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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Tom Twilight on June 27, 2005, at 16:09:24
Hey everyone
My Social Anxiety is really getting me down at the moment :(
SA doesn't seem to be much talked about on the board these days.
I’m wondering if the good people of Babbleland have any new ideas for treating SA?
I’m looking beyond the usual SSRI/Benzo ideas hereFor simplicities sake I’m going to summarise all the treatments I’ve tried:
SSRIs/SNRIs: Venlafaxine, Fluoxetine, Citalopram none of these really helped, Citalopram helped a little but I didn’t like the side effects.
Clomipramine: Helped a bit, horrible side effects
Moclobemide: Didn’t help
Mirtazapine: Somewhat helpful, caused weight gain
Dexedrine: Didn’t help much
Tramadol: Didn’t help
Pregabalin/Lyrica: Worked great for a couple of days, then pooped out
Diazepam: Didn’t really help, made me feel lazy
Clonazepam: Wiped out SA, but left me feeling very sleepy and depressed
Amisulpride: Didn’t help
GHB: Works great, my treatment of choice for a while, risk of addiction, rebound anxiety and the fact that its illegal work against it.
Phenibut: Worked great, then pooped out
I guess the next step would be Phenelzine, I’m just a bit hesitant about trying such a powerful med, for one thing the weight gain worries me!
I’m a bit reluctant to try another Benzo because of the risk of tolerance, also there almost impossible to get prescribed long term in the UK.
Posted by Declan on June 28, 2005, at 5:02:22
In reply to Social Anxiety Treatment, Thinking Outside the Box, posted by Tom Twilight on June 27, 2005, at 16:09:24
Hi Tom
I guess I've got SA. I've got depression as well. I'm going for low dose Parnate. Won't be as good as Nardil for SA, but the s/e will be OK. I just won't expect too much of it, and that way I'll keep the dose low, especially in the beginning. At least that is my resolution. Today I took 10mg/1 tablet. Relief within the hour, and lasted all day.
Declan
Posted by ed_uk on June 28, 2005, at 5:51:19
In reply to Re: Social Anxiety Treatment, Thinking Outside the Box, posted by Declan on June 28, 2005, at 5:02:22
>Today I took 10mg/1 tablet. Relief within the hour, and lasted all day.
Really? Tell us more.......
Kind regards
~Ed
Posted by Jazzed on June 28, 2005, at 6:58:06
In reply to Re: Social Anxiety Treatment, Thinking Outside the Box » Declan, posted by ed_uk on June 28, 2005, at 5:51:19
Do you all do therapy as well as meds for SA?
What helps more the meds or the therapy?
Anyone here have a CBT therapist? How's that working or not working for you?If you were doing therapy, and no meds for the SA, would you ask for meds? Or would you just stick with the therapy? I have meds for anxiety (Xanax), but it doesn't help with the SA stuff, just the general physical symptoms.
Jazzy
Posted by mike84 on June 28, 2005, at 8:45:12
In reply to Social Anxiety Treatment, Thinking Outside the Box, posted by Tom Twilight on June 27, 2005, at 16:09:24
There are a variety of treatments for SA, some legal, some illegal. Please, don't use illegal drugs and try to self-medicate yourself. This is very dangerous. If SSRI's and Benzo's have had little effect, talk to your doctor about going on an antipsychotic such as Risperdone or Zyprexa. Antipsychotics are not just used for psychosis...It is actually indicated for severe social anxiety. An SSRI with a small dose of risperdone should be very effective. The thing about phenalzine is that you have to be on a very careful diet, and there are little medications that you can mix with MAOI's.
Posted by SLS on June 28, 2005, at 8:45:35
In reply to Re: Social Anxiety Treatment, Thinking Outside the Box, posted by Declan on June 28, 2005, at 5:02:22
> I guess I've got SA. I've got depression as well. I'm going for low dose Parnate. Won't be as good as Nardil for SA,
Unless you have already tried it, there is no way of knowing for sure that Parnate will not have a robust anti-anxiety effect. People often overlook Parnate for SA because of all the good press that Nardil gets. For some people, Parnate is all they need.
I don't know the logic in purposely limiting the dosage of Parnate. I think you should titrate the drug clinically (with your eyes closed), and arrive at the right dosage based on results, and not target low dosages. If dosages of </= 30mg don't work, keep going.
It is interesting that you felt better after a single dosage of Parnate. Do you react the same way after a single dosage of Adderall or any other stimulant? Don't be discouraged if this initial stimulant-like improvement doesn't persist for more than a few days. It is not a predictor of how you will respond at therapeutic dosages.
