![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 33. Go back in thread:
Posted by michael on August 15, 2000, at 22:23:19
In reply to Hi from another 'symptomological soulmate'; my 2¢ » Billb, posted by S.D. on August 13, 2000, at 18:11:56
Hey S.D. -
Great summary of a lot of good info.
Just wondering - you mentioned klonopin, any idea how lorazepam (ativan) rates, relatively speaking? (for SAD) Or is it a case of same med class, but not typically used for this? Thanks for the info/summary. michael
> Your post, and AndrewB's reply, bring up a couple of questions I've had for a long time, which I'll post soon in separate new threads. One is how several here with SAD have spouses when I can't even get a gf...
> Other than that bright spot in your life and perhaps the lower severity of your SAD that it implies to me (not to minimize your suffering; just envious), from your description of yourself we could almost be twins.
>
> My 2¢...
> As AndrewB and others can also tell you, there are a several meds that can fight SAD. Some specifics:
>
> SSRIs can help and since one (Paxil) has helped you, but not for SAD, something to consider would be a switch to one of the other SSRIs. But I would empathize with reluctance to risking loss of the benefits that Paxil was able to provide.
> --------
> Beta-adrenergic blockers work on your sympathetic nervous system to specifically inhibit physical symptoms of anxiety, which you described were prominent. These are usually used "as-needed" for particular "performance" situations such as speaking to a group of people. Inderal (generic name propranolol) is typical example of this type.
> ----------
> Some other meds fight SAD for some people. Particularly, perhaps, (my own impression) the symptom you described which is one of those with which I am agonizingly familiar:
> "I was more apt to speak up in meetings, out of
> apparent instinct, rather than the usual gut
> wrenching decision making process that usually
> proceeds speaking up"
>
> Klonopin (generic = clonazepam, which might not be as strong/effective) - probably no med is more effective for more SAD people;
>
> Kava-Kava (the 'herbal supplement') at 1000mg/day;
>
> amisulpride or the similar sulpiride, at 50mg/day and 150mg/day, respectively - these are also effective against dysthymia and major depression in partial remission;
>
> Neurontin (a non-benzodiazepine Anti-Epileptic drug effective in a smaller fraction of cases according to one clinical trial);
> ----------
> You should know that some Non-SSRI drugs labeled as antidepressants also fight SAD in some people:
>
> Nardil (generic = phenelzine), an MAOI (monamine oxidase inhibitor). About as effective (and as often) as Klonopin, this is also an antidepressant as effective as SSRIs, but *more (or more often) effective* than TCAs (and maybe others) for 'atypical depression' - a feature of which is "rejection sensitivity", which will be familiar to many with a SAD diagnosis. Comes with drug-drug interactions, some diet restrictions and higher intolerance rate (side effects) but underutilized in my layman's opinion. Effectiveness of other MAOIs (for SAD) is less certain.
>
> Reboxetine I think has some clinical trial support but is not available in USA. Wellbutrin (bupropion), Effexor (venlafaxine) and Serzone (nefazedone) may be considered "promising".
> Wellbutrin affects norepinephrine and dopamine so may help similarly to why MAOIs do. I don't think there have yet been controlled trials with it for SAD.
> Effexor effects all the 'big 3' neurotransmitters, to dose-dependant degrees, and has particularly difficult side- / withdrawal-effects for some people. Multiple studies using this med for SAD are currently underway.
> Serzone (nefazedone) is similar to an SSRI but also blocks norepinephrine reuptake. It is more sedative, and would make your trazadone unneeded if you replaced Paxil with this. However, it is unlikely to cause the delay/anorgasmia that for you is a *positive* side effect. I believe there is at least one study underway using this med for SAD.
>
> I have medical journal references for all the objective statements made here. When I get my sh!t together, I'll collect them all so I can provide a convenient way to point to all of them. Statements about studies underway are based on my personal knowledge from doctors or responding to "volunteers wanted" ads in San Diego where I live.
>
> peace and health,
>
> S.D.
>
> PS I feel like I have so much stuff to do, with few accomplishments ever to ultimately show for my efforts, so I think I should resist the compulsion to spend such time posting and reading here. The answer is to be more organized and efficient in doing something to help (and connect with) those who suffer like me - for of course that is why I do this.
>
> - "SAD in SD"
Posted by S.D. on August 16, 2000, at 16:33:44
In reply to Re: Hi from another 'symptomological soulmate'; my 2¢ » S.D., posted by michael on August 15, 2000, at 22:23:19
> Hey S.D. -
>
> Great summary of a lot of good info.Thanks! (Like anyone, I appreciate being appreciated...)
> Just wondering - you mentioned klonopin, any
> idea how lorazepam (ativan) rates, relatively >speaking? (for SAD)I seem to recall reading a couple of individual testimonials of it helping, either alone or in combo with an antidepressant. I'm not aware of any clinical trials testing its effectiveness for SAD, but haven't searched medline for articles.
