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Dr. Bob is Robert Hsiung, MD,
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Posted by King Vultan on August 7, 2004, at 11:17:19
In reply to whats the best for social phobia???????, posted by woolav on August 7, 2004, at 9:56:07
Probably Nardil is the best one; I have social phobia, and it is the best out of the ten or so drugs I've tried. Nardil is very serotonergic like the SSRIs and also does something with GABA, providing an additional anxiolytic effect somewhat like the benzodiazepines do. Beyond that, Nardil also works on norepinephrine, which is also helpful for social phobia IMHO, this being based on my own experience with the three tricyclic antidepressants I tried, which were all selective norepinephrine reuptake inhibitors.
I've read people say that Parnate is also good, and I suppose I will have the opportunity to see how true that is in a few weeks when I am on it. I am near the end of tapering off Nardil, as it did not do enough for my anhedonia problems. It did not completely eliminate my social phobia but probably reduced it 90%, and I also found myself being the most sociable around people that I can ever remember.
Todd
Posted by woolav on August 7, 2004, at 12:17:42
In reply to Re: whats the best for social phobia???????, posted by King Vultan on August 7, 2004, at 11:17:19
So why are you stopping Nardil now? And did you have any issues with the food issues with MAOI's? My pdoc is afraid to prescribe parnate or nardil because she doesnt know enough about the drugs. So its just ssri's for me...
Thanks
S
Posted by cosis on August 7, 2004, at 13:07:39
In reply to whats the best for social phobia???????, posted by woolav on August 7, 2004, at 9:56:07
> Im just curious because nothing has worked for me. Tried paxil years ago, got way too "social", totally out of character for me. Everyone thought i was crazy. Tried it again and the only thing it does was make me swear like a sailor..I take xanax daily to function without paranoia, but Im curious if MAOI's are the only drug that truely work for social phobia....
> Thanks
> SNardil and beer, j/k... Nardil has worked wonders for my SAD. I recommend you try it, the diet is not hard to follow.
Posted by King Vultan on August 8, 2004, at 8:06:19
In reply to Re: whats the best for social phobia???????, posted by woolav on August 7, 2004, at 12:17:42
> So why are you stopping Nardil now? And did you have any issues with the food issues with MAOI's? My pdoc is afraid to prescribe parnate or nardil because she doesnt know enough about the drugs. So its just ssri's for me...
> Thanks
> S
Nardil is apparently not dopaminergic enough for my particular situation, as it's finally become clear from my reactions to various drugs that it's one that has a strong effect on dopamine which is what I actually need. As for the MAOIs, many doctors are afraid to prescibe them, but IMO, this only does a disservice to patients. A dedicated doctor could do some research here on this board and learn everything they would ever want or need to know about MAOIs.As for the food restrictions, they are overblown, but there are certain things that must be avoided, for instance, cheddar cheese and tap beer. The total number of prohibited items, however, is really quite small. Many of the items that show up on some lists, such as chocolate and wine, are actually okay in most instances. The MAOI diet is probably an order of magnitude less restrictive than an Atkins diet and is much easier to follow.
I personally have a bit of bias against SSRIs because while they do lift my mood, they do not solve my fundamental problem and leave me feeling flat and emotionally aloof after awhile. They are also only somewhat effective for my social phobia, perhaps reducing the problem by 50%. While they do seem to work very well for some people, I think it's a significant drawback to be limited to this one class of meds.Todd
Posted by carriejane on August 8, 2004, at 9:16:19
In reply to Re: whats the best for social phobia???????, posted by woolav on August 7, 2004, at 12:17:42
I think i have. I dont like going out, i get very anxious at the thought of it and the lead up to it. I imagine that people are looking at me and thinking horrible things about me. I never feel like i belong on this planet.
I sweat like mad when its bad, my heart races and i feel soo angry inside mixed in with the anxiety.
I hear klonopin helps, is this available on prescription in the uk?
ps i have started efexor 2 wks ago
Sorry to butt in on this conversation
Cx
Posted by Sabino on August 8, 2004, at 11:57:38
In reply to Re: whats the best for social phobia???????, posted by cosis on August 7, 2004, at 13:07:39
Cosis, I'm just curious how much Nardil do you take, and what is your dosing schedule?
