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Dr. Bob is Robert Hsiung, MD,
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Posted by Phillipa on February 10, 2005, at 19:39:50
In reply to Re: What's working well for social anxiety these days?, posted by med_empowered on February 10, 2005, at 19:14:01
Adderal and Provigil, to my limited understanding, are much more potent than wellbutrin. Or am I wrong? Fondly, Phillipa
Posted by Rocket Jackson on February 10, 2005, at 23:03:31
In reply to Re: What's working well for social anxiety these days?, posted by med_empowered on February 10, 2005, at 19:14:01
> Tell me more about provigil, if you could please...I'm really interested in it. I like adderall, don't get me wrong, but I'd like to augment my current dose (60mgs) without adding more adderall to the mix, and Wellbutrin kind of scares me.
Provigil is a weird one. How's that for a ringing endoresement? In a nutshell, it is a non-amphetamine with no apparent dependency potential (I only take it on occasion, so I couldn't tell you if this is entirely true) that promotes a sense of alertness and wakefullness without overt anxiety or "wiredness." Though I haven't tried adderall or the like, from what I read (and from some experience taking it) Provigil is much more mild. Some feel it actually isn't doing much if anything at all, so I guess results may vary. All I know is it seems to alleviate the pesky sedation from the Klonopin and in a way sort of "isolate" its anxiolytic effect.
Posted by gromit on February 11, 2005, at 4:54:32
In reply to Re: What's working well for social anxiety these days? » med_empowered, posted by Phillipa on February 10, 2005, at 19:39:50
I'll have to second this, methamphetamine and provigil both helped my social anxiety greatly. I'm not generally anxious, only in some social situations. Both of these drugs speed up and clarify my thinking. Valium, which is the only benzo I've tried made me even more uncomfortable. Anything that slows my thought process increases the chance that I will freeze up and say something really stupid.
Rick
Posted by med_empowered on February 11, 2005, at 8:34:59
In reply to Re: What's working well for social anxiety these d, posted by gromit on February 11, 2005, at 4:54:32
hey! I think its true that stimulants help with anxiety, or at least are pro-social. When I just took Klonopin, people said my voice could sometimes be flat and I just seemed cold and distant...when I added adderall and later tapered the klonopin in favor of buspar, I got anti-anxiety effects+ a bump in energy, concentration, and the "ooomph" needed to socialize. Unfortunately, my current psychologist doesn't believe me...when I told him about the effects I experienced from adderall, he flat out told me he didn't think it was true and that I was either lying or just lucky not to experience side-effects. Ugh.
Posted by Optimist on February 11, 2005, at 9:34:31
In reply to Re: What's working well for social anxiety these d, posted by med_empowered on February 11, 2005, at 8:34:59
I'm not sure if you're looking for something new or not but the MAOIs Parnate and especially Nardil are supposed to be the best for social anxiety. Mix that with a benzo like Clonazepam or Xanax and you're set.
Brian
Posted by Rocket Jackson on February 11, 2005, at 14:35:32
In reply to Re: What's working well for social anxiety these d, posted by med_empowered on February 11, 2005, at 8:34:59
Will a psychiatrist or primary care physician prescribe something like adderall for social anxiety disorder? I would love to try this in addition to the Klonopin +/- the Provigil, but would be a little hesitant to ask for it. Being in the medical profession, I know how physicians will often immediately put up a red flag when a patient requests a controlled substance such as this. But if it helps it shouldn't matter, right?
Posted by sabre on February 11, 2005, at 15:14:43
In reply to Re: What's working well for social anxiety these d, posted by Rocket Jackson on February 11, 2005, at 14:35:32
I have found valium is the only drug that has helped social anxiety but like Rick, I couldn't stand the mental slowness and sedation it induces. I have just trialled the supplement glutamine and to me it felt like speed. (see alternative babble)
I think perhaps the glutamine converted to glutamate causing excitation in the brain but perhaps I have a problem converting glutamate to GABA and so there is reduced inhibition.It might be woth a try for those who can't or don't want to get stimulant drugs. I suspect combining glutamine with an anti convulsant or valium could be useful for some.
I just wish they would bring out the valium drugs minus the sedation and brain damage!!
sabre
Posted by SLS on February 11, 2005, at 15:50:25
In reply to What's working well for social anxiety these days?, posted by Rocket Jackson on February 10, 2005, at 17:41:18
I know this is bound to be an unpopular choice, but Effexor has shown some efficacy for SA recently. I would consider using it in combination with Klonopin.