>Or is it a case of same med class, but not
>typically used for this? Thanks for the
>info/summary. michael
>
I think that's the case. In absence of statistal info on its effectiveness, one reason to not typically try it might be its shorter half-life compared to clonazepam (Klonopin)peace and health,
S.D.
Posted by AndrewB on August 19, 2000, at 13:43:00
In reply to Re: AndrewB, JohnL, Social Anxiety (long), posted by Billb on August 11, 2000, at 15:42:55
Bill,
Sorry to take so long to reply to your post, I was out of town camping. It seems like you have already received some good advice though. I would also like to chip in my suggestions here but I want you to know that I have no professional training and that my opinions are not in line with mainstream thought. The suggestions I give are no substitute for your own diligent research combined with the counsel a psychiatrist experienced with social anxiety and psychopharmacology.
That being said, I think it is clear that social anxiety can be symptomatic of dysfunction within various receptor systems; dopaminergic, serotonergic, GABA, noradrenergic and, quite likely, others. The social anxiety many experience often consists of, in part or whole, a cognitive/psychological component that responds well to therapy. Others however find their social anxiety seemingly of the a wholly physiological variety that is impervious to therapy.
With the above considerations in mind, and also due to the fact that many social anxiety meds are fast acting and have a quick wash-out period, it is my belief that an aggressive approach towards treating social anxiety is called for when there is no concurrent serious mood disorder. Such an aggressive approach would consist of the trialing of selected anti-anxiety meds and med combos in rapid succession. The hoped for result of such an approach would be the timely identification of the most efficacious med or med combo for treating one’s social anxiety.
To follow through with this approach, a person first needs to obtain a variety of meds to trial, your ‘tool kit’, so to speak. Some of these meds can be obtained through your doctor, others need to be obtained overseas, with or without a prescription.
Bill, I have read your posts carefully. Thank you for being so candid, I know it can be hard for those of us with social anxiety to be so revealing. I think your detailed responses to my questions will help me give you some useful suggestions. So let’s delve into some specific medicine trial suggestions. Remember to add only one medicine at a time, allow a washout period, and try to remove a medicine for each one that you add. Research each drug for possible interactions with the drugs you are already taking.
Adrafinil: Your results with adrafinil are so very encouraging. You may want to try varying the dosage of the adrafinil to identify at which dosage you benefit most.
Provigil: Provigil’s active ingredient is modafinil. Modafinil is a metabolite of adrafinil. Provigil, being related to adrafinil, may offer you as good as or better anxiety relief as adrafinil. I’d suggest a three day trial at 100mg. and, if the side effects are minimal, a further 3 days at 200mgs.Klonopin (Clonazepam): Some claim that klonopin is the most effective social anxiety medicine out there. It works on the GABA receptors. Apparently, its potential for addiction is minimal if doses are kept below twice daily dosing of 2mgs. Rick, another poster, noted that the combination of klonopin (1mg. in the morning, .25mg in the afternoon) is very effective for his social anxiety with no associated sleepiness or cognitive deficits. You may have the same luck with this combo or a klonopin/adrafinil combo. For more info, look at Rick’s posts entitled ‘Social Phobia Cocktail-- Wow’ on June 8th-12th. Another option is to take kloniopin (.5mg-2mg.) a couple of hours before bedtime for a restful sleep instead of taking trazadone. I do this myself. It makes me feels rested and rejuvenated with no morning grogginess. You may find it interesting that a Chronic Fatigue Syndrome specialist, Dr. Cheney, recommends taking 1mg. klono at night for a restorative sleep and taking .25mg or .125mg in the morning and evening to improve energy and clarity! (He believes that klono acts as an NMDA receptor antagonist at such low doses.) You can try trialing klonopin at a variety of dosages and timings over a 2 week period, You will need approximately 30 to 40 .5mg. tablets for the trial
Stimulants: Your improved confidence on the diet pill as well as adrafinil indicate that a stimulant may be able to increase your social confidence. I have noticed that adderall increases my social confidence significantly, though I haven’t been taking it long enough to say whether this effect will stay or fade away. Irritability does not have to be a side effect. From what I have read, given a choice of stimulants to trial (dexedrine, ritalin, adderall), I would trial adderall first. Stimulants also may improve your mood response with Paxil. Adderall is normally taken once in the morning and once shortly after noon. The dosage would be either 10 or 20 mg. For a four day trial you would need up to 16 x 10mg. tablets.
Buspar: Didn’t work at first, no reason to try it again.
Piracetam: I have tried this med as well as read much about it. It is inappropriate for what you are seeking.
Paxil: It sounds like you have something that works here. No reason to change it. Do ask yourself though whether Paxil contributes to your feelings of emotional detachment.