I started Nardil 18 days ago, have only been doing 30mgs for about the last week. I experienced a fair amount of what I call 'brain fog'. But Nardil is also a tease, because although I often feel no benefit (or sometimes worse on it), there are times for an hour or two when I feel better, and not socially inhibited/avoidant. I just wish I could get that on a consistent basis. A week and a half til my next pdoc appt. Thinking about calling him and asking if I can increase to 45, or even 60 if need be. 30 doesn't seem to be cutting it.
... or perhaps Nardil won't work out, and I'll try Parnate next. One thing I've decided is that if Nardil isn't doing it for me after a month's trial, I'll ask to switch to Parnate. I've read of others who reacted to Nardil as I am, and had great success switching to Parnate. It's so hard trying to start a new med, with all the attendant side effects.Glad Nardil is working for you. How long did it take to kick in, and at what dose?
Thanks, Sabino
Posted by Kon on August 8, 2004, at 22:09:35
In reply to whats the best for social phobia???????, posted by woolav on August 7, 2004, at 9:56:07
> Im curious if MAOI's are the only drug that truely work for social phobia....
I'm not sure this is accurate. Two fairly recent meta-analyses suggest that the 3 major drugs used for social phobia are not significantly different wrt effectiveness. In the Blanco (2003)review, the authors write:
"Until relatively recently, pheneline (Nardil)was considered the gold standard in the treatment of SAD. However, results from the meta-analysis suggest that its efficacy is not superior to that of the SSRIs or clonazepam..."
They further write:
"Our analysis found that clonazepam, based on a single study, hadt he largest mean effect size of all medications. The effect sizes of SSRIs and phenelzine (Nardil) were similar to each other and numerically (but not statistically) smaller than those of clonazepam."
I've posted their results below...the higher the score, the more effective the drug.
1. Effect size based on Liebowitz social anxiety scale:
Benzos-1.54
Nardil-1.02
SSRIs-0.652. Effect size based on clinical global impression scale:
Benzos-16.61
Nardil-5.53
SSRIs-4.1In the end, the authors still recommend SSRIs as first-line treatment for SAD partly due to anti-depressive properties of SSRIs over benzos and better safety profile of SSRIs over both benzos and especially Nardil. I personally don't buy this argument which is why Ive chosen the benzo route.
Posted by woolav on August 9, 2004, at 13:51:15
In reply to Re: whats the best for social phobia??????? » woolav, posted by Kon on August 8, 2004, at 22:09:35
Thats interesting...I take benzo's already 2mg of xanax daily and prozac. So, perhaps I am on the best route. I know there is no "miracle" drug that is going to make every all better, but heck, maybe i am on the right track after all..
Thanks
S
Posted by JahL on August 9, 2004, at 19:07:08
In reply to whats the best for social phobia???????, posted by woolav on August 7, 2004, at 9:56:07
> Im just curious because nothing has worked for me. Tried paxil years ago, got way too "social", totally out of character for me. Everyone thought i was crazy. Tried it again and the only thing it does was make me swear like a sailor..I take xanax daily to function without paranoia, but Im curious if MAOI's are the only drug that truely work for social phobia....
> Thanks
> S
Hi.Here in the UK Sulpiride and Amisupride - selective dopamine antagonists (i.e. antipsychotics, but ones which seem to work presynaptically on certain dopamine receptors at low doses) - are highly regarded as potential solutions for social phobia, should first-line treatments (SSRIs then Nardil or perhaps Clomipramine) fail. Both my brother and I suffer from social phobia and we both enjoy significant improvements (though sadly not complete remission) on low dose Sulpiride (and nothing else). My s. phobia is particularly bad and I could not function in any meaningful way w/o Sulpiride.
Just one more idea...
Ta,
Jah.
(PS - not going to get onto the rights and wrongs of prescribing old-style antipsychotics. Ta)
Posted by JahL on August 9, 2004, at 19:23:07
In reply to have i got social phobia?, posted by carriejane on August 8, 2004, at 9:16:19
> I think i have. I dont like going out, i get very anxious at the thought of it and the lead up to it. I imagine that people are looking at me and thinking horrible things about me. I never feel like i belong on this planet.
