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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by 3 Beer Effect on December 19, 2001, at 3:47:37
I am a social phobic who is attending a chemical dependency/alcohol & depression rehabilitation program at a mental hospital on an outpatient basis. The psychiatrist prescribed 25 mg of Asendin (amoxapine) at bedtime and told me to stay on my previously prescribed dose of klonopin 0.5 mg in the morning and 0.5 mg at night. He plans to increase the amoxapine & only prescribed that low of a dose because I objected to taking this old tricyclic antidepressant. I don't know hardly anything about old tricyclic antidepressants except that I read almost no one uses them anymore because the newer antidepressants are safer & the old tricyclics are rife with side effects.
Anyways, I tried to talk him into giving me a high dose of Remeron instead (60 or 75 mg)- Asendin is supposed to be somewhat sedating like Remeron but not as much as Remeron. I have previously taken Remeron 45 mg and slept 17 hours per day, could not get out of bed for class etc, so I thought at 60 or 75 mg of Remeron the norepinephrine has to kick in and get rid of that excessive sleep. But anyways, I am tired of arguing with psychiatrists & doctors so I am going to try this asendin stuff even though I am somewhat apprehensive.
I don't think any antihistamine side effects like dry mouth will bother me so much b/c I used to take Benadryl to sleep all of the time & that never bothered me, but it does say that asendin has neuroleptic action which I think means anti-psychotic? The problem with that is that sometimes neuroleptics can cause irreversible tardive diskensia (involuntary muscle movements/spasms). In other words, if you get tardive diskensyia you are a weirdo/outcast for the rest of your life & everyone is afraid of you or thinks you are a psycho.
Does anyone have any experience with asendin? any efficacy for social phobia?
My doctors keep trying to treat me for depression & basically ignoring & not diagnosing me for my social phobia (which I believe is my main problem). I think the depression I've suffered was simply because of insomnia & nervous reactions i've had to all of the anti-depressants they've tried like all of the SSRIs & most notably Effexor XR. I am much happier when I just take Klonopin only with no anti-depressant, but I think the dose of Klonopin i'm on 1 mg/day is much too low to be effective for social phobia- if I ask for more I get the standard crapola line "Klonopin is a very addictive medicine" that is not supported by any of the research, or by my own experience. (How a drug that takes 2 hrs to work, causes no euphoria or instant gratification, & half of the time you can't even tell its working or not can be an addictive drug is beyond me. (I think bad publicity from the overprescribing of Valium in the 1960s and from Xanax & Ativan, all of which cause instant gratification has warped doctors' brains into thinking all benzodiazepines are the spawn of the devil & considering the medicines used to treat social phobia are very few & far between this anti-benzodiazpine attitude is a great tragedy of modern psychiatry).
I think I may resort to self medication in a few years (buying Klonopin by mail order from Australia- which may be illegal since Klonopin is a controlled substance IV) because of my frustration with psychiatrists & doctors.
Posted by IsoM on December 19, 2001, at 13:39:47
In reply to Asendin (amoxapine)? Also my 2 cents about doctors, posted by 3 Beer Effect on December 19, 2001, at 3:47:37
A number of years ago when the only SSRI available was Prozac (it did nothing for me even after 1 1/2 months on it except for constant nausea), I was prescribed amoxapine. It worked pretty well for me but had the rapid heart-beat, constipation, & dry mouth problems usually associated with tricyclics. No twitches or any other problems for me. I didn't sleep more on it either. Because it wasn't a bad med for me doesn't mean you would breeze through it though, but I preferred it over desipramine & imipramine at that time.
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> I am a social phobic who is attending a chemical dependency/alcohol & depression rehabilitation program at a mental hospital on an outpatient basis. The psychiatrist prescribed 25 mg of Asendin (amoxapine) at bedtime and told me to stay on my previously prescribed dose of klonopin 0.5 mg in the morning and 0.5 mg at night. He plans to increase the amoxapine & only prescribed that low of a dose because I objected to taking this old tricyclic antidepressant. I don't know hardly anything about old tricyclic antidepressants except that I read almost no one uses them anymore because the newer antidepressants are safer & the old tricyclics are rife with side effects.
