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Dr. Bob is Robert Hsiung, MD,
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Posted by Rocket Jackson on November 2, 2002, at 12:00:25
In reply to Re: Klonopin/Provigil combo for SP! » Rocket Jackson, posted by viridis on November 2, 2002, at 0:19:13
> I can see how that would work -- I took 1 mg Klonopin and 100 mg Provigil together for a while. But the diagnosis was different -- panic disorder, ADD, and major depression. Klonopin was (and continues to be) great for panic/anxiety, but Provigil didn't really do it for ADD. However, Provigil was stimulating without added anxiety, and did make me more assertive (which I imagine -- for someone with SP -- could equate to greater confidence in social situations).
>
> Now I take K and Adderall. The Adderall is better for me for focus/concentration and has an additional calming effect at low doses (as well as being a great antidepressant). My pdoc says that Provigil is very hit-or-miss for various conditions, with certain people responding extremely well. He considers it very safe, alone or together with benzos. It's great that this combo is working for you!Hi Viridis,
Thanks for the info. I'm definitely glad you've found a combo that is working for you! As we all know, it sure can be tough sometimes. But I'm happy for ya and wish you all the best!
Rocket
Posted by Rocket Jackson on November 2, 2002, at 12:03:02
In reply to Re: Klonopin/Provigil combo for SP! » Rocket Jackson, posted by Kari on November 2, 2002, at 7:27:25
> Interesting- thanks for the idea.
> BTW, does provigil act as a dopamine agonist?Hi Kari,
That's a great question. I wish I had the answer! From my research, it appears to be unclear how this works, other than in general as a CNS stimulant. Kinda scary that we have no idea where they're going in the brain and how they work! But if I find out something, I'll be sure to post it.
Take care,
Rocket
Posted by Rocket Jackson on November 2, 2002, at 12:14:48
In reply to social phobia, posted by Kari on November 2, 2002, at 7:36:46
> Are there different types of social phobia? For instance, can it be assumed that the SP suffered by schizoids or schizotypals would be helped by reducing dopamine, while the more "purely anxious" types would necessitate an increase in this neurotransmitter? I know it isn't that simple, but...any thoughts on this?
> Thanks.Hi Kari,
I definitely think you're right on on your theory. It makes sense that that there are different types of SP, even with observation of myself and posts from others on this forum. "Depressive" SP seems to be pretty common, for which the SSRIs would theoretically work quite well in, plus the dopamine agonism as you mentioned. But I could see it getting pretty complicated in cases where SP coexists with such disorders as schizoid and schizotypal PDs. I'm sure dopamine would need to be blocked in certain areas of the brain but unaffected/stimulated in others.
As for me, I think I have the "purely anxious" type of SP. For this reason I gave Wellbutrin a try, as its mechanism of action appears to include a reuptake inhibition of dopamine. But I experienced zero benefit from it (I actually think I was more anxious, and even quite irritable :)) But I'm considering a trial with something like selegiline or the like in the future. We'll see!
Just curious: do you have SP? What seems to be working best for you?
Take care,
Rocket
Posted by disney4 on November 2, 2002, at 13:11:04
In reply to Re: Klonopin/Provigil combo for SP!, posted by Rocket Jackson on November 2, 2002, at 12:03:02
I also take Neurontin for bipolar disorder, and my Dr mentioned a possible switch to the Gabatril. I have read some really strange reports on this site, and am afraid to make the switch, although I have read some very positive reports as well. I know people all respond differently, but I think the Neurontin is inherrantly safer than the Gabatril, due to the way its metabolized. What is your opinion on this?
Elsie
Posted by BK on November 2, 2002, at 13:17:31
In reply to Re: social phobia, posted by Rocket Jackson on November 2, 2002, at 12:14:48
Rocket,
I've really enjoyed your messages! I suffer from SP, depression and ADD -a real nice combination as you can well imagine. The only medication that provided any relief was Nardil, albeit only for four months. After which time it completely pooped-out and actually made me more anxious. Since that time, about 15 years ago, I've tried just about everything out there. I recently tried Paxil CR and it made me anxious and I just couldn't focus or concentrate on anything. I stopped it after only 1 week. I almost always give a drug a full two months to be certain that I've given it sufficient time to work.
