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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by utopizen on December 1, 2002, at 12:21:12
I have been taking Effexor since September, now at 300mg, and have been for a few weeks. I use to be at 225, and earlier at 150.
I have social anxiety, although mild. Oddly, not responding to anything besides Klonopin, but I'd like to avoid it as much as my p-doc would (although I'll admit, if they were sold near the Blistex OTC, I would pop them daily). I've tried Paxil, Celexa, Buspar, Neurontin, and Gabitril, to no avail.
Should i add Wellbutrin, or Serzone (which I know nothing about) or something else, or just drop the Effexor? Anyone combine their Effexor for anxiety? I have no side effects from Effexor. And oddly, this new Gabitril I am trying now, it just acts as a mild sedatative, oddly similar to Benadryl's feeling on me.
Posted by comftnumb on December 1, 2002, at 12:39:41
In reply to No response to Effexor XR/300mg for Anxiety, posted by utopizen on December 1, 2002, at 12:21:12
Hey u know, your situation sounds very similar to what mine was about 4months ago. I went up to 375mg on the Effexor, and it helped only slightly with the social anxiety. With my doc we added 300mg Wellbutrin and dropped the Effexor down to 300mg. This helped greatly with the depression I was having. But my social anxiety remained high. So a month ago we added Klonopin, and that greatly improved my social anxiety, just like you. I'm on 2mg a day, how bout u? Anyways, because the Effexor/Wellbutrin isn't working well for the SA, I'm switching to Nardil, an MAOI. It is supposed to be VERY GOOD for social anxiety. Only two problems with MAOI: some people report bad side effects, and you have to washout completely from your other antidepressants, and be on no AD for a week at least (klonopin you can keep). The way I figure though, if it helps my SA, it is sooo worth it. Cause social anxiety sucks a hell of a lot. So read a bit about Nardil. Also there is Parnate, another MAOI, could have less side effects but it doesn't have the same reputation as being good for SA. Read the posts of people here about Nardil. Do a search on google.com with terms like "Nardil social anxiety" or "MAOI social phobia". Then you can make up your mind.
Hope that helps,
comftnumb
Posted by utopizen on December 1, 2002, at 16:12:57
In reply to Re: No response to Effexor XR/300mg for Anxiety, posted by comftnumb on December 1, 2002, at 12:39:41
Well of course, Klonopin will work, I mean, does Heroin fight depression? Sure thing!
Unfortunately it is habit-forming, so coming off regular use of Klonopin afford many doctors to devote entire careers over (including a doctor friend of my therapist, who has written an entire clinical book on how to wean off benzos!)
Also, I'm vegan- doesn't Nardil mean you can't have processed soy (e.g., tofu)? If that's the case, I can't even think of it, that's crazy. I've thought of Nardil, of course.
Posted by utopizen on December 1, 2002, at 16:20:30
In reply to Re: No response to Effexor XR/300mg for Anxiety, posted by comftnumb on December 1, 2002, at 12:39:41
Hey,
I'm in college now, with social anxiety- I avoid parties b/c I end up not talking to anyone anyway.
My p-doc thinks I want to use pills to over-compensate and be better than normal, and won't give Klonopin in more than small amounts for special events (.5mg, 15 doses every few months).
I'm like, I don't have a girlfriend, I'm a loser, I don't want to keep living like this. He's like, you'll just take longer to develop socially than others. Isn't this like chemical calvinism? They don't say that to depressed people, or manic-depressants, but somehow socially anxious people, you guys need to cope and live with it, it's not so bad. They have no idea.
Posted by joy on December 1, 2002, at 17:16:56
In reply to No response to Effexor XR/300mg for Anxiety, posted by utopizen on December 1, 2002, at 12:21:12
A former boyfriend of mine added Buspar to his Effexor [high dose also] and it made all the difference. He had sweating and slept a lot, but he felt good; the Buspar helped with the anxiety, very low dose first 2x day then built up. It's the only combo that worked for him.....
Joy
Posted by utopizen on December 1, 2002, at 17:36:27
In reply to Re: No response to Effexor XR/300mg for Anxiety, posted by joy on December 1, 2002, at 17:16:56
I tried Buspar by itself and it didn't work- I always wondered why Buspar combined with something tended to get good results in studies- I always assumed it was the thing it was with that was responsible, and Buspar was just a placebo along for the ride.
But maybe there's some truth to the synergy...
