hard to withdraw from after a couple of years (some people after month) that's why many Pdoc are reluctant to prescribe it.
Here's a little but very instructive web site about which meds are the most effective in Social phobia. http://www.socialfear.com/
Marty
Posted by MrBrice on April 14, 2006, at 11:10:26
In reply to Re: Social anxiety with no energy or motivation » tgo, posted by MARTY on April 14, 2006, at 8:51:16
Maybe you should try Sulpiride.
I have exactely the same as you, Prozac did nothing, neither did efexor.
But now I'm on Sulpiride and Protheaden and it works pretty well.
I'm still depressed tough, but i think these meds will be good for you.
all the best,
Brice
Posted by Caedmon on April 14, 2006, at 16:30:30
In reply to Re: Social anxiety with no energy or motivation, posted by MrBrice on April 14, 2006, at 11:10:26
This sounds like the story of my life.
Klonopin is good for anxiety. Unfortunately it may be sapping your motivation, as it did mine. I have not found valium (diazepam) to be nearly so bad in this regard. Your most conservative first step might be to swap benzos.
The next step I might try is to increase the Prozac. Do you find it sedating? If it sedates you that might make it worse, in which case I would add bupropion (Wellbutrin) to it instead.
If various things don't work out down the road you may do very well on Parnate. It's an MAOI that tends to be very helpful for energy and motivation as well as social phobia. In some cases of excessive stimulation it can be augmented with a benzo and the combination is killer. It's sort of a "sawed-off shotgun" approach; it'll almost definitely work but you may want to try something more selective first.
Those are my thoughts anyway. Best of luck,
- C
Posted by nutjob on April 14, 2006, at 22:08:58
In reply to Social anxiety with no energy or motivation, posted by tgo on April 13, 2006, at 15:15:44
I've struggled with social anxiety my entire life. The Prozac-Klonopin combination worked well for me in this regard. Unfortunately I became highly impulsive and prone to rages. I began to drink very heavily and use illicit drugs for the first time in my life. This combination of meds afforded me both the best and worst social experiences of my life.
I do not mean to suggest that you will have the same reaction. In my case it seems I was experiencing "Prozac-induced mania." I've now been taking Klonopin alone for the past several months, and while I do feel more relaxed in the presence of others I do not find myself socializing with people anymore than I do off the drug. If anything I am much worse off than without it because what little motivation I did have before is now gone, and sustaining my attention on anything is nearly impossible. Without the uplifting effects of Prozac I am more depressed than ever. I am both isolated and inert. As such, I am now in the process of weaning off Klonopin.
I will soon be trying Amisulpride. Many people claim to have had success in treating their symptoms of social anxiety with this particular drug. Further it is said to be somewhat activating. I'm not getting my hopes up about it though. Unfortunately I have no choice but to order it online from overseas without a prescription, because my doctor refuses to prescribe it.After I receive it in the mail I fully intend to describe my experience with amisulpride on this bulletin board.
Best of luck to you.
--job
> Hi. I have social anxiety and hardly any energy or motivation and tiredness. Does anyone know of a good med combo for this condition? I take Klonopin as needed and prozac 20 mg, but that doesn't help the lack of energy and tiredness. Anyone else have these conditions and found something that works?
Posted by tgo on April 17, 2006, at 9:19:57
In reply to Re: Social anxiety with no energy or motivation, posted by nutjob on April 14, 2006, at 22:08:58
Let me know how the amisulpride works out for you. I don't know much about it, but am wondering if it causes weight gain. I gained 50 lbs on paxil and zoloft and am always cautious now about more weight gain.
I find the klonopin does not work as well for me now that I have started prozac. But, the prozac does help my mood. Provigil makes me feel great, but then it causes a headache and a crash, I'll have to try adding a 25 mg or 50 mg dose in the afternoon to see if that helps or take klonopin with it to see if that helps when it wears off.
It's unfortunate that these doctors don't know how to treat social anxiety properly which leaves us to try to figure out for ourselves what will help us. And I think that many of us are quite desperate especially when it limits the type of job you can get or even your ability to get a job.