Amisulpride: Amisulpride can be effective for negative thoughts, social anxiety, feeling of social detachment (makes a person feel socially open). It also can improve one’s mood, especially the persistent low mood associated with dysthymia. It is prescribed overseas for social anxiety, dysthymia and atypical depression. Personally I have found it incredibly effective in turning off the negative self talk, To receive an information piece on amisulpride I have put together, email me at andrewb@seanet.com. A trial with amisulpride will take two weeks. Dosage starts at 25mg. for 4 days, escalating to 50mg for 5 days and then to 100mg. for the final 5 days. A person will need 17 x 50mgs tablets for their trial.
Beta-andrenergic blocker: For your physical symptoms of social anxiety (i.e. facial trembling, blushing) you are likely to respond to a beta blocker. Several options are out there. Someone relayed to me that Dr. Jensen (whom JohnL is such a fan of) thinks Kerlone is by far the most effective. I don’t have details on its usage. But the pharmacist that sells this (i.e. xxx) will be able to answer dosing questions. I think you will know immediately whether this med. is effective for you.
Other anti-anxiety meds not mentioned: If you are still with social anxiety after trying the above meds you can look into trying: kava kava, neurontin, clonidine, and selegiline. If all else fails, you can try Nardil, the ‘gold standard’ for social anxiety meds that unfortunatley has significant side effects and dietary restrictions.
Ordering Info.: The above meds can all be obtained through your doctor except for amisulpride, which is available overseas. Amisulpride can be obtained without a prescription from xxx, Kerlone and (I believe) klonopin can also be obtained from xxx. The pharmacist there is helpful and will try to answer any questions you have. Great service. xxx.
Best wishes, feel free to ask further questions,
AndrewB
Posted by Billb on August 20, 2000, at 7:20:22
In reply to Social Anxiety: BillB, posted by AndrewB on August 19, 2000, at 13:43:00
Andrew, thanks so much for your help. Awesome!!!!
I am sure I will have questions as I proceed.
I did try to go to xxx today, but it appears their web site is down because I was unable to connect.
Thanks again,
Bill
Posted by Billb on August 20, 2000, at 16:38:53
In reply to Re: Social Anxiety: AndrewB, posted by Billb on August 20, 2000, at 7:20:22
You da man!
Posted by Rick on August 26, 2000, at 17:47:11
In reply to Cam and Others, Social Anxiety Cocktail Evaluation, posted by Billb on August 10, 2000, at 18:59:02
Man, what a lot of good info! Andrew could write a book!
A few comments:
The daily challenges and symptoms mentioned in these posts are so closely aligned with my own experiences that I can hardly believe it! I found the head-shakiness comment especially interesting because that was my initial troubling physical symptom of what I later learned was a mental disorder. Oddly, that symptom spontaneously resolved after a few years, but was soon replaced with the voice shakiness that has been my biggest source of embarrassment and increased work/social/family avoidance for the many years since. In fact, I sometimes use my patented VMAC Scale (Voice Mail as a Crutch) to measure my progress: Before treatment I re-recorded meassages ad nauseum until most traces of tremulousness or other vocal tenseness was gone; now I re-record infrequently. (Sweating was a significant secondary issue, but I don't know whether that decreased due to the meds, losing a lot of weight, lowered blood pressure, lowered blood sugar, or a synergistic combo of the above. Also, part of the voice problem may be physical in nature, since it sometimes re-surfaces a bit when I'm feeling weak due to excessive hunger and/or sleepiness from late-night work, etc.)
My own Social Anxiety cocktail was mentioned in one of the posts. One of the unexpected benefits of my moderate-dose Klonopin is that I now rarely have bouts of insomnia, even though I take most of my daily dose first thing in the morning, and seldom take any after 3 p.m.
To Andrew: While Provigil has supplied me with plenty of the outgoingness (is that a word?), wakefulness, and cognitive enhancement that you reoport with the related adrafinil, I haven't yet seen any of the touted memory enhancement. Have you noticed a memory effect with adrafinil?
Best of luck to all posters and lurkers,
Rick
Posted by Gracie on September 2, 2000, at 11:34:14
In reply to Social Anxiety: BillB, posted by AndrewB on August 19, 2000, at 13:43:00
Hi Guys,
Would you mind listing the meds and dosages you are presently using? I'd also be interested in the level of improvement you've seen with your current cocktail. Our symptoms sound so very alike, I would appreciate your input.
I'm sure you have all posted these before, and I apologize for asking you to repeat yourselves. If you can point me to a date of a previous post, I can retrieve the information.
Thank you
Posted by KarenB on September 2, 2000, at 14:27:04
In reply to Cam and Others, Social Anxiety Cocktail Evaluation, posted by Billb on August 10, 2000, at 18:59:02
Billb,
I highly suggest Amisulpride, 50mg morning and afternoon, if you have not yet tried it. I have a piece from, I think, AndrewB on this that cites ordering info, etc. If you are interested, you can e-mail me.