- Scott
Posted by Tom Twilight on June 28, 2005, at 11:53:59
In reply to Re: Social Anxiety Treatment, Thinking Outside the Box, posted by SLS on June 28, 2005, at 8:45:35
As always SLS offers some of the best advise on the board
Its Interesting that Declan responded so well to Parnate.
Unfortunatly in the UK the Maximun dosage of Parnate is allowed is 30mg, and thats for hospital inpatients!Tranylcypromine in social phobia.
Versiani M, Mundim FD, Nardi AE, Liebowitz MR.
Department of Psychiatry, Federal University of Rio de Janeiro, Brazil.
Thirty-two patients meeting DSM-III criteria for social phobia entered a 1-year drug treatment with tranylcypromine in dosages between 40 and 60 mg/day. After exclusion of the early dropouts, improvement was rated as marked and moderate in 62% and 17% of the sample (N = 29), respectively. Alcohol abuse was associated with a poor outcome. Side effects were frequent and in some cases delayed the attainment of efficacious dosages until the third month of treatment. No serious adverse reactions occurred. The findings, relative to efficacy, are in accordance with a previous trial with phenelzine but need confirmation in double blind controlled studies.
Posted by ed_uk on June 28, 2005, at 13:39:14
In reply to Re: Social Anxiety Parnate, posted by Tom Twilight on June 28, 2005, at 11:53:59
Hi Tom :-)
The UK manufacturer doesn't specify a maximum dose as such. They make the rather vague statement.... 'doses above 30mg should be given under close supervision only'. Hopefully, if your doctor has a brain, s/he will titrate the dose based on how you respond :-) Does your doc have a brain? Mine doesn't :-O
Perhaps you could reassure your doc by pointing out the the 'official' maximum dose in the US is 60mg........and some people successfully take much more!!
Kind regards
~Ed
Posted by Tom Twilight on June 28, 2005, at 15:04:22
In reply to Re: Social Anxiety Parnate » Tom Twilight, posted by ed_uk on June 28, 2005, at 13:39:14
> Hi Tom :-)
>
Hey Ed
Thanks for replyMy doc NHS doc isn't supid, but rather evil!
Seriously I need to find a private doc ASAP
I've been feeling quite bad for the last few days, so much for being medication free!
Posted by Declan on June 28, 2005, at 15:12:49
In reply to Re: Social Anxiety Treatment, Thinking Outside the Box, posted by SLS on June 28, 2005, at 8:45:35
Hi Scott and everyone
I do respond favourably to amphetaminey thingos, but not especially well, and once I've had them in my system for greater than 3 or so hours I need Valium, alcohol, whatever. Good for Saturday nights and not much else. My hazy recollection of Parnate 25 years ago was that the initial stimulant effect was not so strong or long lived. It could be the deprenyl (2mg yesterday, 1st day of Parnate), but I don't think so. It is probably the SAMe (800mg am) that somehow has already increased the available neurotransmitters and therefore potentiated the Parnate. The moclobemide was like this too. I never took more than 75mg in the morning. If I'd taken 300+mg/d I too would have been in bed, all curled up.
So I dunno. Maybe I'm sensitive to excessive stimulation. Maybe the SAMe has primed me such that I have reacted more strongly to these 2 MAOIs. In any case it makes a lot of sense to keep the dose of any drug to a minimum. I can always increase it later. And I shall tell myself 3 times a day not to be greedy, and not to screw around with the dose. (Thanx Ace and Willy there)
And yes, the effect is good for SA. But like I get stuck. Don't want to go in, can't leave, mostly feeling engulfed with people. Sometimes can't walk down the street. How do you walk *past* people? My vectors must be out of whack...I walk into people, not just people, I walk into dogs. You know when you can't get passed because you both go the same way each time. Well like that sometimes happens to me with dogs.
Will keep you all informed.
Declan
Posted by willyee on June 29, 2005, at 13:10:04
In reply to Re: Social Anxiety Treatment, Thinking Outside the Box, posted by mike84 on June 28, 2005, at 8:45:12
> There are a variety of treatments for SA, some legal, some illegal. Please, don't use illegal drugs and try to self-medicate yourself. This is very dangerous. If SSRI's and Benzo's have had little effect, talk to your doctor about going on an antipsychotic such as Risperdone or Zyprexa. Antipsychotics are not just used for psychosis...It is actually indicated for severe social anxiety. An SSRI with a small dose of risperdone should be very effective. The thing about phenalzine is that you have to be on a very careful diet, and there are little medications that you can mix with MAOI's.