Anyway, the Rocket combo seems something worth investigating. I've tried Provigil it didn't really seem to help. I've thought about using Klonopin and will give it a try independently and then try augmenting with Provigil. Thanks again for sharing your experiences.
Posted by Rocket Jackson on November 2, 2002, at 14:11:29
In reply to Re: Klonopin/Provigil combo for SP!, posted by disney4 on November 2, 2002, at 13:11:04
> I also take Neurontin for bipolar disorder, and my Dr mentioned a possible switch to the Gabatril. I have read some really strange reports on this site, and am afraid to make the switch, although I have read some very positive reports as well. I know people all respond differently, but I think the Neurontin is inherrantly safer than the Gabatril, due to the way its metabolized. What is your opinion on this?
> ElsieHi Elsie,
I, too, am a little confused on the Neurontin vs. Gabatril issue. There seems to be way quite a lot more anecdotal information out there on Neurontin than with Gabatril.
The info I received from a doc at a Pysch conference a few months back on Gabatril made it seem as if this is the new "wonder drug" for anxiety. He, in fact, was of the strong opinion that Gabatril is much cleaner than Neurontin due to its precise mechanism of action (GABA reuptake inhibition) and fewer "dirty" effects on other parts of the system. He also harped on the dosing issue in that Gabatril is only once, possibly twice per day as compared to Neurontin's multiple regimen. But he couldn't emphasize more the importance of the lower doses that are sufficient for anxiety treatment. He has found that the optimum ranges for anxiety are between 4-8mg (sometimes up to 12mg), and that it should be taken with food to alleviate the nausea and dizziness that seems to be common. So I'm gonna try it and find out! I'll let you know!
Of course, I have no stake in either one of the drugs (re-reading my post makes me look like a Gabatril rep :)), so I'll be as candid as possible with my experiences. I'm actually hoping the Gabatril will work so I won't have to take it as many times per day. But ultimately whatever works will have to do!
Please keep me up-to-date if you decide to make the switch to Gabatril. I definitely understand your reluctance to switching. Hopefully one will hit the spot!
Take care,
Rocket
Posted by Rocket Jackson on November 2, 2002, at 14:20:32
In reply to Re: social phobia, posted by BK on November 2, 2002, at 13:17:31
> Rocket,
>
> I've really enjoyed your messages! I suffer from SP, depression and ADD -a real nice combination as you can well imagine. The only medication that provided any relief was Nardil, albeit only for four months. After which time it completely pooped-out and actually made me more anxious. Since that time, about 15 years ago, I've tried just about everything out there. I recently tried Paxil CR and it made me anxious and I just couldn't focus or concentrate on anything. I stopped it after only 1 week. I almost always give a drug a full two months to be certain that I've given it sufficient time to work.
>
> Anyway, the Rocket combo seems something worth investigating. I've tried Provigil it didn't really seem to help. I've thought about using Klonopin and will give it a try independently and then try augmenting with Provigil. Thanks again for sharing your experiences.
>Hi BK,
I hope this combo ends up working for you. Don't you hate the whole "poop out" phenomenon? I'm afraid that what I find to be working now will eventually poop out as well. But hopefully taking it off and on might keep my brain "guessing." We'll see...
I think you'll most likely see some benefit from the Klonopin alone, but hopefully it won't end up exacerbating your depression. It sometimes makes me feel depressed a little later in the day if I take it in the morning, but this may be just an early side effect that my body will eventually get used to. The problem is, I'm trying not to take it daily just in case it doesn't work in the future like it does now. But there's quite a few posters out there for whom daily Klonopin for years has maintained its positive effects. I'll keep my fingers crossed! But for now the Provigil is definitely balancing it out.
Best of luck with your drug "trials." :) Please let me know how it turns out.
Take care,
Rocket
Posted by jyl on November 2, 2002, at 16:25:40
In reply to Re: social phobia, posted by Rocket Jackson on November 2, 2002, at 14:20:32
i tried paxil
trazodone
now on effexor-150mg
cant seem to find any sort of relief from this hell...
no side effects..
no nothing!
jyl
Posted by chad_3 on November 2, 2002, at 18:31:18
In reply to Re: Klonopin/Provigil combo for SP!, posted by Rocket Jackson on November 2, 2002, at 12:03:02
Rocket -
I noticed some sort of interaction between provigil and klonopin also. Provigil seems to act kind of like a serotonin 3 agonist, and partial da agonist.
