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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Michael Bell on December 23, 2004, at 20:53:38
I really find that everyone on this board has great input into med combos, so I'm hoping for some advice.
In dealing with severe social phobia, let's just say I've run the gamut of meds. SSRIs, SNRIs, MAOIs, Atypical APs, Benzos, mood stabilizers, etc. Eventually, I've settled on Klonopin as the foundational med and I play with a variety of others as addition to the Klono. Currently I'm on Klono + Lamictal + Neurontin.
But I CAN'T STAND the dysthymia/anhedonia or whatever the h*ll you want to call it that klonopin causes, and nothing seems to help that. Just going through life day by day, no pleasures, no reward, no nothing. No anxiety, but no positive feelings either.
So I'm thinking of a couple things:
1) my first choice is switching to xanax: for those who've tried it, do you recommend this? I say this b/c of the supposed additional antidepressant effect. I know klono is a longer acting med, but how about xanax xr? And is the abuse potential really that much higher for xanax than klonopin?
2) second, I'm considering going back onto Nardil: when I was on it (briefly), it worked wonders for SP and there was no dythymia. But the food restrictions scared me into quitting. For those of you who've tried it, how real is the chance for hypertensive crisis, assuming I follow the prohibited food list? Also, what is the safest, fast acting drug that I can take in case a hypertensive crisis does start?
I really would appreciate some feedback. I really want to start living as opposed to just *existing*.
Thanks.
Posted by blanding on December 23, 2004, at 21:15:52
In reply to I need a change and I need some guidance please, posted by Michael Bell on December 23, 2004, at 20:53:38
Hi Michael,
Alprazolam (e.g. Xanax) is an excellent anxiolytic AND antidepressant as augmentation to one's basic meds. That's how it works for me and studies have shown likewise results.
Regarding tolerance risk to this benzo I simply take it every other day instead of daily.
With clonazepam (e.g. Klonopin) I don't have any experience, neither do I have any with MAOIs.
Posted by anxiety_free on December 24, 2004, at 4:32:02
In reply to I need a change and I need some guidance please, posted by Michael Bell on December 23, 2004, at 20:53:38
Hi! The xanax switch sounds like a winner, especially for someone who is treatment resistant. Short-acting xanax isn't all THAT addictive unless placed in the wrong hands...then things can wrong, as they can with any controlled substance. Xanax XR is supposed to be like a blissful mix of long-action and...xanax potency. If you can, try it. Personally, I would avoid the MAOIs if you can avoid it. True, alpha and/or beta blockers could be used if you encounter heart trouble, (I think that's standard treatment) but why not try out some augmentation first? I personally think you may benefit from a stimulant.
Posted by BradD on December 24, 2004, at 6:45:49
In reply to I need a change and I need some guidance please, posted by Michael Bell on December 23, 2004, at 20:53:38
Hi Michael!
I remember that you mentioned you were going to try Buprenorphine and Proglumide for Social Phobia. How did it go?
I've tried Tianeptine for my SP/dysthymia and it didnt work.
Right now I'm using Tramadol at 400-600mg/day - every other day - it is 2nd best treatment for my SP/dysthymia, 1st being Adderall+GHB (but Im unable to acquire GHB any more).Take care and merry christmas !
Brad
Posted by Michael Bell on December 24, 2004, at 7:15:35
In reply to Re: I need a change and I need some guidance please » Michael Bell, posted by BradD on December 24, 2004, at 6:45:49
>>Hi Michael!
I remember that you mentioned you were going to try Buprenorphine and Proglumide for Social Phobia. How did it go? <<
Thanks for responding, and happy holidays to you too.Re: the proglumide and buprenorphine: The proglumide was anxiolytic (though not as powerful as a benzo), completely wiped out my IBS symptoms and also took care of the pain I get in my finger, wrist and elbow joints. But it a rather weak CCK-B antagonist and is just too difficult to get and too expensive to treat long term with. However, I can say with a fair degree of confidence that a more powerful, more selective cck-b antagonist will be very effective for social phobia, once one hits the market.
The buprenorphine had some antidepressant qualitites, but it also made me feel really depersonalized, like I was observing myself the whole time. Also, it seemed to cause more anxiety rather than less, and did nothing for sociability.
Merry Christmas, Happy Hannukah, Merry Festivus, etc!
,
Posted by TheOutsider on December 24, 2004, at 10:09:07
In reply to Re: I need a change and I need some guidance please » BradD, posted by Michael Bell on December 24, 2004, at 7:15:35
I can say with a fair degree of confidence that a more powerful, more selective cck-b antagonist will be very effective for social phobia, once one hits the market.