I did have a good response in the past to prozac plus gabitril plus a small dose of risperdal. I felt great on it and no anxiety. I became hypomanic on it. I think if my doctor had just lowered my prozac instead of taking me off it, it might have been a good solution. Though I have heard people say that gabitril stops working after a while. I'm wondering if klonopin instead of gabitril would have a similar effect.
Good luck with the amisulpride!
> I've struggled with social anxiety my entire life. The Prozac-Klonopin combination worked well for me in this regard. Unfortunately I became highly impulsive and prone to rages. I began to drink very heavily and use illicit drugs for the first time in my life. This combination of meds afforded me both the best and worst social experiences of my life.
> I do not mean to suggest that you will have the same reaction. In my case it seems I was experiencing "Prozac-induced mania." I've now been taking Klonopin alone for the past several months, and while I do feel more relaxed in the presence of others I do not find myself socializing with people anymore than I do off the drug. If anything I am much worse off than without it because what little motivation I did have before is now gone, and sustaining my attention on anything is nearly impossible. Without the uplifting effects of Prozac I am more depressed than ever. I am both isolated and inert. As such, I am now in the process of weaning off Klonopin.
> I will soon be trying Amisulpride. Many people claim to have had success in treating their symptoms of social anxiety with this particular drug. Further it is said to be somewhat activating. I'm not getting my hopes up about it though. Unfortunately I have no choice but to order it online from overseas without a prescription, because my doctor refuses to prescribe it.
>
> After I receive it in the mail I fully intend to describe my experience with amisulpride on this bulletin board.
>
> Best of luck to you.
>
> --job
>
>
> > Hi. I have social anxiety and hardly any energy or motivation and tiredness. Does anyone know of a good med combo for this condition? I take Klonopin as needed and prozac 20 mg, but that doesn't help the lack of energy and tiredness. Anyone else have these conditions and found something that works?
>
>
Posted by MARTY on April 17, 2006, at 15:50:39
In reply to Re: Social anxiety with no energy or motivation » tgo, posted by Chairman_MAO on April 14, 2006, at 4:43:39
How are you Chairman_MAO ?Just wondering, has Dexedrine helped with the tiredness/sleepeness ? if yes, at which degree ?
that would be a very valuable info for me...
Marty> Nardil + Dexedrine turned literally and unequivocally turned my life around.
Posted by ihadapony on April 20, 2006, at 9:50:34
In reply to Re: Social anxiety with no energy or motivation » tgo, posted by Chairman_MAO on April 14, 2006, at 4:43:39
How effective is Nardil vs. Parnate? Tried Parnate, nothing happened. Might Nardil still be worth a try in your opinion? Atypical, vegetative anhedonic depression. No luck with SSRI's whatsoever.
Thanks
Posted by SLS on April 20, 2006, at 10:26:44
In reply to Re: Social anxiety with no energy or motivation » Chairman_MAO, posted by ihadapony on April 20, 2006, at 9:50:34
> How effective is Nardil vs. Parnate? Tried Parnate, nothing happened. Might Nardil still be worth a try in your opinion? Atypical, vegetative anhedonic depression. No luck with SSRI's whatsoever.
There are people who respond to Nardil but don't respond to Parnate. I'm not sure why. Sometimes different is different enough to be different :-)
Have you tried Effexor?
- Scott
Posted by ihadapony on April 20, 2006, at 10:36:29
In reply to Re: Social anxiety with no energy or motivation » ihadapony, posted by SLS on April 20, 2006, at 10:26:44
> > How effective is Nardil vs. Parnate? Tried Parnate, nothing happened. Might Nardil still be worth a try in your opinion? Atypical, vegetative anhedonic depression. No luck with SSRI's whatsoever.
>
> There are people who respond to Nardil but don't respond to Parnate. I'm not sure why. Sometimes different is different enough to be different :-)
>
> Have you tried Effexor?
>
>
> - Scottyes, and lots of others. Nothing ever had any effect. Actually, Wellbutrin had an effect, but it was merely speedy, which isn't really the answer for me. I'm searching for something more subtle, that feels more natural. Kinda want to get up and do things because, well, just because, like others do; and not because I feel pushed to because of a speed-high thing. Don't know; maybe I want too much.