> I sweat like mad when its bad, my heart races and i feel soo angry inside mixed in with the anxiety.
> I hear klonopin helps, is this available on prescription in the uk?
> ps i have started efexor 2 wks ago
> Sorry to butt in on this conversation
> Cx
Hi Carrie.You describe perfectly my symptoms of social phobia.
Social phobia is, amongst other things, an intense feeling of being (critically) scrutinised by others.
In social situations the sufferer experiences acute symptoms of anxiety, such as the racing heart you describe.
It's not for me to diagnose of course; I'll let you draw your own conclusions.
I too live in the UK (for my sins) and am prescribed Lamotrigene + Sulpiride + *Clonazepam*.
You will have a job obtaining the latter due to the all pervasive benzophobia that afflicts UK doctors so (with some justification I suppose).
If you want to discuss the disgusting state of UK psychiatry, feel free!
Best,
Jah.
Posted by woolav on August 9, 2004, at 19:31:01
In reply to Re: have i got social phobia? » carriejane, posted by JahL on August 9, 2004, at 19:23:07
Thanks for the advise all...jah, i am going to look into the medicine your taking. It may be called something else here because i have never heard of it..but i take lamictal and xanax, so if if i added the other drug your taking, it would be the same pretty much.
thanks
s
PS- carriejane, you sound just like i did years ago. I had no idea what was wrong with me, thought i was going mad, hated myself because i wasnt normal..its an awlful disorder, but if you seek help you will feel soooo much better. paxil did work for me years ago. You might try a low dose of that first...
Good luck to you!
Posted by JahL on August 9, 2004, at 20:02:47
In reply to Re: have i got social phobia?, posted by woolav on August 9, 2004, at 19:31:01
> Thanks for the advise all...jah, i am going to look into the medicine your taking. It may be called something else here because i have never heard of it..but i take lamictal and xanax, so if if i added the other drug your taking, it would be the same pretty much.
> thanks
> sHi S.
The names I supplied are generic. They are old European antipsychotics and as such are probably not licensed by the all powerful FDA for use in the US.
You would be amazed at how many novel psychotropics (SSRAs etc) are denied access to the US market. There's some particularly interesting stuff going on in France. Stick 'Servier' in your search engine.
Best,
Jah.
Posted by JahL on August 9, 2004, at 21:49:12
In reply to Re: have i got social phobia?, posted by woolav on August 9, 2004, at 19:31:01
> ...jah, i am going to look into the medicine your taking.
...Some years ago there was a sound fella round here going by the name of AndrewB, a fellow sufferer of s. phobia.
He posted a lot of info on Amisulpride - apparently his saviour - and it might be worth scouring the archives ('99/2000).
J.
Posted by Jbee on August 9, 2004, at 22:30:58
In reply to One last thing... » woolav, posted by JahL on August 9, 2004, at 21:49:12
I’ve been on paxil for a few years and I believe that it’s begging to lose it’s effect on my
SAD. Have you ever heard of this? Could it be related to my switch to generic paxil?
Info please?
Posted by pinky on August 10, 2004, at 0:49:40
In reply to Re: Sulpiride. » woolav, posted by JahL on August 9, 2004, at 20:02:47
I started taking clonazepam(klonopin/rivotril) about 6 weeks ago. I didnt really have the time to titrate up slowly enough due to rapidly approaching social obligations, so I might have done myself a slight diservice with regards to side effects and tolerance, but whatever.
The initial side effects were lack of balance, no short term memory, and irritibility. I was packing my suitcase before catching a flight and was stuck in a constant circle of
"where are my keys? Oh here they are. But where is my shirt? Oh good, I've found it, but where are my keys."
And then I would find myself flying into a rage each time I couldn't find something. But, I also noticed that people were calling me on the phone and ringing my doorbell and I was completely relaxed (instead of wilting like a little girl). All of this without one drink. So although the side effects were kind of irritating I was feeling pretty up-beat because perhaps the impossible was about to happen; things were going to change.
