![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 3 to 27 of 33. Go back in thread:
Posted by Nixon on February 14, 2005, at 19:23:50
In reply to Re: Social Anxiety HELP » BobD, posted by Michael Bell on February 14, 2005, at 18:42:15
> >
> Your symptoms are classic SA disorder. I don't want to speculate about the possibility of other conditions, but SA seems without a doubt to be the primary problem. Now, as someone who has experienced very similar symptoms as yourself, to the same degree of severity, let me give you a treatment rundown. Keep in mind, we all react to meds differently, but if SA is truly your primary/only diagnosis (try to get a Psychiatrist who SPECIALIZES in anxiety) then here's how I believe the following classes of drugs will affect you. By the way, I've tried all of the below:
>
> THEY'RE RATED ON A SCALE OF 1-10 (10 BEING BEST)
>
> SSRIs (4 OUT OF 10:(Zoloft, Paxil, Prozac etc.): can be somewhat helpful, but new studies show efficacy to be less than originally thought , somewhere in the 40% range if not lower. Usually increase anxiety for the first couple of weeks, then create a sort of numb feeling that works pretty well against anxiety but tends to cause low affect. Big problems with sexual function. I don't recommend them, but they're a billion dollar industry, so many psychiatrists may want you to try one first.
>
> SNRIs (reboxetine, etc.) 3 OUT OF 10: They inhibit the reuptake of norepinephrine. Not great for social anxiety, makes you feel removed from situations and somewhat less social. However, they don't seem to cause any increase in anxiety, not for me anyway. Cause problems with urinary retention, premature ejaculatory fluid (a.k.a messy sex, sorry but true).
>
> ST JOHN'S WORT - 5 OUT OF 10: worked incredibly well for about a couple months, then pooped out never to give quite the same effects again. Eventually cause flattening of mood like SSRIs do. However, much less anxiety provoking than SSRIs and without the sexual side effects.
>
> L-TYROSINE (1-3 OUT OF 10): amino acid precursor to dopamine creation. Can be beneficial as adjunct to other meds, but it is not good as monotherapy and has a rate-limiting effect that inhibits its effectiveness. DO NOT, I REPEAT, DO NOT COMBINE WITH DEPRENYL (SELEGILINE) TO TRY AND TREAT SA.
>
> OPIOIDS (buprenorphine, percocet, codeine) initially 8-9 OUT OF 10, then drops to about 5 OUT OF 10: may be beneficial in the short term, but there is the risk of addiction and tolerance. The tolerance issue may be alleviated by taking memantine at the same time, but that is an expensive combo. Problem is that Opioids lower GABA levels in the long run, and you do NOT want to do that when you suffer from SA. More of an explanation on that below. Overall, I didn't take well to opioids as long term therapy b/c the anxiety relief has a surreal aspect to it. On opioids, I just don't give a sh*t about anything at all.
>
> ATYPICAL ANTIPSYCHOTICS (Amisulpride, Mirapex, etc.)Range from 2 OUT OF 10 to 8 OUT OF 10: Hmmm... now these are strange drugs. At times they can seem a godsend and very effective for SA, alone or as an adjunctive drug. But... inconsistent results, big poopout factor, daytime sleepiness a big issue. As far as side effects go, they're very minor compared to some of the other devillish things out there. I recommend giving AMISULPRIDE a try and seeing if it works for you. Maybe you'll get consistent long term results.
>
> NOOTROPICS (Adrafinil, Modafinil, etc.) 4 OUT OF 10, higher rating as adjunctive med: Don't let the websites fool you. No one knows how these drugs really work. But they very well for some people, while for others it's like taking a sugar pill. My experience - very inconsistent results. When they do work, they tend to wipe out SA completely for several hours and be very prosocial. But the effects are fleeting. ADRAFINIL + AMISULPRIDE is a pretty good combo. Again, maybe the effects will last for you.
>
>
> NOW WE GET TO THE SERIOUS SA DRUGS!!!
>
> BENZODIAZEPINES (Klonopin, Ativan, Xanax) 8-9 OUT OF 10: I give that rating based on my long-term experience with Klonopin. The following is a fact - for most SA sufferers, KLONO DESTROYS SOCIAL ANXIETY!! Let no one tell you differently... Benzodiazepines, particularly Klonopin, should be the FIRST LINE OF DEFENSE for social anxiety disorder. And don't get scared by some of the literature, b/c KLONO DOES NOT CAUSE ADDICTION! Especially if you truly suffer from an anxiety disorder. There may be some tolerance issues, but most reach an effective dose that lasts a very long time. They work by binding to the benzodiazepin sub-receptors, causing the GABA receptors to change shape and allowing more efficient transmission of GABA. HOWEVER - long term benzo use eventually causes the body to produce less GABA, hence rebound anxiety and tolerance may occur. Additionally, KLONO tends to cause low grade depression even in people who never experienced depression before.