Thanks
Posted by SLS on April 20, 2006, at 11:12:29
In reply to Re: Social anxiety with no energy or motivation, posted by ihadapony on April 20, 2006, at 10:36:29
> Don't know; maybe I want too much.
Go for it.
- Scott
Posted by ihadapony on April 20, 2006, at 11:16:43
In reply to Re: Social anxiety with no energy or motivation » ihadapony, posted by SLS on April 20, 2006, at 11:12:29
> > Don't know; maybe I want too much.
>
> Go for it.
>
>
> - Scott~smile~ Thanks.
Posted by jedi on April 23, 2006, at 16:28:37
In reply to Re: Social anxiety with no energy or motivation » Chairman_MAO, posted by ihadapony on April 20, 2006, at 9:50:34
> How effective is Nardil vs. Parnate? Tried Parnate, nothing happened. Might Nardil still be worth a try in your opinion? Atypical, vegetative anhedonic depression. No luck with SSRI's whatsoever.
Hi,
I'm one of those people that had almost no response to anything but Nardil. I went through most all of the SSRIs. I gave a two month trial to Parnate and had no response against my atypical depression and social anxiety. I so wanted Parnate to work because of the extreme weight gain while on Nardil. I have double depression and am currently in a mild dysthymia being somewhat controlled by 150mg of nortriptyline and high dosage omega-3s. Nardil is the only medication that has worked on my 3+ episodes of major depression. Yes, Nardil works for some people when nothing else will, even Parnate.
Take care,
Jedi
Posted by ihadapony on April 23, 2006, at 20:15:30
In reply to Re: Social anxiety with no energy or motivation » ihadapony, posted by jedi on April 23, 2006, at 16:28:37
> > How effective is Nardil vs. Parnate? Tried Parnate, nothing happened. Might Nardil still be worth a try in your opinion? Atypical, vegetative anhedonic depression. No luck with SSRI's whatsoever.
>
> Hi,
> I'm one of those people that had almost no response to anything but Nardil. I went through most all of the SSRIs. I gave a two month trial to Parnate and had no response against my atypical depression and social anxiety. I so wanted Parnate to work because of the extreme weight gain while on Nardil. I have double depression and am currently in a mild dysthymia being somewhat controlled by 150mg of nortriptyline and high dosage omega-3s. Nardil is the only medication that has worked on my 3+ episodes of major depression. Yes, Nardil works for some people when nothing else will, even Parnate.
> Take care,
> JediThank you, Jedi. That gives me hope. I didn't know whether to even try anymore on the maois. I appreciate you sharing with me.
~~pony
Posted by germanium on April 26, 2006, at 0:42:34
In reply to Re: Social anxiety with no energy or motivation » ihadapony, posted by jedi on April 23, 2006, at 16:28:37
Sounds like Emsam may help in this situation as that is my symptoms as well & I take selegiline the active ingredient in Emsam & it helps emensely but watch it as it can overboost you & make you agitated. I feel slight agitation but not severe & it actually helps me to get off my dead butt & do something meaningfull. It can also interfere with sleep as it has me in the past, but for me that subsided & I get really good sleep now, in fact some of the best I ever had without oversleeping or feeling groggy upon wakening. Everyones milage seems to vary with this medicine quite radically but to me it seems tailor made for these symtoms.
By the way it was originally developed as an antidepressant with psychic (mental) energizing properties & for the people it does work for it is a godsend for them but like all other AD meds it is not for everyone. However it didn't seem to help enough people at the low doses to justify using it in that way as an antidepressant but did work at higher doses but then the need for the MAOI diet comes into place unless you can bypass the stomach which is what the patch does. the lowest dose of the patch puts conciderably more selegiling in the system than the highest dose orally used to treat parkinsons but without the tyramine sensitivty of going to an equivolent oral dose which would be way beyond even the highest recomended dose that Ive seen used for severe depression. The actuall amount of selegiline that gets into the system as selegiline from the patch is equivolent to 100mg oral selegiline & that is the lowest patch dose & the highest oral selegiline used for depression that I've seen is 60mg. anything above 10mg oral requires the diet as there have been a few hypertensive crisis even at that dose orally.