Wow i actualy believe in the opposite of everything you just said:
"Please, don't use illegal drugs and try to self-medicate yourself
Im not gonna advocate street drugs,but i also am not gonna plug pharmacutic drugs to be any more safer.Why because the chemical found some people willing to invest tons of money and do a vague couple of weeks trial to have it approved.Pharm drugs manipulate brain chemistry in the same way sreet drugs do,the manf doesent claim its curing or even sure its treating something they are aware of,all they know are the actions of their drug seem to help MASK certain symtpoms.We are not eve SURE at this point if there are any long term damage with any of them since they are all fairly new.How many people take their meds as directed by their docter and end up in trouble,how many EFFEXOR withdrawal horror stories are there?How many paxil horror stories are there?How many people enter detox on account of benzo addiction?Or perhaps tell the little girl who DIED due to serzone destroying her liver?
Do you not think some people medicate themselves from depression with MJ,and do it successfully,well i know of some.I find it hard to see how someone can be so abdenment in their warnings on "street drugs" when script drugs do pretty much the same thing.
Please, don't use illegal drugs and *try to self-medicate yourself*
Not everyone needs to be playing around with street drugs nor script drugs.However a LOT of people have had the system fail them,they waited the 6 weeks for their doc appointments,and got very poor treatment,they listened to their docs and allowed their bodies to ingest medication they simply knew by effect was making them worse.Long ago the main source of information came from a PDR,so a paitent was a a docters mercy.Now u have pub med,u have various newsgroups and tons of information at ur finger tips,why shouldent a intelligent individual who unlike a doc is willing and CAN invest up to and more than 90 percent of their time researching their disease,why would we limit oursleves to be at the mercy of a doc,who at best,even if he or she wanted to,can simply invest a mere fraction of that.Besides no docter as caring as they are will put in the blood and guts that someone will to their own treament,so WHY,WHY is their this constant believe that a patieant should do nothing without their docters consent?Have a doc play a role in ur treatment,but i dont see why u cant play a bigger one.
"The thing about phenalzine is that you have to be on a very careful diet, and there are little medications that you can mix with MAOI's.We have gone over this time and time and time again.Yess there are food restrictions,but we through tons of personal experieances have come to relaise that a small fraction of people will have problems with most foods on the list.
What we have come to learn that aside from those,the overwhelming MAJORITY of users will find certain foods here and there they personaly react to.
And we find that in general the reactions in the list for the most part are more *just to let u be aware* situation and most people will NOT have nearly as much trouble with half of them.
We have also come to learn through many maoi users right here at babble that many meds thought to be taboo in conjunction with maois can be used effectivly allowing the maois to have like ssris quite a few options to augment them with.
To portray them as having food interactions and not giving a full account as i just did,as well as portraying them as being so dangerous most meds cant be used with them as well to me seems very unfair.Comments like these have people terrified of them which is a shame cause many MANY people did NOT find them helpful as a last resort,instead found them to be the only med which effectivly brings relieaf and resent the time wasted in years pain and money simply because they were misled and not given the TRUE facts on these meds.
I redomend anyone who has been suffering,to talk to ur doc about these meds,email one of the maoi veteran users such as myself,or ace,or chairman,search groups like remedyfind,get real peoples expereiance with it,rather then the constant general overdated showndown incorrect information u find on very GENERAL websites.If u truly believe it might help,dont let diet restrictions stop u,instead find out how to approach the med and the meds side effects including diet restrictions.I wonder how many people now could find relieaf had they tried these so called taboo drugs.I agree with the comment on ssris and anti psych meds,however i dont believe the other information is posted with enough information.
Note: I also dont believe im on a "medication".Many street drugs are simply maois,also i know if i stop my drug my disease is not lessened or cured.I am told by my docter,and the company itself that the reason my drug makes me feel better is a matter of theory.However i accept the fact that i need to mask my symptpoms and keep them at bay,this although not a cure,still allows me to function and life a life closes to "normal" as i can get.I did the no drug thing,and life was much harder,so if i knew there was a drug,street drug or not,that helped with minimal risk,id be the first one there to get.I suffered enough,as well as a lot of u guys im sure,its time we get some relieaf even murderes get a last me eal in jail,i wanna be thrown a bisuit.
This as always,is one mans opinion,and i present it always as such.
Posted by willyee on June 29, 2005, at 13:10:24
In reply to Re: Social Anxiety Treatment, Thinking Outside the Box, posted by mike84 on June 28, 2005, at 8:45:12
> There are a variety of treatments for SA, some legal, some illegal. Please, don't use illegal drugs and try to self-medicate yourself. This is very dangerous. If SSRI's and Benzo's have had little effect, talk to your doctor about going on an antipsychotic such as Risperdone or Zyprexa. Antipsychotics are not just used for psychosis...It is actually indicated for severe social anxiety. An SSRI with a small dose of risperdone should be very effective. The thing about phenalzine is that you have to be on a very careful diet, and there are little medications that you can mix with MAOI's.