- Scott
Posted by med_empowered on February 11, 2005, at 16:08:58
In reply to Re: What's working well for social anxiety these days?, posted by SLS on February 11, 2005, at 15:50:25
hey! yeah, shrinks are weird about controlled substances. If you say "hey, I can't leave my house...for the love of god, gimme a little klonopin," they get upset/suspicious/etc. Now, if they freely come to the conclusion that you need Klonopin, Adderall, whatever, that's completely different, of course. It sucks. It makes me think of my ideal psychiatric relationship, proposed by Thomas Szasz: The relationship would be consensual, and contractual. The shrink would use his/her expertise to help you improve your life through therapy and the use of any available substances the two of you thought might be helpful (in his model, everything would be readily available). There wouldn't be "mental illness" labels; psychiatry would just exist to help people live and live well. Simple, right? Anyway, to answer somebody's question about asking your shrink for adderall, why not? I told an old shrink I wanted a stimulant, if only provigil, b/c all the meds I was on were turning me narcoleptic and underproductive. He said no, I found a new shrink. Simple as that.
Posted by gromit on February 11, 2005, at 16:19:07
In reply to Re: What's working well for social anxiety these d, posted by med_empowered on February 11, 2005, at 8:34:59
> Unfortunately, my current psychologist doesn't believe me...when I told him about the effects I experienced from adderall, he flat out told me he didn't think it was true and that I was either lying or just lucky not to experience side-effects. Ugh.
My doc is the one who prescribed provigil and still didn't believe me when I told him it helped, it even helped me sleep better as long as I took it early enough, maybe because I was more active and my mind was more active during the day. It kind of pooped out on me though and he's doesn't want to give me any other stims.
Posted by SLS on February 11, 2005, at 16:25:02
In reply to Re: What's working well for social anxiety these days?, posted by SLS on February 11, 2005, at 15:50:25
> I know this is bound to be an unpopular choice, but Effexor has shown some efficacy for SA recently. I would consider using it in combination with Klonopin.
If the anxiety is part of a depressive disorder, using Remeron or one of the tricyclics might help. Nortriptyline would probably be my first choice for a TCA. Doxepin and Amitripyline are sedating and might also be considered.
- Scott
Posted by banga on February 11, 2005, at 16:34:56
In reply to Re: What's working well for social anxiety these days?, posted by SLS on February 11, 2005, at 16:25:02
With nortryptiline--is it less activating than desipramine then? And again about weight--does it seem like desipramine is less notorious than nortryptiline for weight gain? It seems to be the case for me...
Posted by Phillipa on February 11, 2005, at 16:49:09
In reply to Re: What's working well for social anxiety these days? » SLS, posted by banga on February 11, 2005, at 16:34:56
I still don't understand how a stimulant can help social anxiety, or any anxiety at all unless you're ADD or ADHD. Please explain. I looked it up on a "search" and it was only indicated for narcolepsy. I know drugs are used for other purposes, but does it have a paradoxical reaction? Also, when I took valium years ago it didn't dull my mind, it just relaxed me enough so that I could concentrate, and be social. Fondly, Phillipa
Posted by med_empowered on February 11, 2005, at 17:02:26
In reply to Re: What's working well for social anxiety these days?, posted by Phillipa on February 11, 2005, at 16:49:09
hey! You're right that no stimulant is yet FDA approved as adjunctive therapy or anything else for anxiety, and conventional wisdom holds that stimulants=anxiety, depressants=less anxiety. And you're right...benzos can clear your head. When my mind was racing left and right with anxiety, Klonopin stopped it and cleared my head. My personal theory, just based on my own experience, is that sometimes stimulants aren't so much anti-anxiety as they are pro-social, pro-self-confidence, etc...its indirect. Amphetamines in particular are known for giving a slight bump in one's outlook when given in appropriate doses (this is why they were used for depression and sometimes are used to augment anti-depressant therapy). Sooo, here's my theory: benzos are known to relieve anxiety through GABA, which inhibits to some extent the release of a number of neurochemicals. Barbiturates do pretty much the same thing, and things like neurontin..well, nobody really knows about that. BUT, look at the success of SSRIs for anxiety; they're now first-line treatment for mild-to-moderate anxiety. They BOOST serotonin. They don't tranquilize the anxiety away; they get rid of it by boosting feel-good chemicals in your brain, so some people who take them feel considerably less anxious. Now, amphetamines cause the release of a number of neurochemicals, most notably dopamine, and then they act to block the re-uptake of these same just-released chemicals, so your brain cells kind of soak in their own feel-good juices. What you get, assuming there aren't underlying problems like psychosis or drug-addiction or heart disease to complicate the picture, and assuming the dosing is done correctly, is improved overall MOOD and OUTLOOK, and enhanced concentration and motivation. Again, there are all kinds of problems with amphetamines-some people abuse them to no end, some people get anxious, some people get high blood pressure, some people go psychotic (usually a sign of abuse, but it can happen at prescribed doses). That said, for most of people, small doses of amphetamine are pleasant...add an anxiolytic, like Klonopin, in carefully calibrated doses to the amphetamine, and you end up killing off excess sedation (thanks to the amphetamine), preventing jitteriness or nervousness (thanks to the sedative), and, hopefully, balancing quelling anxiety with improving concentration/motivation. In the past, when barbiturates ruled the earth and drug companies pushed the hard stuff, there were all kinds of sedative+barbiturate combos for both dieting (appetite suppression without the jitters of pure stimulants) and depression (mood elevation with minimal sedation or jitteriness). Among these were: Dexamyl (amytal+dexedrine), desbutal, and, I think, Eskatrol.