The drive to the airport was humourous. Taking my giant suitcase off the carousel and then slamming it into a small woman was less humourous. She wasn't hurt and just laughed, so no harm done I guess. So, yeah, my motor skills/coordination etc. were a little off. But no sweaty palms! And no wigging out at the check-in counter or with the stewardesses if conversation became in anyway personal. I even chatted freely with the person sitting beside me on the plane. A new experience.
So the first week/week and a half was a cloud. I would lose entire blocks of memory. The first guy I saw when I arrived in town, I spent two days with and even crashed on his couch. When I saw him again two weeks later I was literally unable to remember whether I had seen him yet during my visit. Weird.
Anyway, all of those side effects have passed and my short term memory and attention span is back to normal - which are usually pretty poor. Is it because we're born this way, or have we become like this from spending so much time living in our own heads?
What where the other, subtler, and longer lasting side effects? Anhedonia and dysthymia (look at all the fancy new words that this forum has forced me to look up). So while I have found clonazepam to be quite anxiolytic, it has also caused a degree of anhedonia and dysthymia. These negative effects were relieved somewhat, though, by the natural pleasure of being more socially active. Although they have diminished somewhat over time, I can't say they've completely vanished. Some other poster said it best: "klonopin left me feeling mushy and just... blah." Clonezepam rids you (almost) of your anxiety, but doesn't make you anymore outgoing.
Sexual disfunction? Thats a tricky one. While I did find myself flying at half mast, I recalled that this was often the case with this particular girl even when I was drug free. Was it my lack of sexual attraction to her or was it the pills?
I ended that "product-of-social-phobia-relationship" and found a latin girl to help me solve this quaqmire. Yes, I was ready, willing, and able. However, I do find that I have a decreased sexual desire. And I find this interesting.
I haven't done much research into it, but I have seen it written here and there that people with our various afflictions are often "over-sexualized" (or something like that). I suppose sexual fantasies have dominated my thoughts in the past; and I remember ex-girlfriends finding my voracity agreeable during the first couple of weeks, but a little tiresome after the fourth month. Perhaps my current sexual desire is just normal. Whatever, as long as I can perform when I need to, I'm not bothered.
Other revelations:
Although others have commented on the sedative effects being bothersome, I actually find that I have more energy now. Thats not to say that I feel energized - far from it. I often crash hard in the middle of the day. Its just that I found that my previous anxiety was more of a drain. Neat.
Obsessive behaviour. This was an aspect of myself that I was previously unaware of. I wasn't one of those switch the lights on and off ten times kind of guys, but I did have repetitive habits: thoughts, utterances, routines; I suppose even physical gestures. A friend of mine said that he found me far less irritating to be around now, because you dont do those whistles and say those repetetive phrases, and I was like, "what whistles?" How Curious.
Thank god for this site though. Otherwise I never would have known that there actually is an almost perfect cure for what they refer to as social phobia. I had originally intended to take the clonazepam with dexedrine, but it takes a little longer to get it here because the pharmacy has to order it. My GP was very excited about Seroxat(Paxil), but I had a bad experience with prozac years ago so...
I'm hoping to keep up the clonazepam, and tie up the loose ends (depression, attention span, etc.) with the amphetamines.
QUESTION:
In your opinion, what is the best combo (xanax/clonazepam + adderall/dexedrine)? I heard dexedrine caused less anxiety.
Posted by carriejane on August 10, 2004, at 5:51:03
In reply to Re: have i got social phobia? » carriejane, posted by JahL on August 9, 2004, at 19:23:07
Hi J, I have made an appointment with doc on thursday, I am going to ask him about rivitrol clonazepam, because the anxiety is pretty constant, its stopping me doing the things i need to do. You know that feeling of knowing you are capable of sooo much more yet the fear is too much to go through. Can you tell me what the other 2 medicines are and what they do please?
Thanks alot for helping.
Oh by the way i do have a history of drug addiction, mainly heroin and crack, so doc may be put off by that. Although i know i used heroin to relieve my anxiety, not the right choice i know but i happened upon it and the relief was very seductive. Trouble was i grew a tolerance which lead to even darker places. Im clean from habit nearly 5 yrs now though.