Wow i actualy believe in the opposite of everything you just said:
"Please, don't use illegal drugs and try to self-medicate yourself
Im not gonna advocate street drugs,but i also am not gonna plug pharmacutic drugs to be any more safer.Why because the chemical found some people willing to invest tons of money and do a vague couple of weeks trial to have it approved.Pharm drugs manipulate brain chemistry in the same way sreet drugs do,the manf doesent claim its curing or even sure its treating something they are aware of,all they know are the actions of their drug seem to help MASK certain symtpoms.We are not eve SURE at this point if there are any long term damage with any of them since they are all fairly new.How many people take their meds as directed by their docter and end up in trouble,how many EFFEXOR withdrawal horror stories are there?How many paxil horror stories are there?How many people enter detox on account of benzo addiction?Or perhaps tell the little girl who DIED due to serzone destroying her liver?
Do you not think some people medicate themselves from depression with MJ,and do it successfully,well i know of some.I find it hard to see how someone can be so abdenment in their warnings on "street drugs" when script drugs do pretty much the same thing.
Please, don't use illegal drugs and *try to self-medicate yourself*
Not everyone needs to be playing around with street drugs nor script drugs.However a LOT of people have had the system fail them,they waited the 6 weeks for their doc appointments,and got very poor treatment,they listened to their docs and allowed their bodies to ingest medication they simply knew by effect was making them worse.Long ago the main source of information came from a PDR,so a paitent was a a docters mercy.Now u have pub med,u have various newsgroups and tons of information at ur finger tips,why shouldent a intelligent individual who unlike a doc is willing and CAN invest up to and more than 90 percent of their time researching their disease,why would we limit oursleves to be at the mercy of a doc,who at best,even if he or she wanted to,can simply invest a mere fraction of that.Besides no docter as caring as they are will put in the blood and guts that someone will to their own treament,so WHY,WHY is their this constant believe that a patieant should do nothing without their docters consent?Have a doc play a role in ur treatment,but i dont see why u cant play a bigger one.
"The thing about phenalzine is that you have to be on a very careful diet, and there are little medications that you can mix with MAOI's.We have gone over this time and time and time again.Yess there are food restrictions,but we through tons of personal experieances have come to relaise that a small fraction of people will have problems with most foods on the list.
What we have come to learn that aside from those,the overwhelming MAJORITY of users will find certain foods here and there they personaly react to.
And we find that in general the reactions in the list for the most part are more *just to let u be aware* situation and most people will NOT have nearly as much trouble with half of them.
We have also come to learn through many maoi users right here at babble that many meds thought to be taboo in conjunction with maois can be used effectivly allowing the maois to have like ssris quite a few options to augment them with.
To portray them as having food interactions and not giving a full account as i just did,as well as portraying them as being so dangerous most meds cant be used with them as well to me seems very unfair.Comments like these have people terrified of them which is a shame cause many MANY people did NOT find them helpful as a last resort,instead found them to be the only med which effectivly brings relieaf and resent the time wasted in years pain and money simply because they were misled and not given the TRUE facts on these meds.
I redomend anyone who has been suffering,to talk to ur doc about these meds,email one of the maoi veteran users such as myself,or ace,or chairman,search groups like remedyfind,get real peoples expereiance with it,rather then the constant general overdated showndown incorrect information u find on very GENERAL websites.If u truly believe it might help,dont let diet restrictions stop u,instead find out how to approach the med and the meds side effects including diet restrictions.I wonder how many people now could find relieaf had they tried these so called taboo drugs.I agree with the comment on ssris and anti psych meds,however i dont believe the other information is posted with enough information.
Note: I also dont believe im on a "medication".Many street drugs are simply maois,also i know if i stop my drug my disease is not lessened or cured.I am told by my docter,and the company itself that the reason my drug makes me feel better is a matter of theory.However i accept the fact that i need to mask my symptpoms and keep them at bay,this although not a cure,still allows me to function and life a life closes to "normal" as i can get.I did the no drug thing,and life was much harder,so if i knew there was a drug,street drug or not,that helped with minimal risk,id be the first one there to get.I suffered enough,as well as a lot of u guys im sure,its time we get some relieaf even murderes get a last me eal in jail,i wanna be thrown a bisuit.
This as always,is one mans opinion,and i present it always as such.