>
> Which is why I moved on to NARDIL (an MAOI):
>
> MAOIs: there are three main ones out there. In simplistic terms, they inhibit the enzyme that breaks down neurotransmitters, making more of them available for the brain to use:
> 1) DEPRENYL - 1 OUT OF 10: Inhibits MAO-B at dosages under 10 mg/day and increases dopamine and PEA levels. Sounds good, right? Hell no! Stay AWAY from this drug as monotherapy for SA! Trust me, don't do it. Taking the similarity of your symptoms into consideration, I can guarantee that it will cause increased paranoia, increased anxiety, jitters. Bad drug for SA, period.
>
> 2) PARNATE - Inhibits MAO-A, creates more norepinephrine, serotonin, dopamine and GABA. Never had experience with this one, but you should do a Google search to find out what others have to say
>
> 3) NARDIL - 9 or 10 out of 10: Alrightythen. As many with SA can attest, NARDIL does not diminish SA. It does not alleviate SA. What it does is, it aims a nuclear warhead at SA and blasts the sh*t out of it. Add in a small dose of daily KLONO, and it's all over folks! Assuming the effects lasts, of course. It works similarly to PARNATE, but has the added affect of inhibiting the enzyme that breaks down GABA in the brain, creating a drastic rise in GABA levels. Not only does it kill the "physical anxiety" portion of SA, it also does away with the "phobic" part. More confident, more relaxed, more social, blah blah blah. BUT - Nardil has many problems, which it why it's not prescribed that often. First, there are risks of hypertensive crises with certain foods and meds. Also, it tends to decrease blood pressure, cause anorgasmia, may cause dizziness, temporary blurred vision, and a host of other things. Most of these side effects do go away after a couple of months, however.
>
> Anyway, to make a long story longer: I've tried many other drugs not listed above, but I say try KLONOPIN first and add something if necessary to battle the depression it can cause. If all else fails, try Nardil.
>
> Sorry for the novel. Good luck!
>
>
>
>
> Hi, Im new to this board which i have been reading over for a while with interest. Im male, 22 and from the UK. I would like some advice, to discuss or hear from anyone with regards to effective treatment or even just discussion about my illness which is social anxiety (and maybe other illnesses im not sure of but think i may have). Here are my symptoms : on going anxiety in social situations (almost all) with varying degrees of severity depending on the type of situation and setting. (For those unfamiliar with SAD the anxiety manifests itself in the visible physical symptoms of shaking, voice distortion, sweaty palms, red face, and non visible psycological symptoms of panic and in general severe uncomfortable feelings) Had this since i was about maybe 16 (or even less if memory serves me right) I am 22 now and have self diagnosed SAD which isnt that hard to do as you can imagine given the obvious. It is severe but i am not bad at disguising it and tend to avoid contact with people. Now i crave to be normal!! the encouraging reports of people having relief with medication or therapy on this board has inspired me to write this as i long to be cured - it's just no life at all living the way i do now and have for so many years. I CAN leave the house and even held down a job for four years that didnt require much contact with people. But what also inspired me to seek help is that i now have much worsening of the condition (or other things wrong with me i dont know if they are seperate or related to SAD) but i will try my best to describe them.... recently i have experienced short term memory loss which is more annoying than severe , I have lost a lot of self confidence (not that I had much to begin with but I am more easily led and have far reduced decision making skills even in small matters and when i speak inferiority prevails) I get paranoid thoughts when outdoors that people (even on the other side of the street) are looking at/listening to me all the time, I have a lack of emotion and it shows when speaking - I almost seem robotic, I am tired during the day which doesnt really bother me all that much, I have strong difficulty finding the right words or just any words for a conversation: im often asked what im thinking - and usually its nothing at all! or just what do i say next? I also feel that I am very mentally slow (I know im not stupid but i come across that way to people) , I have a lack of attention span, much decreased libido - about 3/10 (although im in my 20's now so maybe thats just natural with age) and FINALLY mild depression, It may sound hard to believe but I want to socialise and mix with people, I think my life would benefit greatly from increased social contact and as they say you can never have too many friends! which i dont have many of at the moment as you can imagine. I would be v. grateful if any members could contribute any thoughts, suggestions or treatments which they found most effective and especially thoughts from those who have suffered or are suffering identical or similar symptoms. I do not have any problems going to my doctor for anything else but for SAD i wish to self medicate (i do most of the time anyway) or see a specialist who has a better understanding of the condtion(s) as I beleive most Doctors (especially here in the UK) have little or no understanding of it at all!! . Thank You all