Ive rambled lol x
Posted by carriejane on August 10, 2004, at 5:55:08
In reply to Re: have i got social phobia?, posted by woolav on August 9, 2004, at 19:31:01
Hi Woolav, thanks i have had counselling and tried hypnotherapy, 3 other ssri anti ds, but ive never been diagnosed with social phobia, docs always said depression, and i supose they are interlinked of course. Ive started efexor 2 wks ago so i need to give that a chance although i will ask doc for clanazepam. I tried to get a mental health nurse but they refused me.
Hey thanks xx C
Posted by JahL on August 10, 2004, at 17:28:46
In reply to Re: have i got social phobia? » JahL, posted by carriejane on August 10, 2004, at 5:51:03
> Hi J, I have made an appointment with doc on thursday, I am going to ask him about rivitrol clonazepam, because the anxiety is pretty constant, its stopping me doing the things i need to do.
Hi Carrie.
>You know that feeling of knowing you are capable of sooo much more yet the fear is too much to go through.
Uh huh. S phobia can restrict your every movement, w/o a shadow...
>Can you tell me what the other 2 medicines are and what they do please?
Will have a stab tomorrow. Am very stoned right now (registered smoker - cannot sleep or get through the day w/o it) and am having cognitive difficulties anyway.
> Thanks alot for helping.
> Oh by the way i do have a history of drug addiction, mainly heroin and crack, so doc may be put off by that.Interesting. I have imbibed vast amounts of virtually every drug bar the two you mention. I smoked crack once but I didn't have much of a choice at the time (looong story involving a big knife...).
Fortunately my pdoc used to run an alcoholism clinic and so isn't prejudiced against the likes of us. I've also seen a neurologist at The Priory who confirmed that drugs were not the cause of my problems (I knew that) - they were just a form of self medication for a confused lad.
I've always steered clear of heroin because *I just know* it would banish my pain and temporarily kill the depression. I would become hooked in an instant.
I know I'm opioid responsive because I have taken low dose Methadone (5ml daily for cognition and energy benefits) for a few years now (diverted source).
*(BTW if anyone from America is reading this and is lucky enough to be prescribed low dose Vicodin, and I know there's a few of you, I would give the earth to be put in contact with yr pdoc, via personal email so Dr B doesn't wipe the post and also for obvious reasons. I'm no crank; I've been here for years and my medical history is well documented on this site. Having tried in excess of over 50 drugs with only limited success, this could be my last throw of the dice. Literally. I have not abused drugs for over 7 years and have full references from my pdoc of 7 years. Anyone? Please? No?)*
>Although i know i used heroin to relieve my anxiety, not the right choice i know but i happened upon it and the relief was very seductive. Trouble was i grew a tolerance which lead to even darker places. Im clean from habit nearly 5 yrs now though.
I'm pleased for you. Maybe we'll talk about H sometime, if you're comfortable with it. It fascinates me. As you say, very seductive in a hedonistic kinda way. But very dangerous of course...
> Ive rambled lol x
I do the same.
J.
Posted by JahL on August 10, 2004, at 19:13:13
In reply to Paxil losing effect?, posted by Jbee on August 9, 2004, at 22:30:58
> I’ve been on paxil for a few years and I believe that it’s begging to lose it’s effect on my
> SAD. Have you ever heard of this? Could it be related to my switch to generic paxil?
> Info please?Hi Jbee.
Sounds like good old fashioned 'poop-out', where the medication simply ceases to work. It's a widely known phenomenon. I'm not sure what the consensus of how to proceed is exactly, but I think switching to another antidepressant is a popular move. Just how successful this approach is a matter of contention, but I think as with most medications, efficacy varies widely from person to person.
If it is poop-out you are experiencing, I am truly sorry. The only time I have ever felt normal was when briefly euthymic on a variety of SSRIs. I got about 2 months of normalcy before the dreaded poop-out kicked in. *ucker.
The switch to generics should theoretically make no difference; they are identical in chemical make-up to brand versions. If it was me, superstition would compel me to switch back to brand name, just to check that the loss of efficacy was not down to this. But then I'm a little paranoid. And desperate.