The PDR does state Provigil antagonizes Clozapine. I noticed that provigil - like wellbutrin and dhea - also reduced the effectiveness of Propecia I was taking. This was couple years ago - i do not care for dhea but think that wellbutrin and provigil would more likely have potential utility in polypharmacy - all just IMO since you bring up 2 useful meds I think for SP - especially the radically awesome Klonopin.
Later dude - keep up the good work Doc - you add something new to the crew here!
Chad
http://www.socialfear.com/
Posted by Rocket Jackson on November 2, 2002, at 21:33:07
In reply to Provigil partial synergy with Klonopin, posted by chad_3 on November 2, 2002, at 18:31:18
> Rocket -
>
> I noticed some sort of interaction between provigil and klonopin also. Provigil seems to act kind of like a serotonin 3 agonist, and partial da agonist.
>
> The PDR does state Provigil antagonizes Clozapine. I noticed that provigil - like wellbutrin and dhea - also reduced the effectiveness of Propecia I was taking. This was couple years ago - i do not care for dhea but think that wellbutrin and provigil would more likely have potential utility in polypharmacy - all just IMO since you bring up 2 useful meds I think for SP - especially the radically awesome Klonopin.
>
> Later dude - keep up the good work Doc - you add something new to the crew here!
>
> Chad
> http://www.socialfear.com/
>
>
>Hi Chad,
Thanks for the info. I'm always fascinated with this kind of stuff, particularly from experienced and knowledgeable posters such as yourself. Considering Wellbutrin's mechanism of action, I was hoping it, along with Klonopin, would prove to be an effective combo. But it sure did nothing for me personally. In fact, I found myself much more irritable and anxious, the latter which certainly didn't benefit the SP all that much. :) And I even felt as if the WB was antagonizing the Klonopin to some extent, as I wasn't experiencing near the benefit as I was with K alone. Perhaps this combo might work for others.
And by the way, your website is great! It's nice to see an informative site out there on this frustrating condition. You, too, keep up the great work!
Rocket
P.S. I know I've read this in previous posts, but what do you find is working best for you at this point?
Posted by Rocket Jackson on November 2, 2002, at 21:38:46
In reply to help help help » Rocket Jackson, posted by jyl on November 2, 2002, at 16:25:40
> i tried paxil
> trazodone
> now on effexor-150mg
> cant seem to find any sort of relief from this hell...
> no side effects..
> no nothing!
> jylHello,
Sorry to hear about your frustrations. I definitely know how you feel. Perhaps in the near future we'll finally have that one, amazing wonder drug that'll cure us all!
Have you tried Klonopin yet? Both the literature and anecdotal experience suggest this is one of, if not the best med for SP. I can certainly attest to this claim. I would highly recommend suggesting this option to your doc if you haven't tried it yet.
Nardil also appears to work well, but many have mentioned an apparent "poop out" eventually. I haven't personally tried it.
Again, sorry about your situation. Keep us posted on any progress.
Rocket
Posted by utopizen on November 3, 2002, at 1:01:00
In reply to help help help » Rocket Jackson, posted by jyl on November 2, 2002, at 16:25:40
> i tried paxil
> trazodone
> now on effexor-150mg
> cant seem to find any sort of relief from this hell...
> no side effects..
> no nothing!
> jyltrazodone? I've only heard of it here- and for sleeping.
well anyway, I'm on Effexor. I tried for 6 wks with Effexor 150, and no side effects, no good effects, no nothing.
My SP is just as bad. So I upped it to 225 yesterday. I'm giving it 6 more weeks. You've invested a lot of time already in Effexor. And who knows, it might not work even at higher doses. But you should give a higher dose a shot, especially since you don't have to worry about side effects.
good luck! :)
Posted by Kari on November 3, 2002, at 10:20:14
In reply to Re: social phobia, posted by Rocket Jackson on November 2, 2002, at 12:14:48
Hi Rocket,
Thanks for your response.