Posted by Willow on December 2, 2002, at 7:20:58
In reply to Adding Buspar to Effexor?, posted by utopizen on December 1, 2002, at 17:36:27
I too have been on effexor for awhile with success, but still am getting bouts of anxiety. I take clonazepam with codeine and baclofen at bedtime, and apparently this will be my combo for life unless a cure comes along. Should I need to increase the dosage of clonazepam or the codeine I will choose to cut down on them and then take a holiday from the drug, waiting for it to be affective again. COULD you not choose to use the clonazepam at an effective dosage and at the same time use cognitive therapy to help get the anxiety under control?
Whispering Willow
ps i've increased the dosage of the baclofen
Posted by joy on December 2, 2002, at 7:41:10
In reply to Adding Buspar to Effexor?, posted by utopizen on December 1, 2002, at 17:36:27
Hi. Buspar by itself works for very few people, but combined with some of the ADs, it has been known to reverse poop out, or at least give the drug a 'lift'. It probably does not work for everyone, but I know my friend was so functional with this combo, despite side effects. He told me when his Psych had him add it, the difference was really positive for him. I hope you find the answer.
Joy
Posted by utopizen on December 2, 2002, at 18:14:35
In reply to Clonazepam ..., posted by Willow on December 2, 2002, at 7:20:58
I don't get to choose to have Klonopin, I can't get it, my p-doc would feel more comfortable about putting me on anti-freeze to avoid Klonopin.
I just starting CBT. But I still think I will need Klonopin, I mean, I deserve it, if anyone, me, me, me!!! I think it's just that I'm 19, so it's like, "oh, you'll grow out of this." Sure, let the 40 year old obese soccer mom score xanax and valium by the gallon, but don't give the kid who's patiently taken every concoction possible to take for over a year to no avail the simple Klonopin, we can't have that now...
Posted by sergios_c on December 4, 2002, at 6:08:36
In reply to Clonazepam ..., posted by Willow on December 2, 2002, at 7:20:58
Tolerance to opiods (I was also just prescribed codeine 60mg TID) does NOT go away within reasonable time unless you are willing to wait a decade. There has been a study recently that ultra low dose naloxone (1/10000) prevents opiate tolerance and addiction. A pharm. company is ready to market an oxycontin/ultra low dose naloxone combo. You may search with google for that study/discovery, I do not remember the url alas. It has gotten quite some medical media attention especially in chronic pain forums and lists!
Posted by Willow on December 5, 2002, at 13:05:31
In reply to Re: Clonazepam ..., posted by utopizen on December 2, 2002, at 18:14:35
>I think it's just that I'm 19, so it's like, "oh, you'll grow out of this." Sure, let the 40 year old obese soccer mom score xanax and valium by the gallon, but don't give the kid who's patiently taken every concoction possible to take for over a year to no avail the simple Klonopin, we can't have that now...
I so feel for you. I don't understand how your age should affect the treatments available for you. As a teenager, my psychologist wanted to put me on anti-depressants and went to my gp with me. She had no luck. So I know it is out there the bias regarding age. And that slightly confused teenager turned into a neurotic middle age housewife!! AGH!
The only reason I can see which would be legit if someone had an addiction problem, which hopefully at your age you haven't suffered. Regarding the therapy, meds in my opinion can help the process work. Just talking from my own expierence!
Hang in there, things do get better!!
Willow
Posted by Willow on December 5, 2002, at 13:24:41
In reply to Re: Clonazepam ... » Willow, posted by sergios_c on December 4, 2002, at 6:08:36
I was rx'd 30mg at bedtime, so I sleep better. I only take about 15 though. I'll keep my fingers crossed that I don't have to increase the dose.
Willow
Posted by utopizen on December 5, 2002, at 17:21:02
In reply to Age ... » utopizen, posted by Willow on December 5, 2002, at 13:05:31
Yeah, I always come into his office and finish his sentences and he's like "you know, you need to stop that"
But it's Adderall! I need Klonopin simply to have psychotherapy work. He thinks I want to be "better than normal" to over-compensate for anxiety/add. Well even if that were the case, why is over-compensating such a bad thing?
Didn't Einstein over-compensate? He was a late learner. His 4th grade teacher told his parents there's no use in keeping him in school because he's retarded. I mean it seems like many geniuses are products of their over-compensations. Why is it such a demonized term?
Posted by utopizen on December 5, 2002, at 17:26:11
In reply to Opiates ... » sergios_c, posted by Willow on December 5, 2002, at 13:24:41
> I was rx'd 30mg at bedtime, so I sleep better. I only take about 15 though. I'll keep my fingers crossed that I don't have to increase the dose.