>
> The buprenorphine had some antidepressant qualitites, but it also made me feel really depersonalized, like I was observing myself the whole time. Also, it seemed to cause more anxiety rather than less, and did nothing for sociability.
>
High Mike
Its good to see someone discussing social phobia and treatments. At the moment I;m worried that I'll never control my SA!
I have the same problems with Klonopin that you do.
I'd like to try an MAOI but am quite reluctent because of the risks.
I have no experience with Xanaz but can say from personal experience that GHB works very well for social anxiety and doesn't cause disymphia like Klonopin.Strangley enough I had a similar experience with buprenorphine as you did, I had high hopes for it but it had little positive effect on me.
I'm very interested in cck-b antagonists, I've never heard of them before, are then any plans to release any in the near future?
Posted by King Vultan on December 25, 2004, at 10:51:43
In reply to I need a change and I need some guidance please, posted by Michael Bell on December 23, 2004, at 20:53:38
I've been on both Nardil and Parnate and think the risks of a hypertensive crisis are nil if you avoid the foods that have a genuine risk of containing tyramine, such as cheddar cheese, tap beer, and sauerkraut, and the prohibited drugs, such as most of the decongestants. The key is to become aware of which foods actually pose a risk versus which ones do not. Some of the lists I've seen contain large numbers of bogus items; for instance, wine, chocolate, and yogurt are all generally okay with MAOIs, as long as they're consumed in moderation. I carry 2 x 10 mg nifedipine, a powerful calcium channel blocker, in case I suffer a hypertensive crisis, but it is more for peace of mind. I really do not expect to ever have to use it. My experience has been that once I got going on the MAOIs, I realized that the hysteria surrounding the food restrictions is vastly overblown, and it's really not that big a deal to avoid the few foods that are truly problematic.
Todd
Posted by Michael Bell on December 26, 2004, at 16:31:22
In reply to I need a change and I need some guidance please, posted by Michael Bell on December 23, 2004, at 20:53:38
In case hypertensive crisis becomes an issue, I'm just trying to sort everything out:
1) nifedipine - I hear this is the first line of defense and is quick acting, but there's the danger of the blood pressure going too low. Who recommends this drug?
2) thorazine - This is also used, and from posts I've read it does not pose the same danger as nifedipine as far has making your blood pressure too low. In fact, you can use it with normal blood pressure and it shouldn't be a problem (beyond the usual anti-psychotic issues). Is that true?
3) klonopin - this inhibits the release of norepinephrine, right? WOuld using a couple fast-acting wafers help to bring blood pressure down?
4) and finally - reboxetine: I read one study on biopsychiatry.com which claims that coadministration of reboxetine with an MAOI completely eliminated the risk of hypertensive crisis. If this is true, it's amazing, but I haven't found any other studies on this issue. Anyone have any info or experience with this?
Sorry for all the questions. I hope everybody had a nice holiday.
Posted by jparsell82` on December 27, 2004, at 8:16:05
In reply to Re: I think I'm going back to NARDIL, but...., posted by Michael Bell on December 26, 2004, at 16:31:22
> In case hypertensive crisis becomes an issue, I'm just trying to sort everything out:
>
> 1) nifedipine - I hear this is the first line of defense and is quick acting, but there's the danger of the blood pressure going too low. Who recommends this drug?
>
> 2) thorazine - This is also used, and from posts I've read it does not pose the same danger as nifedipine as far has making your blood pressure too low. In fact, you can use it with normal blood pressure and it shouldn't be a problem (beyond the usual anti-psychotic issues). Is that true?
>
> 3) klonopin - this inhibits the release of norepinephrine, right? WOuld using a couple fast-acting wafers help to bring blood pressure down?
>
> 4) and finally - reboxetine: I read one study on biopsychiatry.com which claims that coadministration of reboxetine with an MAOI completely eliminated the risk of hypertensive crisis. If this is true, it's amazing, but I haven't found any other studies on this issue. Anyone have any info or experience with this?
>
> Sorry for all the questions. I hope everybody had a nice holiday.I've been on Xanax XR & regular forms. I developed tolerances to both of them though. So, I'm currently sticking with my Klonopin although I don't always take it. I was on Nardil for 2 months a little while ago but I found it didn't provide enough relief for me as far as "social motivation". Plus, I was too tired and had some mild memory problems on Nardil. I'm now on Parnate(starting week 3) only 20-30mg/day. The side effects were bad for me on the first week of Parnate(worse than Nardil) but they aren't that bad now. I'm getting some relief from my Social Anxiety and other disorders but I'm not yet where I wanna be. Hopefully, the Parnate pro-social effects will get stronger as I increase the dose.... too early to tell. Anyways, I posted some references about Social Anxiety and the Dopamine relation below. You should especially check out the first one.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=4040468
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