Combining Amisulpride with a stimulant (Adderall) has been a winning combination for me. It is effective for social anxiety, has sedating effects without the annoying sleepiness and has a mild antidepressant action. As with almost all neuroleptics, weight gain is a possibility, so you have to keep the carbs under control and exercise to keep your girlish figure (hee hee). I am assuming you are William, not Willemina? But, of course I am assuming "Bill" is your real name. Silly me.
If Amisulpride has already been addressed by someone else, please forgive me - I didn't read the entire thread... The Adderall doesn't fix EVERYTHING, you know.
Karen
Posted by Billb on September 3, 2000, at 8:41:17
In reply to Re: Cam and Others, Social Anxiety Cocktail Evaluation, posted by KarenB on September 2, 2000, at 14:27:04
>Karen,
Thanks for the suggestions! I am glad you have found a combination that works for you - thats fantastic! I have Amisulpride on order and plan to give it a try soon. AndrewB has been a big help in sharing his experiences and providing tips/info. I have also been considering Adderall but I'm not sure it will help with my particular anxiety.
Keep up the good work on that great (I imagine) girlish figure.
Thanks again,
Bill
Posted by Billb on September 7, 2000, at 17:56:46
In reply to Re: AndrewB for President, posted by Billb on August 20, 2000, at 16:38:53
Hey guys, ready to start part of the trial. Currently taking 40 mg. Paxil, 300 mg. adrafinil, and 50 mg. trazodone at night for sleep. I have done some back-sliding lately, regarding progress.
I have trial amounts of Amulsipride and Kerlone. How should I approach a trial of these meds.?
Posted by AndrewB on September 7, 2000, at 18:46:27
In reply to Re: AndrewB, S.D., and JohnL, posted by Billb on September 7, 2000, at 17:56:46
> Hey guys, ready to start part of the trial. Currently taking 40 mg. Paxil, 300 mg. adrafinil, and 50 mg. trazodone at night for sleep. I have done some back-sliding lately, regarding progress.
>
> I have trial amounts of Amulsipride and Kerlone. How should I approach a trial of these meds.?You can take kerlone anytime that you have a free day. Had a great feedback on it. Hope it really helps.
Don't trial two drugs at once to avoid confusing the results.
Stop taking Paxil for at least 2 weeks before starting amisulpride.
Long range goal is to stop trazadone or switch it out with something less problematic.
Any other Q's feel free to ask.
AndrewB
Posted by JohnL on September 9, 2000, at 5:30:43
In reply to Re: AndrewB, S.D., and JohnL, posted by AndrewB on September 7, 2000, at 18:46:27
Bill,
You ask tough questions! :-) I'm not sure exactly how I would trial these meds. There are so many options.You could add in the Amisulpride along with everything else you are already taking. I would prefer not to do that, because I personally prefer to keep the number of meds I take as few as possible. Sometimes various meds will counteract or confuse other meds anyway, sometimes in ways we aren't even aware of or understand.
So in my mind at the very least one of your current drugs should be completely eliminated. Preferably two. Whichever two you think are helping you the least. Just off the top of my head, that would probably be Paxil and Traz. I hate Traz anyway. That's a very complicated drug that can really confuse things.
I would probably keep the 300mg Adrafinil on board. And if stopping the other drugs is not an option for you, then perhaps at least lower Paxil to 10mg or 20mg.
In any case, start the Amisulpride at 25mg for 3 or 4 days to feel it out, then go up to 50mg. You could go up to 75mg or 100mg after a couple weeks if you wanted to, though that isn't often needed. Anywhere in the 50mg to 100mg range is fine.
And then give it a few to weeks to see. I generally find Amisulpride's benefits most evident starting in about week 3.
I wouldn't try anything else or change anything else until after Amisulpride has been given a fair shot. We just don't want to cloud the picture by changing other variables at the same time we're trying Amisulpride. The hardest part of the whole deal will be lowering or eliminating some of the other drugs you are taking, if you go that route. Brace yourself for some bumps in the road. As long as you know they're coming, you can be strong and weather the storm, knowing it will be only temporary, if it happens.
John
Posted by Billb on September 10, 2000, at 17:43:31
In reply to Re: AndrewB, S.D., and JohnL, posted by JohnL on September 9, 2000, at 5:30:43
Andrew and John, thanks for the advice.
I am ready to try to drop the traz. The Paxil, which hasn't been exceptional for social anxiety, I am hesitant to drop because of the weight loss and sexual condition it has unexpectantly caused. I think I will try to cut back on the Paxil to 20 mg for a couple weeks and see how I feel, then cut back to 10 mg. If I feel ok at that point I'll add in the amulsipride. I feel somewhat like a chicken but I have come so far and yet, I have so far to go. Overall, life is getting better but there are certain situations, at work and socially, that totally disable me, and perhaps one of the trial meds. will help here. Thanks for your wise thoughts. If my thoughts or plans are flawed, please let me know. Thanks!