>
>
Hi,Bob if I were you I would print out the list Micheal provided, look at it, and then look for a Dr. that specializes in Anxiety Disorders. These meds he listed WILL help with your symptoms. It may seem simple but an ssri/benzo ie Klonopin should provide relief enough to get you on the right track. The other meds can also help either alone or in combination. JN
Posted by awatts on February 14, 2005, at 20:06:04
In reply to Social Anxiety HELP, posted by BobD on February 14, 2005, at 17:04:04
I agree with another poster who suggested that you try Klonopin (clonazepam) first, but start with a VERY low dose and increase gradually. Sedation side effects usually go away in a few weeks, and depression from Klonopin is usually not a problem unless you take too much. (for some people 1 mg a day is too much)
For the physical symptoms a beta blocker such as Inderal (propranolol) can help control flushing and sweating. I also fould that loosing weight helped in this area since I was overweight.
From my personal experience, doen't even consider SSRIs for anxiety. Effexor XR and Cymbalta were even worse than the SSRIs by INCREASING anxiety and reducing sexual performance even more.
Posted by Phillipa on February 14, 2005, at 21:17:16
In reply to Re: Social Anxiety HELP, posted by awatts on February 14, 2005, at 20:06:04
I agree with the above, but don't forget valium, especially since you are in the uk. For me, valium calmed when I was your age. I'm about to try it again as I just finally found an older pdoc who is familiar with it and is more than willing to try. I just hope it works as well as it did in the past. SSRI's make me a robot, like you feel when you are typing on the computer. Klonopin makes me feel numb and I think depressed. We'll see. Fondly, Phillipa
Posted by enjay on February 15, 2005, at 1:15:42
In reply to Re: Social Anxiety HELP » BobD, posted by Michael Bell on February 14, 2005, at 18:42:15
Hi MIchael
Found your info on the various med options very interesting. Several questions on Nardil:-Is the effective dosage of Nardil in direct
proportion to the severity of SA you have ?
i.e a low dose will fix not too severe SA
-Are the expected side effects of lesser
intensity at a lower dosage ?
-Aside from the dietary restrictions- are there
any s/e that generally won't go away after a
couple of months ?
-How long does it take to work ?Thanks in advance
Enjay
Posted by BobD on February 15, 2005, at 5:46:55
In reply to Re: Social Anxiety HELP » BobD, posted by Michael Bell on February 14, 2005, at 18:42:15
> >
> Your symptoms are classic SA disorder. I don't want to speculate about the possibility of other conditions, but SA seems without a doubt to be the primary problem. Now, as someone who has experienced very similar symptoms as yourself, to the same degree of severity, let me give you a treatment rundown. Keep in mind, we all react to meds differently, but if SA is truly your primary/only diagnosis (try to get a Psychiatrist who SPECIALIZES in anxiety) then here's how I believe the following classes of drugs will affect you. By the way, I've tried all of the below:
>
> THEY'RE RATED ON A SCALE OF 1-10 (10 BEING BEST)
>
> SSRIs (4 OUT OF 10:(Zoloft, Paxil, Prozac etc.): can be somewhat helpful, but new studies show efficacy to be less than originally thought , somewhere in the 40% range if not lower. Usually increase anxiety for the first couple of weeks, then create a sort of numb feeling that works pretty well against anxiety but tends to cause low affect. Big problems with sexual function. I don't recommend them, but they're a billion dollar industry, so many psychiatrists may want you to try one first.
>
> SNRIs (reboxetine, etc.) 3 OUT OF 10: They inhibit the reuptake of norepinephrine. Not great for social anxiety, makes you feel removed from situations and somewhat less social. However, they don't seem to cause any increase in anxiety, not for me anyway. Cause problems with urinary retention, premature ejaculatory fluid (a.k.a messy sex, sorry but true).