Posted by Michael Bell on February 11, 2005, at 19:12:59
In reply to What's working well for social anxiety these days?, posted by Rocket Jackson on February 10, 2005, at 17:41:18
Posted by Phillipa on February 11, 2005, at 19:48:46
In reply to Tried everything - Nardil best, Klono close 2nd (nm) » Rocket Jackson, posted by Michael Bell on February 11, 2005, at 19:12:59
Med-empowered; That's very interesting. It made me remember way back after I had given birth to my son who is 36 just to give you an idea. I was already slim, but I wanted to lose "just l0lbs". At the time, stimulants were't condemmed and my OBGYN, whose wife was a friend, gave me a 30 day supply of an upper {can't remember what but it was considered a diet aid}. I remember energy that was astounding. I washed the windows every day. I only took the pills every other day as I wanted to conserve them. I remember at the end of the 30 days having trouble falling asleep. At the time, I did not exhibit any signs of anxiety or depression, and as a matter of fact, was the happiest I've ever been. I never believed I would have a son, and he slept through the night from ll till 9am at 2 wks old, and to top that he never cried. He was the perfect baby. No problems in my life at that time. I wonder what happened that about 3 yrs later I experienced my first Panic attack when I was 22? Fondly, Phillipa
Posted by gromit on February 11, 2005, at 23:10:43
In reply to Re: What's working well for social anxiety these days?, posted by Phillipa on February 11, 2005, at 16:49:09
> I still don't understand how a stimulant can help social anxiety, or any anxiety at all unless you're ADD or ADHD. Please explain. I looked it up on a "search" and it was only indicated for narcolepsy. I know drugs are used for other purposes, but does it have a paradoxical reaction? Also, when I took valium years ago it didn't dull my mind, it just relaxed me enough so that I could concentrate, and be social. Fondly, Phillipa
I don't know how it works but it does for me. I guess it's self-confidence and feeling if a spontaneous conversation starts I won't do or say something to humiliate myself. Or even worse stand there making a trout mouth while I'm trying to think what to say. Everyone is so different, when I took valium within 2 days I was in a real bad place. It was prescribed as a muscle relaxant and at the time I wasn't even depressed, just in alot of pain.
I suspect that I do have ADHD but my diagnosis is MDD + excessive daytime sleepiness.
Rick
Posted by banga on February 11, 2005, at 23:55:23
In reply to Re: What's working well for social anxiety these d, posted by gromit on February 11, 2005, at 23:10:43
I definitely have paradoxical reactions...klonopin sent me spiralling down back into deep, weeping all day depression and anxiety. Adderall does calm me, though I feel it is for at least some part because it cuts through the haze in my mind, the one that creates anxiety for me as I wonder just how brain-damaged I am...
Posted by tecknohed on February 12, 2005, at 1:10:53
In reply to Re: What's working well for social anxiety these days? » Rocket Jackson, posted by Phillipa on February 10, 2005, at 17:48:15
> I still don't understand how an upper can help anxiety. Can you explain as I have yet to find a combo that works. Fondly, Phillipa
High. Was just browsing through the posts when your question caught my attention. I suffered with extremely bad Social Phobia until just over a year ago (almost gone now, thanks to my beloved Nardil).
I also used to take illicit drugs to cope with it. Amphetamine was always my favourite drug of choice! I would go from being this scared, introvert, shy boy who sat in the corner on his own and say very little, to suddenly feeling alive, strong and confident and be able to talk and talk and talk and talk...........
I think that (for me at least),the reason a stimulant can work for Social Anxiety is that a big part of the problem is slow cognitive function. You cant think of what to say, your mind will go blank, etc. A stimulant can open some of these blocked pathways to make thinking much quicker whilst the added "buzz" gives confidence so you worry less about what you do say.
I would say this is probably why some of the "smart" drugs work also - cognitive enhancement.
Of corse, Social Phobia/anxiety is in a class of its own and stimulants will no doubt worsen many other types of anxiety.
Hope I've made some sense.
Kevin.
Posted by Buckeye Fan on February 12, 2005, at 5:42:36
In reply to Re: What's working well for social anxiety these days? » Phillipa, posted by tecknohed on February 12, 2005, at 1:10:53
The best pro-social "drug" that appears to work in 90percent of the population is....good old fashioned alcohol! Think about it....it lowers your inhibitions, and can turn a shy guy into the life of the party.