Bill
Posted by Billb on October 16, 2000, at 20:10:54
In reply to Re: AndrewB, S.D., and JohnL, posted by JohnL on September 9, 2000, at 5:30:43
I am having difficulty. I am reluctant to reduce the paxil (no guts?). I am eager to try the amilsipride. However, I have tried 2 mg. of clonazepam daily and feel such a positive step change I am reluctant to further experiment. I am told that clonazepam is addictive and is therefore non-desirable, however, it is such an effective social anxiety med. My doc. is reluctant to go with the clono because it is potentially addictive. Wow, life has gotton good since clono, what should I be watching out for? Also, my doc's recomendation to go from 40 to 60 mg. on Paxil- is this ok? Is it ok to add in, as, of course, an experiment, 25 to 50 mg. of amulsipride on top of everything else ok? For me clonazepam is so much more effective for SAD than xanax. Life is getting better but I am not an experienced experimenter (I need to maintain a notebook). The adrafinil seemed ok for a while until I withdrawled (could be a southern term) it, then things got neg. I tried provigal for a week but that did not work for me (might as well suck on coffee beans - wow). Should I try the 60 mg. of Paxil and see what it does before I demand clono? Is clono a long term solution? Ouch!, confusion abounds. Help if you can. Love ya.
SAD in SC
Posted by JohnL on October 17, 2000, at 5:44:59
In reply to Re: AndrewB, S.D., and JohnL, posted by Billb on October 16, 2000, at 20:10:54
Bill,
I hear ya on the Provigil. Yuck.
I don't like the option of increasing the Paxil dose, but that's just me. Certainly it's a well supported option. I just tend to feel if a medication isn't doing the job at a lower dose, then it's missing the mark anyway.
If Clono is working well, I would certainly do whatever is needed to convince your doctor to continue with it. As long as you stay at lower doses, longterm dependence should be minimal. The thing to watch out for is developing tolerance to it, where you find you need higher and higher doses over time. That's not good, and in my mind would warrant either staying at lower doses or discontinuing altogether. Becoming addicted at higher doses could cause way more problems than you ever had to begin with.
Certainly 25mg to 100mg of Amisulpride could be added. I don't see any prob with that at all. I've taken Amisulpride with all sorts of things, including a small dose of Prozac at the moment. If I had to rate meds as most effective, Amisulpride would be on the list. If I had to rate meds by tameness, it would be on that list too. Because it mainly affects just D2 dopamine receptors, it has little interaction with the mechanisms of other meds, and has a near absence of any side effects.
You could definitely consider Adrafinil as well. It's funny, Adrafinil and Provigil look practically identical in molecular diagrams. But they are in reality two completely different and two totally unrelated meds. I do very well with Adrafinil, and did very poorly with Provigil. They are totally different, even though they are supposedly similar. Not similar at all.
The best I've found for apathetic depression and for social anxiety is the combo of Amisulpride+Adrafinil. Either alone is very good, but the two together are really special. At least for me anyway. The things I like best about either of these meds is that they are far tamer than the meds our doctors give us, and yet far more effective. That never ceases to amaze me. Paxil for example is a heavy duty med compared to Adrafinil or Amisulpride, and yet either of the latter work so much better than Paxil for me. And yet they seem almost as tame as vitamins.
John
Posted by nhgrandma on October 17, 2000, at 9:47:42
In reply to Re: AndrewB, S.D., and JohnL, posted by JohnL on October 17, 2000, at 5:44:59
>
> The best I've found for apathetic depression and for social anxiety is the combo of Amisulpride+Adrafinil. Either alone is very good, but the two together are really special. At least for me anyway. The things I like best about either of these meds is that they are far tamer than the meds our doctors give us, and yet far more effective. That never ceases to amaze me. Paxil for example is a heavy duty med compared to Adrafinil or Amisulpride, and yet either of the latter work so much better than Paxil for me. And yet they seem almost as tame as vitamins.
> JohnIs Adrafinil worth the out-of-pocket expense? Would combining it with .5 mg Klonopin help? Do Drs. usually give their blessing on its use? Is there any corelation between sudafed and adrafinil? If sudafed makes my heart race, would the same happen with Adrafinil? Thanks
Posted by JohnL on October 17, 2000, at 20:02:39
In reply to Re: lots of questions for JohnL, posted by nhgrandma on October 17, 2000, at 9:47:42
> >
> > The best I've found for apathetic depression and for social anxiety is the combo of Amisulpride+Adrafinil. Either alone is very good, but the two together are really special. At least for me anyway. The things I like best about either of these meds is that they are far tamer than the meds our doctors give us, and yet far more effective. That never ceases to amaze me. Paxil for example is a heavy duty med compared to Adrafinil or Amisulpride, and yet either of the latter work so much better than Paxil for me. And yet they seem almost as tame as vitamins.