>
> Anyways, I tried to talk him into giving me a high dose of Remeron instead (60 or 75 mg)- Asendin is supposed to be somewhat sedating like Remeron but not as much as Remeron. I have previously taken Remeron 45 mg and slept 17 hours per day, could not get out of bed for class etc, so I thought at 60 or 75 mg of Remeron the norepinephrine has to kick in and get rid of that excessive sleep. But anyways, I am tired of arguing with psychiatrists & doctors so I am going to try this asendin stuff even though I am somewhat apprehensive.
>
> I don't think any antihistamine side effects like dry mouth will bother me so much b/c I used to take Benadryl to sleep all of the time & that never bothered me, but it does say that asendin has neuroleptic action which I think means anti-psychotic? The problem with that is that sometimes neuroleptics can cause irreversible tardive diskensia (involuntary muscle movements/spasms). In other words, if you get tardive diskensyia you are a weirdo/outcast for the rest of your life & everyone is afraid of you or thinks you are a psycho.
>
> Does anyone have any experience with asendin? any efficacy for social phobia?
>
> My doctors keep trying to treat me for depression & basically ignoring & not diagnosing me for my social phobia (which I believe is my main problem). I think the depression I've suffered was simply because of insomnia & nervous reactions i've had to all of the anti-depressants they've tried like all of the SSRIs & most notably Effexor XR. I am much happier when I just take Klonopin only with no anti-depressant, but I think the dose of Klonopin i'm on 1 mg/day is much too low to be effective for social phobia- if I ask for more I get the standard crapola line "Klonopin is a very addictive medicine" that is not supported by any of the research, or by my own experience. (How a drug that takes 2 hrs to work, causes no euphoria or instant gratification, & half of the time you can't even tell its working or not can be an addictive drug is beyond me. (I think bad publicity from the overprescribing of Valium in the 1960s and from Xanax & Ativan, all of which cause instant gratification has warped doctors' brains into thinking all benzodiazepines are the spawn of the devil & considering the medicines used to treat social phobia are very few & far between this anti-benzodiazpine attitude is a great tragedy of modern psychiatry).
> I think I may resort to self medication in a few years (buying Klonopin by mail order from Australia- which may be illegal since Klonopin is a controlled substance IV) because of my frustration with psychiatrists & doctors.
Posted by Guinnee Pig on December 19, 2001, at 14:21:28
In reply to Asendin (amoxapine)? Also my 2 cents about doctors, posted by 3 Beer Effect on December 19, 2001, at 3:47:37
As far as Klonopin not being addictive...I know for a fact from watching a close family member try to come off of it that It Is Very Addictive and made her extremely ill, confused, etc...until she tried to kill herself. She is a little better now and refuses to take klonopin ever again--No matter how difficult it gets. We'll see.
Posted by stjames on December 19, 2001, at 14:23:48
In reply to Asendin (amoxapine)? Also my 2 cents about doctors, posted by 3 Beer Effect on December 19, 2001, at 3:47:37
TCA's are still the most effectve AD's for more significant depressions.
Posted by OldSchool on December 19, 2001, at 19:14:11
In reply to Asendin (amoxapine)? Also my 2 cents about doctors, posted by 3 Beer Effect on December 19, 2001, at 3:47:37
> I am a social phobic who is attending a chemical dependency/alcohol & depression rehabilitation program at a mental hospital on an outpatient basis. The psychiatrist prescribed 25 mg of Asendin (amoxapine) at bedtime and told me to stay on my previously prescribed dose of klonopin 0.5 mg in the morning and 0.5 mg at night. He plans to increase the amoxapine & only prescribed that low of a dose because I objected to taking this old tricyclic antidepressant. I don't know hardly anything about old tricyclic antidepressants except that I read almost no one uses them anymore because the newer antidepressants are safer & the old tricyclics are rife with side effects.