So...my point is this.
Shouldnt the pharmacutical Companies produce something very similiar to the properties in alcohol..WITHOUT the negative by-products of alcohol consumption?
Just a question.....BF
Posted by SLS on February 12, 2005, at 9:01:46
In reply to Re: What's working well for social anxiety these days? » SLS, posted by banga on February 11, 2005, at 16:34:56
> With nortryptiline--is it less activating than desipramine then? And again about weight--does it seem like desipramine is less notorious than nortryptiline for weight gain? It seems to be the case for me...
I think your depiction of the two drugs is generally true. However, I think the weight problem with either of these drugs is less than what one would expect from a very serotonergic drug. However, if desipramine is the better match for one's neurodysregulation, it will have a greater anxiolytic effect than would nortriptyline. Currently, I think there is a trend towards treating symptoms rather than a putative core pathology. What seems to get confused sometimes is that these symptoms can be used to define subtypes of disorders and choose medications with a greater chance of working rather than simply treating each symptom palliatively.
- Scott
Posted by banga on February 12, 2005, at 11:16:07
In reply to Re: What's working well for social anxiety these days?, posted by SLS on February 12, 2005, at 9:01:46
Thanks!
I feel better having chosen desipramine over nortryptiline.
I am beginning to think al neurotransmitters are underactive in me, and all need a boost. I am sure the adderall is doing this. But I also thought--I can "make" anafranil, which helped me a lot once before pooping out--by taking desipramine and luvox.
I know anafranil supposedly is a dirty SSRI, but its metabolite, as you may know, is actually an extremely potent norepinephrine reuptake inhibitor. So I think i do need a bit of both. Effexor and cymbalta however aren't for me.Do you know how much desipramine affects 5ht2a, compared to anafranil?
Posted by SLS on February 12, 2005, at 12:35:39
In reply to Re: What's working well for social anxiety these days? » SLS, posted by banga on February 12, 2005, at 11:16:07
> Thanks!
> I feel better having chosen desipramine over nortryptiline.
> I am beginning to think al neurotransmitters are underactive in me, and all need a boost. I am sure the adderall is doing this. But I also thought--I can "make" anafranil, which helped me a lot once before pooping out--by taking desipramine and luvox.
> I know anafranil supposedly is a dirty SSRI, but its metabolite, as you may know, is actually an extremely potent norepinephrine reuptake inhibitor. So I think i do need a bit of both. Effexor and cymbalta however aren't for me.
>
> Do you know how much desipramine affects 5ht2a, compared to anafranil?
I'm afraid I don't. Either "Sad Panda" or "King Vultan" would be good sources of this information. Unfortunately, I haven't seen them post here in quite a while.
- Scott
Posted by ed_uk on February 12, 2005, at 14:14:11
In reply to Re: What's working well for social anxiety these days? » SLS, posted by banga on February 12, 2005, at 11:16:07
> Do you know how much desipramine affects 5ht2a, compared to anafranil?
Desipramine has a lower affinity for 5-HT2a receptors than clomipramine. You'll be getting some 5-HT2a antagonism from the Abilify though.
Ed.
Posted by drbill on February 21, 2005, at 16:24:21
In reply to Re: What's working well for social anxiety these days?, posted by med_empowered on February 10, 2005, at 19:14:01
Well, aside from benzos, I think that Effexor is probably the best of the FDA approved SAD meds, but Lexapro is probably the best overall (fewer side effects). I, however, have had increasingly delayed orgasm with the Lexapro at 20mg, so I've just been switched over to Cymbalta. To early to comment.
Here's the last 6 years of meds for social anxiety in a nutshell:
Lexapro at 15-20 mg worked pretty well, little or no sleepiness after 12 week adjustment, but increasingly harder to have an orgasm at 20 mg.
Effexor 225 mg worked well, but anorgasmia (delayed) and some sleepiness as well.
Zoloft 100 mg was fair, but *very* sleepy and anorgasmia.
Prozac 40 mg was only moderately helpful, but somewhat sleepy and mild anorgasmia.
Serzone did nothing for me.
Gabatril did nothing for me, except make me need less of the benzos when I did take them.
Wellbutrin gave me EXTREMELY PAINFUL (horrible burning sensation) and very dangerous hives and swelling (had to go to the ER), though I've since heard its the extended release coating on the tablet that people are allergic to.
Clonazepem seems to work the best of the benzos, but the only other one I've tried is Lorazepem. Dose of Klonopin is 1/2 to 2 .5mg tabs.
The beta blocker propranolol works well for racing heart, sweating, dry mouth, etc., effects of public speaking. I take 40 mg, but as few as 10-20 can help.
All in all, I'd recommend Lexapro at higher doses with benzos and beta blockers PRN, but I hope Cymbalta does the trick without the sexual side effects.
This is the end of the thread.
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