It is interesting however I do very very well on 2.5mg oral selegiline.So no diet nessesary even though my doc want me stick with the diet anyway so I do & low side effects.
Posted by tgo on April 26, 2006, at 16:53:35
In reply to Re: Social anxiety with no energy or motivation, posted by germanium on April 26, 2006, at 0:42:34
Thanks for your thoughts geranium. I've been keeping up with the Emsam posts hoping that it will actually work for those of us social anxiety and no energy.
I am a going to an income based clinic right now as I don't have a job. My next appt is the end of May. I'll have to ask about Emsam and selegiline. My doctor wanted to put me on Cymbalta, but I really don't think that will help.
It may be hard to convince her to let me try Emsam or seligiline. I mentioned Emsam to her at my last appt and she thinks it's not a very effective medicine. So, I'll really have to plead my case.> Sounds like Emsam may help in this situation as that is my symptoms as well & I take selegiline the active ingredient in Emsam & it helps emensely but watch it as it can overboost you & make you agitated. I feel slight agitation but not severe & it actually helps me to get off my dead butt & do something meaningfull. It can also interfere with sleep as it has me in the past, but for me that subsided & I get really good sleep now, in fact some of the best I ever had without oversleeping or feeling groggy upon wakening. Everyones milage seems to vary with this medicine quite radically but to me it seems tailor made for these symtoms.
>
> By the way it was originally developed as an antidepressant with psychic (mental) energizing properties & for the people it does work for it is a godsend for them but like all other AD meds it is not for everyone. However it didn't seem to help enough people at the low doses to justify using it in that way as an antidepressant but did work at higher doses but then the need for the MAOI diet comes into place unless you can bypass the stomach which is what the patch does. the lowest dose of the patch puts conciderably more selegiling in the system than the highest dose orally used to treat parkinsons but without the tyramine sensitivty of going to an equivolent oral dose which would be way beyond even the highest recomended dose that Ive seen used for severe depression. The actuall amount of selegiline that gets into the system as selegiline from the patch is equivolent to 100mg oral selegiline & that is the lowest patch dose & the highest oral selegiline used for depression that I've seen is 60mg. anything above 10mg oral requires the diet as there have been a few hypertensive crisis even at that dose orally.
>
> It is interesting however I do very very well on 2.5mg oral selegiline.So no diet nessesary even though my doc want me stick with the diet anyway so I do & low side effects.
Posted by Sebastian on April 26, 2006, at 17:56:10
In reply to Social anxiety with no energy or motivation, posted by tgo on April 13, 2006, at 15:15:44
Take wellburtin, for energy, lack of motivation and tiredness. May or may not help with the social anxiety.
Posted by tgo on April 26, 2006, at 18:28:36
In reply to Re: Social anxiety with no energy or motivation, posted by Sebastian on April 26, 2006, at 17:56:10
Oh my, wellbutrin. I took that several years ago. It made me irritable and edgy, though I did lose weight the first time on it. I also tried it in combo with prozac.
I guess I would have to find some combo with the wellbutrin that would counteract the irritability and anxiety it causes for me.
But, yes it did give me some energy.
> Take wellburtin, for energy, lack of motivation and tiredness. May or may not help with the social anxiety.
Posted by patrickhh on April 29, 2006, at 20:21:19
In reply to Social anxiety with no energy or motivation, posted by tgo on April 13, 2006, at 15:15:44
If the social anxiety is under good control, for extra energy you might try adding Wellbutrin, Provigil, or Strattera.
Posted by patrickhh on April 29, 2006, at 20:22:28
In reply to Re: Social anxiety with no energy or motivation, posted by tgo on April 26, 2006, at 18:28:36
> Oh my, wellbutrin. I took that several years ago. It made me irritable and edgy, though I did lose weight the first time on it. I also tried it in combo with prozac.
> I guess I would have to find some combo with the wellbutrin that would counteract the irritability and anxiety it causes for me.
> But, yes it did give me some energy.
You might try Strattera. It seems to be enrgizing without being agitating.
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