> > John
>
> Is Adrafinil worth the out-of-pocket expense? Would combining it with .5 mg Klonopin help? Do Drs. usually give their blessing on its use? Is there any corelation between sudafed and adrafinil? If sudafed makes my heart race, would the same happen with Adrafinil? ThanksHowdy nhgrandma! Haven't seen you in a while.
Ok. Is Adrafinil worth the expense? Well, to me, yeah. I mean, I think it's 40 tablets for about $25, and I take one a day, so a month and a half at $25. Pretty good.I see no problem combining it with Klonopin.
A doctor is highly unlikely to give his blessings on it, because he's probably never heard of it. The closest thing is Modafinil, which most doctors wouldn't be too familiar with anyway. Even though they are supposedly similar, and you can get Modafinil in USA, they are totally different. I hated Modafinil. Though Adrafinil is common in Europe, it isn't available in the USA except by mailorder. When I spoke to the folks that ship it, they said there are hundreds of customers in the USA, but they all must mailorder it.
I don't know much about Sudafed. I know the racing heart feeling you're talking about though. Adrafinil doesn't do that. As a matter of fact, most people who take Adrafinil don't feel anything at all. It's only after a week to a month that they start becoming more active, motivated, socially more talkative, and socially comfortable. But there is none of the speedy feeling like Sudafed or too much coffee or whatever. A rare side effect is listed as 'inner tension', but it is rare, and when it happens it is usually early in treatment and goes away after a week or so generally. But the racing heart feeling....no.
Is the nh for New Hampshire? If so, where in New Hampshire?
John
Posted by nhgrandma on October 18, 2000, at 9:11:44
In reply to Re: lots of questions for JohnL, posted by JohnL on October 17, 2000, at 20:02:39
> Is the nh for New Hampshire? If so, where in New Hampshire?
> JohnYes, it is for New Hampshire. Derry. Have you ever been there?
Posted by AndrewB on October 18, 2000, at 13:00:34
In reply to Re: AndrewB, S.D., and JohnL, posted by Billb on October 16, 2000, at 20:10:54
> I am having difficulty. I am reluctant to reduce the paxil (no guts?). I am eager to try the amilsipride. However, I have tried 2 mg. of clonazepam daily and feel such a positive step change I am reluctant to further experiment. I am told that clonazepam is addictive and is therefore non-desirable, however, it is such an effective social anxiety med. My doc. is reluctant to go with the clono because it is potentially addictive. Wow, life has gotton good since clono, what should I be watching out for? Also, my doc's recomendation to go from 40 to 60 mg. on Paxil- is this ok? Is it ok to add in, as, of course, an experiment, 25 to 50 mg. of amulsipride on top of everything else ok? For me clonazepam is so much more effective for SAD than xanax. Life is getting better but I am not an experienced experimenter (I need to maintain a notebook). The adrafinil seemed ok for a while until I withdrawled (could be a southern term) it, then things got neg. I tried provigal for a week but that did not work for me (might as well suck on coffee beans - wow). Should I try the 60 mg. of Paxil and see what it does before I demand clono? Is clono a long term solution? Ouch!, confusion abounds. Help if you can. Love ya.
>
> SAD in SCI thought you were going to see a new doctor in Atlanta?
AndrewB
Posted by JohnL on October 19, 2000, at 3:00:42
In reply to Re: lots of questions for JohnL, posted by nhgrandma on October 18, 2000, at 9:11:44
Derry is an awesome area. I don't know anyone there, but I've driven through many times. What a beautiful area.
I live almost right next door to you. Old Orchard Beach Maine.
John
Posted by S.D. on October 23, 2000, at 21:19:59
In reply to Re: AndrewB, S.D., and JohnL, posted by Billb on October 16, 2000, at 20:10:54
>However, I have tried 2 mg. of clonazepam daily
> and feel such a positive step change I am
> reluctant to further experiment. I am told
> that clonazepam is addictive and is therefore
> non-desirable, however, it is such an effective
> social anxiety med. My doc. is reluctant to go
> with the clono because it is potentially
> addictive. Wow, life has gotton good since
> clono, what should I be watching out for?If you got your clono some way without your doc,
watch out for running out! I wouldn't expect
major Withdrawal effects after only a couple
weeks, but still...
Regarding withdrawal effects, search medline
( http://www.ncbi.nlm.nih.gov/PubMed/ ) for
studies of this. My impression of my recollection
from when I studied this is that severe and
longlasting effects are rare, and significantly
biased towards people who used it for, say, 2+
years or used unusually large amounts, or both.
I don't have access now to the relevant article
titles, but it's best and easy enough to search
for yourself. I do recall finding
one or more studies showing a constant moderate dose
for at least a few months working well and not
causing any significant withdrawal problem.
These article abstracts may ease your mind. And
if you don't want to change doctors, maybe showing
these to him/her will be persuasive.