You say Welbutrin made you anxious. Have you ever tried an SSRI? If your problem is mainly anxiety, perhaps that would work better for you than a dopamine agonist. Were you prescribed Provigil for SP?
I suffer from SP as well as depression, OCD and ADD. I am also either schizoid or schizotypal and don't know how much of the SP can be explained by the personality disorder.
So far I haven't come across anything really effective for social phobia. Nardil helped for several days but then made it worse. A combination of an SSRI and Klonopin helped some but the Klonopin had to be stopped since it worsened my depression. Perhaps taking an SSRI with an anti-psychotic would work but it seems to be too risky (not only depression but also an increased risk for TD). Provigil sounds interesting but taking it would probably necessitate adding a DA blocker as well.
I'm glad you had a positive experience with the combo and hope it keeps up.
Take care,
Kari.
Posted by disney4 on November 3, 2002, at 10:24:27
In reply to Re: social phobia » Rocket Jackson, posted by Kari on November 3, 2002, at 10:20:14
Hi,
What is a DA blocker?
Thanks,
Elsie
Posted by chad_3 on November 4, 2002, at 1:52:49
In reply to Re: help help help, posted by Rocket Jackson on November 2, 2002, at 21:38:46
Rocket Jackson ....
Where did you go?
Did you want to know my regimen buddy?
People here calling for your help!!!!
Chad2
Posted by chad_3 on November 4, 2002, at 1:54:09
In reply to Re: help help help, posted by chad_3 on November 4, 2002, at 1:52:49
DR. JACKSON?
> Rocket Jackson ....
>
> Where did you go?
>
> Did you want to know my regimen buddy?
>
> People here calling for your help!!!!
>
> Chad2
>
Posted by Kari on November 4, 2002, at 13:22:34
In reply to Re: social phobia » Kari, posted by disney4 on November 3, 2002, at 10:24:27
Hi Elsie,
DA blockers are dopamine blockers, otherwise known as antipsychotic or neuroleptic drugs.
Posted by disney4 on November 4, 2002, at 16:01:18
In reply to Re: social phobia » disney4, posted by Kari on November 4, 2002, at 13:22:34
Thanks for the info.
I have been struggling with the depressive side of my bilpoar disorder lately. After test driving a few AD's I am going to try uping the dosage of my fish oil supplement. I also am changing brands to Health from the Sun, which has been used in some of the research. My brand was working, but there were a few things about it that I didn't feel comfortable about. I am hoping this will help. If not, I am considering a switch from Neurontin to Gabatril.
Posted by Kari on November 5, 2002, at 13:07:03
In reply to Re: social phobia » Kari, posted by disney4 on November 4, 2002, at 16:01:18
> I have been struggling with the depressive side of my bilpoar disorder lately. After test driving a few AD's I am going to try uping the dosage of my fish oil supplement. I also am changing brands to Health from the Sun, which has been used in some of the research. My brand was working, but there were a few things about it that I didn't feel comfortable about. I am hoping this will help. If not, I am considering a switch from Neurontin to Gabatril.
Good luck with the switch:)
Posted by Tepiaca on November 5, 2002, at 16:19:23
In reply to Re: social phobia » Rocket Jackson, posted by Kari on November 3, 2002, at 10:20:14
I was taking Zoloft with and antypsichotic Seroquel , are you sure that there is a higher
risk to suffer Tardive Diskinesia . Where did you
read that ? Im so afraid , because maybe I go
back to the Same combo.
Thanks
Posted by Kari on November 6, 2002, at 8:28:48
In reply to Re: social phobia Robert Jackson, posted by Tepiaca on November 5, 2002, at 16:19:23
Hi,
I heard about the increased risk for TD from several sources. I don't recall precisely but one of them may have been this board:)
Posted by Rocket Jackson on November 6, 2002, at 23:17:23
In reply to ROCKET JACKSON DISAPPEARS!!!!!!, posted by chad_3 on November 4, 2002, at 1:54:09
Hey everybody,
I'm really sorry about my short hiatus from the forum. I had an interview in the midwest and didn't return until late Monday night. Sorry about that!