>
> WillowOkay, I'm sorry, pardon me, I never have been depressed beyond a 24 hour period... not even sure if I was depressed for 24 hours, actually.
But, why the opiates trend on this board? I mean, didn't all those heroin and cocaine and opium and alcohol-based concoctions of the turn of the century, didn't those all claim to relieve depressed persons?
I mean, yeah, Vikoden killed my anxiety when it fought my pain off, but I'm not about to use it for anxiety, though, it's too addicting for that... I don't know, I mean even amphetamines are like no-nos by most docs, who on Earth is going to give our opiates for depression when people in chronic pain have to fight tooth and nail just to get them for their pain?
Posted by sergios_c on December 5, 2002, at 17:44:59
In reply to Re: Opiates ..., posted by utopizen on December 5, 2002, at 17:26:11
> I mean, yeah, Vikoden killed my anxiety when it fought my pain off, but I'm not about to use it for anxiety, though, it's too addicting for that... I don't know, I mean even amphetamines are like no-nos by most docs, who on Earth is going to give our opiates for depression when people in chronic pain have to fight tooth and nail just to get them for their pain?
>I waited 8 years to find a doctor willing to validate my pain and treat it. I suffered 8 years overdosing on NSAIDs and effectively destroying my stomach (now I have reflux for which I have to take 40mg prilosec daily, paid out of my pocket). Just two weeks ago I was started on a pain management program, 60mg codeine/APAP TID. By the way, I found codeine to be rather depressive, not uplifting at all. At least it took away the edge of the pain.
Posted by BrittPark on December 6, 2002, at 16:05:57
In reply to Re: Clonazepam ... » Willow, posted by sergios_c on December 4, 2002, at 6:08:36
Actually, in general, tolerance to opiates declines quite rapidly with abstinence. That's why there are so many heroin deaths. Somebody gets clean and then falls off the bandwagon and ends up taking too much. Sid Vicious is perhaps the most famous example of this.
You can find out about the seemingly paradoxical efffects of low dose naltrexone or naloxone by doing a MedLine search on Crain and Chen. They are the founders of a company called Pain Therapeutics. If their formulations make it to market and prove to be as non-tolerance inducing as hoped, they will be a great boon to pain-management and perhaps to depression management. (Their is a small body of clinical research that shows that buprenorphine is sometimes effective at treating TRD patients. There are also a small number of Psychiatrists who use opioids in treatment. In general, however, broaching the subject of opiates with your average psychiatrist is likely to get you nothing but dirty looks.)
Britt
Posted by utopizen on December 6, 2002, at 16:13:58
In reply to Re: Clonazepam ... » sergios_c, posted by BrittPark on December 6, 2002, at 16:05:57
The Controlled Substances Act specifically stipulates that grounds for punishment of a doctor exists when a doctor subscribes outside of what is common among his peers. Doctors who defend themselves continously claim they were doing something like helping pain sufferers when no one else was daring to, so their peers weren't ones they felt like following. Unfortunately this defense repeatedly does not work, and these doctors enter prison and hefty fines.
Posted by BrittPark on December 6, 2002, at 16:32:26
In reply to Re: Clonazepam ..., posted by utopizen on December 6, 2002, at 16:13:58
I've never heard of doctors being sent to jail for prescribing controlled substances off-label. Amphetamines and friends are schedule 2 drugs and are prescribed quite commonly by psychiatrists off-label (as an augmentation for TRD). Of course if a doctor is writing scripts knowingly for diversion that's a different story.
Cheers,
Britt
Posted by utopizen on December 6, 2002, at 17:36:54
In reply to Re: Clonazepam ... » utopizen, posted by BrittPark on December 6, 2002, at 16:32:26
I've never said anything about off-label.
Once a drug is approved, it is able to be used for anything.
It's not the indication that's always the issue-- it's the dose and appropriateness of the medicine for the individual. Desoxyn is approved for weight loss, but that doesn't give doctors a green light to set up those weight loss Desoxyn clinics they use to have (a la Requiem for a Dream).
It simply states in the Act that doctors must prescribe in accordance to their peers. If it's inconsistent with their peers, then that can be interpreted by a judge as a violation of that Act. It would have to be pretty blatant, though, for a judge to interpret it that way. Hiring a look-out guy to ensure your patients don't sell their drugs outside your office after they pick them up from your partnering pharmacy in crime next door, yeah, that might lead to an investigation over why your patients are getting these drugs in the first place.
Actually, I'm sure they wrote "peers" as a safeguard so the DEA can't arrest doctors doing the same thing everyone else is...
This is the end of the thread.
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