>
> Anyways, I tried to talk him into giving me a high dose of Remeron instead (60 or 75 mg)- Asendin is supposed to be somewhat sedating like Remeron but not as much as Remeron. I have previously taken Remeron 45 mg and slept 17 hours per day, could not get out of bed for class etc, so I thought at 60 or 75 mg of Remeron the norepinephrine has to kick in and get rid of that excessive sleep. But anyways, I am tired of arguing with psychiatrists & doctors so I am going to try this asendin stuff even though I am somewhat apprehensive.
>
> I don't think any antihistamine side effects like dry mouth will bother me so much b/c I used to take Benadryl to sleep all of the time & that never bothered me, but it does say that asendin has neuroleptic action which I think means anti-psychotic? The problem with that is that sometimes neuroleptics can cause irreversible tardive diskensia (involuntary muscle movements/spasms). In other words, if you get tardive diskensyia you are a weirdo/outcast for the rest of your life & everyone is afraid of you or thinks you are a psycho.
>
> Does anyone have any experience with asendin? any efficacy for social phobia?
>
> My doctors keep trying to treat me for depression & basically ignoring & not diagnosing me for my social phobia (which I believe is my main problem). I think the depression I've suffered was simply because of insomnia & nervous reactions i've had to all of the anti-depressants they've tried like all of the SSRIs & most notably Effexor XR. I am much happier when I just take Klonopin only with no anti-depressant, but I think the dose of Klonopin i'm on 1 mg/day is much too low to be effective for social phobia- if I ask for more I get the standard crapola line "Klonopin is a very addictive medicine" that is not supported by any of the research, or by my own experience. (How a drug that takes 2 hrs to work, causes no euphoria or instant gratification, & half of the time you can't even tell its working or not can be an addictive drug is beyond me. (I think bad publicity from the overprescribing of Valium in the 1960s and from Xanax & Ativan, all of which cause instant gratification has warped doctors' brains into thinking all benzodiazepines are the spawn of the devil & considering the medicines used to treat social phobia are very few & far between this anti-benzodiazpine attitude is a great tragedy of modern psychiatry).
> I think I may resort to self medication in a few years (buying Klonopin by mail order from Australia- which may be illegal since Klonopin is a controlled substance IV) because of my frustration with psychiatrists & doctors.I wouldnt take Ascendin. That is an older Tricyclic antidepressant that also has built in anti-psychotic properties (D2 receptor blocking). Its an antidepressant tailor made for psychotic depression. Ascendin has a high risk of TD and EPS...problems you dont need. Mood disordered people are at higher risk for developing movement disorders than are people whose primary problem is a psychotic disorder ie; schizophrenia.
Isnt there another drug or combination of drugs you could take that is safer? Atypical anti-psychotics are much safer than these older type anti-psychotics. Many people combine low dose atypical anti-psychotics with modern class antidepressants...this is much safer than taking an older med like Ascendin. Keep in mind the type of anti-psychotic mechanism built into Ascendin is the old style "typical" anti-psychotic mechanism, again high risk of movement disorders.
IMO, the risk of movement disorders just isnt worth taking these older type anti-psychotic meds unless you are all the way psychotic and probably hospitalized. Movement disorders is serious biz...its a problem you do not want.
Old School
Posted by Elizabeth on December 28, 2001, at 13:31:11
In reply to Asendin (amoxapine)? Also my 2 cents about doctors, posted by 3 Beer Effect on December 19, 2001, at 3:47:37
Hi. It's not all that unusual for people with social anxiety to get in trouble with alcohol and other drugs (which drugs did you have problems with, BTW?). What is unusual is for social phobics to be treated with tricyclics. It's pretty well known that the response rate to TCAs in social phobia is much lower than the response rate to MAOIs. I believe that for patients with social phobia (with or without comorbid depression or panic disorder) or atypical depression, MAOIs should generally be tried before TCAs and that TCAs should be considered a last resort.