As for the Klonopin/Provigil combo, it's still continuing to work well. However, I have noticed less of the sort of "buzz" I was originally feeling on it. It wasn't necessarily a euphoric type buzz, but more of a "who cares what anyone thinks I'm just gonna go for it" type buzz, which is certainly what I like! But this sort of confirms my theory that I shouldn't take it on a daily basis. I'm hoping to limit it to once or twice weekly if I can. Still waiting on the Gabatril and Neurontin to arrive to see if one of them will fill the gaps...
Again, sorry for my short absence from the forum. But I'm back and ready to keep this great thread going! ;)
Rocket
Posted by Rocket Jackson on November 6, 2002, at 23:39:57
In reply to Re: social phobia » Rocket Jackson, posted by Kari on November 3, 2002, at 10:20:14
> Hi Rocket,
> Thanks for your response.
> You say Welbutrin made you anxious. Have you ever tried an SSRI? If your problem is mainly anxiety, perhaps that would work better for you than a dopamine agonist. Were you prescribed Provigil for SP?
> I suffer from SP as well as depression, OCD and ADD. I am also either schizoid or schizotypal and don't know how much of the SP can be explained by the personality disorder.
> So far I haven't come across anything really effective for social phobia. Nardil helped for several days but then made it worse. A combination of an SSRI and Klonopin helped some but the Klonopin had to be stopped since it worsened my depression. Perhaps taking an SSRI with an anti-psychotic would work but it seems to be too risky (not only depression but also an increased risk for TD). Provigil sounds interesting but taking it would probably necessitate adding a DA blocker as well.
> I'm glad you had a positive experience with the combo and hope it keeps up.
> Take care,
> Kari.
>Hi Kari,
Thanks for the post. No, I haven't actually tried an SSRI, and probably most likely never will. I just really have a problem with the side effects so many people seem to be experiencing, namely the sexual problems and weight gain. So I guess I'm going for the sort of "circuitous" route in finding an effective med(s) other than an SSRI.
My decision to try Provigil for SP was based on some anecdotal evidence from this forum a while back (chad I think?). He suggested a reasonable synergism between it and Klonopin that really made sense, so I thought I'd give it a try. And luckily I have a doc whose willing to try different meds out with me no matter what their "official" FDA indications.
Your situation certainly seems to provide quite a dilemma in terms of treatment options. Though I'm definitely not a psychiatrist, it does sort of seem like your SP might be a manifestation of one of the personality disorders. The reps of the newer antipsychotics such as Geodon (ziprasidone) claim that they have lower incidences of some of the nasty side effects like TD, but who knows. But the problem there is in addition to DA blockade, it also antagonizes serotonin, which would obviously adversely affect your OCD, depression, and possibly SP. I would be very interested to hear what a doc might say in regards to a combo of one of the newer antipsychotics and an SSRI. Perhaps I'll run that by one of my attendings when I rotate through inpatient psych in December.
Thanks again for your post. I truly hope you'll be able to find a good regimen to help alleviate your problem. Keep us all posted!
Rocket
Posted by Rocket Jackson on November 6, 2002, at 23:43:13
In reply to Re: help help help, posted by chad_3 on November 4, 2002, at 1:52:49
> Rocket Jackson ....
>
> Where did you go?
>
> Did you want to know my regimen buddy?
>
> People here calling for your help!!!!
>
> Chad2
>Hey Chad,
Sorry for my absence. I had an interview out-of-state and didn't return until late Monday night. But now I'm back and excited to continue with the thread!
I'm definitely still interested to hear your current regimen and some of your ideas about any future "trials" you might have in mind...
Good to be back,
Rocket
Posted by Kari on November 7, 2002, at 8:11:04
In reply to Re: social phobia, posted by Rocket Jackson on November 6, 2002, at 23:39:57
Hi Rocket,
Welcome back!
Thanks for your post and for your suggestions. If only there would be a DA blocker with "normal" side effects as the only risk! :)
Regarding the weight gain which SSRIs can cause, it shouldn't necessarily be that much of a problem. Some people find they gain weight on one SSRI and not another. I gained some weight on Luvox in the past but lost all of it after discontinuing the drug (with no effort on my part). As for the other side effects- I don't know. Perhaps it depends on the dosage.
I hope you find the right combo which will work for you.
Take care,
Kari.
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