(I've had difficulty acting assertively
like that with doctors, but I bet on clono
we both could do it!)But if your doc really isn't gonna go for it, dump
him/her! I'll bet any psychdoc and even primary-
care doc would be happy to give you all the Paxil
you wanted, but only *some* psychdocs will be cool
with clonazepam. So find one that will prescribe it
and haul ass!! I'd bet such docs are on average
the better ones anyway, meaning that I think bias
against it is more likely to be due to lack of
knowledge than willingness to prescribe it is.
Maybe you can call around to find out who will
prescribe it, or maybe they all want their $$
for "initial evaluation" session before they'll
talk to you.
If you do have to "go in blind", here's possibly
a way to increase the chance of getting one that
prescribes it when appropriate:
I've been to three private-practice pdocs; the
last two were listed in the 1996 or 1997
edition of the book "The Best Doctors in America",
which noted 'psychopharmacology' was one of their
subspecialties. I don't know any better way to
get this subspecialty (indicated by the doc
him/herself) information.
Neither of these psychiatrists volunteered clon.
as a '1st line' choice for social anxiety but were
comfortable with it when asked.
This book is no longer published. The method
was to poll doctors as to who, in their own
specialty, they would send their dear sick mother
to. I don't know if these are really the best
doctors; anyhow, check your local library.Since even most withdrawal problems are handled
by tapering off as slowly as needed, something I'm
personally more concerned about is cognitive impairment.
That is, as with other benzos, studies have measured
negative effects on memory and 'mental sharpness'
in some way, persisting long after discontinuaiton
in some cases. Ironically, while many docs are
too afraid of 'addiction potential', my experience is
that none have volunteered info on this cognitive
effect, or considered it important when asked about it.
A person is unlikely to notice his own
impairment, and I'm not saying it is severe. But
since I depend on my brains more than my charm and
good looks, my plan was to quit within 9 months or so,
having in the meantime had enough exposure therapy
to make the changes stick. I'm heartened that I've
had good results with a low 1.25mg/day Klonopin, but
still I gotta quit sometime.The last thing I want to suggest you watch out for
is Brand-name Klonopin vs. a generic clonazepam.
1) some who've had both say Klonopin is better, or
stronger for the same dose
2) Klonopin is more expensive (likely even if
you have insurance) but not bad.
I think my copay was $55 for 100mg.
Cheap at 10 times the price,
for a chance at having a real life.
3) Pharmacy probably will fill with generic unless
you specifically state Klonopin every time
you refill it.
4) I read this tip somewhere, maybe here:
There are multiple makers of generic clon.
so your pharmacy might switch makers on you
and of course won't think to tell you.
The gist of what I remember reading is that
the potency of two makers' generic could
differ from each other enough to knock some
people for a major loop.>Should I try the 60 mg. of Paxil and see what it
> does before I demand clono?
As I recall, 40mg paxil was doing it for you for
depression, but not SAD. Maybe there is a study
out (good ol' pubmed) that compares dose to response
for SAD. If not, maybe let your current side effects
guide you since I presume 60mg will be worse than 40.
> Is clono a long
> term solution?From the studies on withdrawal and cognitive problems
that I mentioned above, being rare but probably increas-
ingly likely with long (years) term use, I think even
most doctors who use it would say no, not like with
many antidepressants for which the conventional wisdom
seems to have moved alot toward accepting multiyear use.
Moreover, published studies tend to show that patients
who were treated only with clonazepam relapsed sooner
(although I wonder if these people remained isolated
after discontinuing the med., because if the clon.
allows you to engage in more social situations, isn't
that in fact 'in vivo exposure therapy'? Or is there
a specific way you have to do the exposure for it to
be 'therapeutic'?)
Take the clon & get some behavioral/exposure-type therapy
(by 'self-help' book if you prefer or circumstances dictate:http://www.amazon.com/exec/obidos/ASIN/0967126509/drbobsvirte00-20
http://www.amazon.com/exec/obidos/ASIN/1879237237/drbobsvirte00-20
http://www.amazon.com/exec/obidos/ASIN/0380783991/drbobsvirte00-20)
The former should make you more able to do latter,
as you have already discovered.
"Cognitive Behavioral Group Therapy" (CBGT) is a phrase
you will see perhaps more than any other, regarding
psychotherapy treatments for SAD. I didn't
think I could face a group situation like that before
Klonopin (and once dropped out of a therapy group that
wasn't even for SAD treatment) but I bet I could now
(too bad very few exist specifically for SAD) and
judging by your comments I'll bet you could too, or
maybe you don't need it and the self-help will be enough.
If you've read this far, thanks, and I hope some of it helps.One request for Billb:
From your comments, clon. must have been as good or better
for you even that it is for me (and it's darn good for me -
right now, you'd have to pry it out of my cold, dead hands
to take it from me.)