Best,
J.
Posted by Jbee on August 10, 2004, at 20:57:33
In reply to Re: Paxil losing effect? » Jbee, posted by JahL on August 10, 2004, at 19:13:13
Thanks J.
I am also paranoid about the generic thing. I think I will try going back to brand name
before deciding that its pure poop-out.
Posted by carriejane on August 11, 2004, at 7:46:05
In reply to Re: have i got social phobia/ opiate request » carriejane, posted by JahL on August 10, 2004, at 17:28:46
Its great to talk to you, and helpful. I supose the heroin is just a really strong painkiller, and it made me totally apathetic, as opposed to me feeling guilt about all the cruelty in the world.
Do you think that even if my doc wont prescribe klonopin for my anxiety, that if i get it online it will be safe enough as long as i check its the right packaging etc?
Posted by carriejane on August 11, 2004, at 7:48:12
In reply to Re: is effexor and klonopin safe mix?? » JahL, posted by carriejane on August 11, 2004, at 7:46:05
Has anyone had problems with this mix? Im not taking any other medication. Just effexor and contemplating klonopin. Thanks
Posted by JahL on August 11, 2004, at 11:04:52
In reply to Re: is effexor and klonopin safe mix?? » JahL, posted by carriejane on August 11, 2004, at 7:46:05
> Its great to talk to you, and helpful. I supose the heroin is just a really strong painkiller, and it made me totally apathetic, as opposed to me feeling guilt about all the cruelty in the world.
Some would say there's a fine line btwn psychogenic and physiological pain. Seems H and related compounds touch both.
> Do you think that even if my doc wont prescribe klonopin for my anxiety, that if i get it online it will be safe enough as long as i check its the right packaging etc?
Wow. Ordering online is definitely frowned upon here since Bob outlawed the discussion of med sources (this place used to be like the Drug Swap Shop). I'd better be careful, though I have to admit I've bought dozen of meds unavailable over here online. Dangerous business tho'.
I imagine you'd have great trouble sourcing a benzo - they're scheduled - and even if you found an obliging third world pharmacy, yr pdoc would probably run a mile. Self-medication is strongly disapproved of here in the UK, as you probably know.
Could you request a very short prescription to begin with? It would make it possible to trial the drug w/o abuse being an issue.
I dunno...tricky one.
J.
Posted by carriejane on August 11, 2004, at 11:37:03
In reply to Re: klonopin » carriejane, posted by JahL on August 11, 2004, at 11:04:52
oops sorry, i didnt realise what has gone down here before i found these pages. The truth is i have already ordered from a swiss company, anyway enough of that, i wont mention anything to do with sources again. Thanks for the advive J, tomorrow i see my doc and will ask for trial prescription.
Thanks again C
Posted by pinky on August 11, 2004, at 11:47:48
In reply to Re: klonopin » carriejane, posted by JahL on August 11, 2004, at 11:04:52
I wouldn't recommend a short trial of clonazepam. I'd say at least three months and make sure you titrate up slow and taper off slow. When you're trying to find an adequate dose, don't look for a "high" or being able to feel it. Instead, experiment with effectiveness of the drug my immersing yourself in situations which are usually stressful and see if you wigg out or not. I find that at first, the apprehension of a situation is still there, but when wigg out time comes, it just doesn't happen. You can actually feel your body about to freak out, but it just ... doesn't. Thats when you know that the clonazepam is working. Once you experience this, you'll recognize the effectiveness of the drug and you will begin to feel less apprehensive and way more confident.
If you start out using high doses until you feel totally chilled out, you'll build up a tolerance way too quickly and waste what could have been a very useful medication.
Keep the doses low and experiment in social situations. Just take your doses at regular intervals 2 or 3 times a day and once it builds up in your system, you'll find it very helpful. DON'T look for any intoxicating effect whatsoever. The "high" that clonezepam can give you anyway is pretty boring. Thats why I think its weird that docs are reluctant to prescribe it because I couldn't see it being a druggy's drug of choice.
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Dr. Bob is Robert Hsiung, MD,
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