I tried amoxapine once -- with Parnate -- and found I couldn't tolerate it once I got up to 75 mg/day. I had the same experience with nortriptyline and it's turned out I probably don't metabolize TCAs normally (due to an enzyme deficiency). The side effects I recall were vivid dreams, constipation, dry mouth, and appetite stimulation -- mainly anticholinergic and antihistaminic side effects. I don't know why, but all the TCAs I've tried (as well as some of the antipsychotics, Risperdal in particular) have given me vivid and sometimes unpleasant dreams. This isn't due to the histaminic or cholinergic receptor blockade, I don't think. Anyway, you should probably find it more tolerable assuming you're a normal metabolizer. If you have trouble with low doses, you might try getting your serum level checked -- if you're like me, a low dose might be all you need to get a therapeutic serum level.
Amoxapine is a somewhat unusual TCA in that it has dopamine antagonist (i.e., antipsychotic) effects as well as the usual TCA effects (NE reuptake inhibition and antagonism at various receptors), but I wouldn't expect it to be any more effective than the rest of them for social phobia or atypical depression. It might be worth it for you to try it, but I think MAOIs would be a better choice if you haven't tried them already and if you've had no success with newer ADs (SSRIs, Effexor, etc.).
I don't recommend arguing with the doctor, but I do think that he owes you an explanation for why he's trying a tricyclic for someone with social phobia and why amoxapine in particular. Amoxapine is less likely than the old antipsychotic drugs to cause extrapyramidal reactions (movement disorders), but all antipsychotics available today carry this risk to some degree and I don't think antipsychotic drugs should be used unless they definitely help the person (they do help many people who aren't psychotic, BTW). If the doctor things you need an antipsychotic, IMO he should try an antipsychotic (one of the newer ones like Geodon or Seroquel, preferably).
It also sounds like you need to emphasize that the social anxiety is the thing that you really need to get treated for. Unfortunately, addiction specialists seem to be even more likely than the average pdoc to consider benzos "out of the question." I think that a lot of this idea that benzos are "addictive" comes from a misunderstanding of what "addiction" is -- people, even doctors, believe that withdrawal symptoms upon discontinuing a drug are evidence that a person is "addicted" to it. (See, for example, Guinnee Pig's post.) It's been well established that anxiety patients treated with benzodiazepines almost never abuse their medication, and often take *less* than the prescribed amount, not more. (I don't know if there's any research specifically on patients with anxiety disorders and histories of substance abuse. This would be interesting. My prediction is that patients receiving adequate treatment (i.e., an effective dose) would not abuse the benzos, especially if slow-acting benzos like clonazepam were used.)
It might help if you can get the doctors to understand that your substance abuse was an attempt at self-medication. Another thing you might try would be to dig up some of the research on benzos (Klonopin is the best tested one, probably) for social phobia and present it to your doctors -- the researchers used much higher doses than what you're getting now. Some people do okay on as little as 0.5 mg/day, but others need quite a bit more. (Some people also need to take it 3 times a day to achieve the maximum benefit.) Here are a few references:
Davidson JR, Potts N, Richichi E, Krishnan R, Ford SM, Smith R, Wilson WH. Treatment of social phobia with clonazepam and placebo. J Clin Psychopharmacol 1993 Dec;13(6):423-8.
Davidson JR, Ford SM, Smith RD, Potts NL. Long-term treatment of social phobia with clonazepam. J Clin Psychiatry 1991 Nov;52 Suppl:16-20.
Reiter SR, Pollack MH, Rosenbaum JF, Cohen LS. Clonazepam for the treatment of social phobia. J Clin Psychiatry 1990 Nov;51(11):470-2.
Ontiveros A, Fontaine R. Social phobia and clonazepam. Can J Psychiatry 1990 Jun;35(5):439-41.
Best of luck to you in getting the help you need. I know it can be really hard once you've been labelled a "drug abuser," but don't give up hope.
-elizabeth
This is the end of the thread.
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