Posted by Tom Twilight on June 29, 2005, at 14:18:34
In reply to Re: Social Anxiety Treatment, Thinking Outside the Box, posted by willyee on June 29, 2005, at 13:10:24
I decided to start taking GHB because the alternatives I was offered were so poor
When I saw a Pdoc about my SA he I should ever have a high dose SSRI or an Olanzapine
What a choice!SA is still not taken seriesly in the UK
Posted by willyee on June 29, 2005, at 16:32:44
In reply to Willyee is Absolutely Right!, posted by Tom Twilight on June 29, 2005, at 14:18:34
> I decided to start taking GHB because the alternatives I was offered were so poor
>
> When I saw a Pdoc about my SA he I should ever have a high dose SSRI or an Olanzapine
> What a choice!
>
> SA is still not taken seriesly in the UKI finaly got my xyrem,today has been such a relieaf,i onyl dread i have a min amount of xyrem left.
P.S I dont know why i choose willyee i think the names were taken,feel free,and if u can remeber id prefer if u guys called me plain ole will,or brklyn since thats been my handle on 90 percent of things for years,if u forget no bigger.Yay xyrem.
Posted by JochenK on June 30, 2005, at 13:19:33
In reply to Re: Social Anxiety Parnate » Tom Twilight, posted by ed_uk on June 28, 2005, at 13:39:14
> The UK manufacturer doesn't specify a maximum dose as such. They make the rather vague statement.... 'doses above 30mg should be given under close supervision only'. Hopefully, if your doctor has a brain, s/he will titrate the dose based on how you respond :-) Does your doc have a brain? Mine doesn't :-O
>
> Perhaps you could reassure your doc by pointing out the the 'official' maximum dose in the US is 60mg........and some people successfully take much more!!That ist absolutely right! I for myself went as high as 200 mg/die, while a rather limited response took place at 160 mg/die (and not before I took that much). I talked to a represantative of the drug company (in Germany) and she told me that even 1200 mg/die (yes, 1.2 g) were in one case administered before betterment was achieved. According to my psychiatrist, high doses of Parnate (= Jatrosom in Germany) even reduce the risk of spikes in blood pressure; can anyone comment on that?
Jochen
Posted by ed_uk on June 30, 2005, at 16:37:18
In reply to Re: Social Anxiety Parnate, posted by JochenK on June 30, 2005, at 13:19:33
Hi Jochen,
Is 200mg Jatrosom the most effective dose for you? Have you tried phenelzine (Nardil, Nardelzine)?
>I talked to a represantative of the drug company (in Germany) and she told me that even 1200 mg/die (yes, 1.2 g) were in one case administered before betterment was achieved.
WOW! I've never heard of anyone taking that much!
>According to my psychiatrist, high doses of Parnate (= Jatrosom in Germany) even reduce the risk of spikes in blood pressure; can anyone comment on that?
I've never heard that before.
Kind regards
~Ed
Posted by Declan on June 30, 2005, at 17:28:51
In reply to Re: Social Anxiety Parnate, posted by JochenK on June 30, 2005, at 13:19:33
Hi Jochen
How do you manage to sleep on that much Parnate? I don't sleep well normally anyway, but I find 10mg Parnate taken on *awakening* still effects my sleep adversely. Not so much deep sleep perhaps. And less overall. Still well worth it though.
Declan
Funny word, sleep, when you think about it.
Posted by JochenK on July 1, 2005, at 7:50:33
In reply to Jatrosom » JochenK, posted by ed_uk on June 30, 2005, at 16:37:18
> Is 200mg Jatrosom the most effective dose for you? Have you tried phenelzine (Nardil, Nardelzine)?
I have gone back to 160 mg of Parnate, which seems to be the most efficient dosage for me (however, the effect is very small but bigger than with anyother medication).
I have never tried phenelzine ... are there advantages over Parnate?
Jochen
Posted by JochenK on July 1, 2005, at 7:54:26
In reply to Re: Parnate and Sleep, posted by Declan on June 30, 2005, at 17:28:51
> How do you manage to sleep on that much Parnate?
Sleep is not much of a problem to me. I tend to sleep too much anyway. I have, however, tried temazepam for falling asleep, which worked pretty well.
Jochen
Posted by ed_uk on July 1, 2005, at 10:23:02
In reply to Re: Parnate » ed_uk, posted by JochenK on July 1, 2005, at 7:50:33
Hi Jochen,
>I have never tried phenelzine ... are there advantages over Parnate?
Although tranylcypromine and phenelzine are both MAOIs, people seem to find them very different. You really need to try both to find out which works best for you.
Kind regards
~Ed
This is the end of the thread.
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