Can you tell us about one or two positive experiences
you've had since it kicked in? I think many people would
get a boost from reading something like that.> SAD in SC
SAD in SD
Posted by Billb on October 26, 2000, at 12:57:45
In reply to Re: AndrewB, S.D., and JohnL, posted by AndrewB on October 18, 2000, at 13:00:34
I am, I'll keep you posted on my doc. hunt. Thanks, Bill
Posted by Billb on October 26, 2000, at 13:17:18
In reply to Re: clonazepam, etc.(Re: AndrewB, S.D., and JohnL) » Billb, posted by S.D. on October 23, 2000, at 21:19:59
SD, thanks for all of the great info. I appreciate it.
> Can you tell us about one or two positive experiences you've had since it kicked in? I think many people would get a boost from reading something like that.
>
[Positive experiences, general: feeling calmer around other people and feeling like they actually want to talk to me. Feeling calmer but not zonked, like when I have tried xanax. Xanax sure killed the anxiety but also seemed to subdue the personality.Positive experiences, specific: Because I feel more like "myself" in public, I'm more relaxed and more open to BE myself and let others see my flaws, defects, ect. Because of this increased openess, lightning up, etc., I'm more fun to be around. Not bragging but, lets face it, I can't be much fun when I'm tense and afraid to open my mouth to avoid committing ANY mistakes or social blunders.
In part because of the above, I have developed a few close relationships with friends in the last few months and these new deeper, trusting relationships are priceless to me.
Professionally, definate improvements in speaking up and taking a lead (less afraid to show that I am human and make mistakes). But these profesional gains pale in comparision with the few personal relationships I have developed in the last few months, and will have forever, because I was able to break through that outer protective shell and develop a deeper and trusting relationship with a few special people.
Thanks again for all of your help. The Pdoc hunt continues.
Posted by Didier on October 26, 2000, at 13:53:56
In reply to Re: clonazepam, etc.(Re: AndrewB, S.D., and JohnL), posted by Billb on October 26, 2000, at 13:17:18
You described being afraid to open your mouth; afraid to make ANY social mistakes plunders. And this is why clonzepam or Klonopin is great. Because the drug allows you to be you and unafraid.
Since I am just the opposite in my personality and was prescribed clonzepam (which I mistakenly said was Klonopin on this board), I wonder if this is why I had such a horrible experience on the drug. I mean, they locked me away and treated me with another drug to treat the symptoms that were created by the clonzepam. I was very confused while I was on the drug, yes, this is true. But I did not handle money right and made terrible decisions that has left me with a terrible financial mess; not to even mention the medical bills. I said all sorts of stuff that came to mind without caring for those around me. I did not seem to be aware that what I said may effect other people. And as I stated before, I could not even make a phone call on a pay phone.
So, is this why someone may be prescribed this drug, to get them to open up with people? Cuz, if it is, I need a drug that shuts me up. I have always realized that even though I may be diplomatic, I have never had any instincts about holding my tongue. I mean, I am farly old now. Over the years, I have practiced to hold my tongue. Maybe this is why I am messed up today? I do not know. I really want to blame my problems on the acrylic polymer medium I was using for 4 months before this anxiety disorder was diagnosed but no such luck.
I am glad you have found something to help you be you and to share with others.
> SD, thanks for all of the great info. I appreciate it.
>
> > Can you tell us about one or two positive experiences you've had since it kicked in? I think many people would get a boost from reading something like that.
> >
> [Positive experiences, general: feeling calmer around other people and feeling like they actually want to talk to me. Feeling calmer but not zonked, like when I have tried xanax. Xanax sure killed the anxiety but also seemed to subdue the personality.
>
> Positive experiences, specific: Because I feel more like "myself" in public, I'm more relaxed and more open to BE myself and let others see my flaws, defects, ect. Because of this increased openess, lightning up, etc., I'm more fun to be around. Not bragging but, lets face it, I can't be much fun when I'm tense and afraid to open my mouth to avoid committing ANY mistakes or social blunders.
>
> In part because of the above, I have developed a few close relationships with friends in the last few months and these new deeper, trusting relationships are priceless to me.
>
> Professionally, definate improvements in speaking up and taking a lead (less afraid to show that I am human and make mistakes). But these profesional gains pale in comparision with the few personal relationships I have developed in the last few months, and will have forever, because I was able to break through that outer protective shell and develop a deeper and trusting relationship with a few special people.
>
> Thanks again for all of your help. The Pdoc hunt continues.
Posted by Billb on October 26, 2000, at 22:05:38
In reply to Re: clonazepam, etc.(Re: AndrewB, S.D., and JohnL), posted by Didier on October 26, 2000, at 13:53:56
Didier, thanks for the feedback. Nobody needs a drug to "hold thier toungue". In my opinion. Everyone's chemistry is different so every drug effects everyone differently. If Klonopin, or clonazipam (generic name) effects you badly then your doctor needs to try something else. Many people respond to chemicals differently. Stay positive, find a doctor you are comfortable with, and do not read posts like mine to mean that this is normal. I have reason to believe that I am very abnormal in my response to medications. Hang in there. My thoughts are with you!
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