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Dr. Bob is Robert Hsiung, MD,
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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.
Posted by pinky on August 11, 2004, at 11:50:22
In reply to Re: klonopin » JahL, posted by carriejane on August 11, 2004, at 11:37:03
Can you actually get this crap from online drugstores without a prescription? Is it way more expensive?
Posted by JahL on August 11, 2004, at 12:03:19
In reply to Re: klonopin » JahL, posted by carriejane on August 11, 2004, at 11:37:03
> The truth is i have already ordered from a swiss company, anyway enough of that.
Fair play.
Regarding another comment made, I wasn't actually suggesting that you give such a long-acting benzo a short trial. I just think that yr pdoc might feel more comfortable handing out a *succession* of short-lived prescriptions, as opposed to the usual month's supply. Would be much harder to overdose.
Good luck with yr appt!
J.
Posted by carriejane on August 11, 2004, at 15:52:27
In reply to Re: klonopin, posted by pinky on August 11, 2004, at 11:50:22
Thanks for the advice pinky, I dont want the high i just want the anxiety gone. Yeh you can get it in most online chemists but most are v expensive apart from a european one which seems pretty reasonable. The american ones are always loadsa money!
Thanks again C
Posted by carriejane on August 11, 2004, at 15:54:44
In reply to Re: klonopin » carriejane, posted by JahL on August 11, 2004, at 12:03:19
Oh I see, I feel a bit nervous about seeing him in the morning lol, hes a new doctor only seen him once which was when he prescribed effexor. I keep thinking hes going to tell me off for asking for pills!
Thanks J
Posted by JahL on August 11, 2004, at 23:32:55
In reply to Re: have i got social phobia? » JahL, posted by carriejane on August 10, 2004, at 5:51:03
> Can you tell me what the other 2 medicines are and what they do please?
Hi CJ.
As promised, explanations of the two drugs I mentioned.
Put simply, Lamotrigene is an anti-convulsant, originally approved as an adjunctive treatment for epilepsy. However, in common with a number of anti-convulsants, Lamotrigene seems to be helpful with affective disorders, particularly Bipolar.
What distinguishes Lamotrigene from the others is that it seems to have particular effectiveness for BP depression, whereas the likes of Depakote are better known for their anti-manic properties. BP depression is notoriously difficult to treat. Technically speaking, Lamotrigene reduces glutamatergic neurotransmission.
Sulpiride is an old European anti-psychotic used originally for schizophrenia. Whilst these old style antipsychotics with their very unpleasant (sometimes longterm) side effects have been superceded by the apparently superior Atypicals, Sulpiride remains in use because it appears to help with dysthymia and social phobia where other agents might've already failed. It also seems to be, relatively speaking, remarkably side-effect free (at least in my case and with others I've spoken to).
Getting technical, it is a dopamine antagonist which blocks selected dopamine receptors (specifically D3 I think. Could be D2 though). It appears to work presynaptically at low doses, giving it (& Amisulpride) a unique mode of action.
Is that OK?
Hope 2day went OK.
J.
(P.S. bear in mind I'm stoned, cognitively retarded and haven't read anything for a couple of years. Not everything I say can be totally relied upon, as is the case here generally I suppose. YMMV and all that. Ta)
Posted by carriejane on August 12, 2004, at 2:15:14
In reply to Re: explanation » carriejane, posted by JahL on August 11, 2004, at 23:32:55
Lol! You are a funny one. Do you mean stoned from pot? When i smoked that stuff, god it made me feel so transparent, as though everyone could suddenly see how different i was. Then paranoid, even with my friends.
That was good info thanks J, I dont think i have bipolar, isnt that what they call manic depression where you have highs then extreme lows? I never get the highs, just always( apart from occasional days) on a bland low, often tipping into real darkness.
Ok, take care for now xx C
Posted by carriejane on August 12, 2004, at 6:22:25
In reply to Re: klonopin » JahL, posted by carriejane on August 11, 2004, at 15:54:44
Hi J, Im probably bugging you but anyway my gp had never heard of clonazepam, he looked it up and saw in HIS little book that it was prescribed for epilepsy or something, the word anxiety nowhere in sight, just my luck. Anyway he said go back in 2wks and by then hel have spoken to a psychiatrist to ask an opinion on klonopin. Meanwhile he prescribed a 2wk of inderal, but i told him ive tried beta blockers before and they did sod all. He was going to initially up my dose of effexor but didnt as he thought they were causing anxiety. I have a months worth and ive upped it myself, to 2 x 75xr
Maybe i should give them a proper chanceHey thanks again xxC
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