>
> ST JOHN'S WORT - 5 OUT OF 10: worked incredibly well for about a couple months, then pooped out never to give quite the same effects again. Eventually cause flattening of mood like SSRIs do. However, much less anxiety provoking than SSRIs and without the sexual side effects.
>
> L-TYROSINE (1-3 OUT OF 10): amino acid precursor to dopamine creation. Can be beneficial as adjunct to other meds, but it is not good as monotherapy and has a rate-limiting effect that inhibits its effectiveness. DO NOT, I REPEAT, DO NOT COMBINE WITH DEPRENYL (SELEGILINE) TO TRY AND TREAT SA.
>
> OPIOIDS (buprenorphine, percocet, codeine) initially 8-9 OUT OF 10, then drops to about 5 OUT OF 10: may be beneficial in the short term, but there is the risk of addiction and tolerance. The tolerance issue may be alleviated by taking memantine at the same time, but that is an expensive combo. Problem is that Opioids lower GABA levels in the long run, and you do NOT want to do that when you suffer from SA. More of an explanation on that below. Overall, I didn't take well to opioids as long term therapy b/c the anxiety relief has a surreal aspect to it. On opioids, I just don't give a sh*t about anything at all.
>
> ATYPICAL ANTIPSYCHOTICS (Amisulpride, Mirapex, etc.)Range from 2 OUT OF 10 to 8 OUT OF 10: Hmmm... now these are strange drugs. At times they can seem a godsend and very effective for SA, alone or as an adjunctive drug. But... inconsistent results, big poopout factor, daytime sleepiness a big issue. As far as side effects go, they're very minor compared to some of the other devillish things out there. I recommend giving AMISULPRIDE a try and seeing if it works for you. Maybe you'll get consistent long term results.
>
> NOOTROPICS (Adrafinil, Modafinil, etc.) 4 OUT OF 10, higher rating as adjunctive med: Don't let the websites fool you. No one knows how these drugs really work. But they very well for some people, while for others it's like taking a sugar pill. My experience - very inconsistent results. When they do work, they tend to wipe out SA completely for several hours and be very prosocial. But the effects are fleeting. ADRAFINIL + AMISULPRIDE is a pretty good combo. Again, maybe the effects will last for you.
>
>
> NOW WE GET TO THE SERIOUS SA DRUGS!!!
>
> BENZODIAZEPINES (Klonopin, Ativan, Xanax) 8-9 OUT OF 10: I give that rating based on my long-term experience with Klonopin. The following is a fact - for most SA sufferers, KLONO DESTROYS SOCIAL ANXIETY!! Let no one tell you differently... Benzodiazepines, particularly Klonopin, should be the FIRST LINE OF DEFENSE for social anxiety disorder. And don't get scared by some of the literature, b/c KLONO DOES NOT CAUSE ADDICTION! Especially if you truly suffer from an anxiety disorder. There may be some tolerance issues, but most reach an effective dose that lasts a very long time. They work by binding to the benzodiazepin sub-receptors, causing the GABA receptors to change shape and allowing more efficient transmission of GABA. HOWEVER - long term benzo use eventually causes the body to produce less GABA, hence rebound anxiety and tolerance may occur. Additionally, KLONO tends to cause low grade depression even in people who never experienced depression before.
>
> Which is why I moved on to NARDIL (an MAOI):
>
> MAOIs: there are three main ones out there. In simplistic terms, they inhibit the enzyme that breaks down neurotransmitters, making more of them available for the brain to use:
> 1) DEPRENYL - 1 OUT OF 10: Inhibits MAO-B at dosages under 10 mg/day and increases dopamine and PEA levels. Sounds good, right? Hell no! Stay AWAY from this drug as monotherapy for SA! Trust me, don't do it. Taking the similarity of your symptoms into consideration, I can guarantee that it will cause increased paranoia, increased anxiety, jitters. Bad drug for SA, period.
>
> 2) PARNATE - Inhibits MAO-A, creates more norepinephrine, serotonin, dopamine and GABA. Never had experience with this one, but you should do a Google search to find out what others have to say
>
> 3) NARDIL - 9 or 10 out of 10: Alrightythen. As many with SA can attest, NARDIL does not diminish SA. It does not alleviate SA. What it does is, it aims a nuclear warhead at SA and blasts the sh*t out of it. Add in a small dose of daily KLONO, and it's all over folks! Assuming the effects lasts, of course. It works similarly to PARNATE, but has the added affect of inhibiting the enzyme that breaks down GABA in the brain, creating a drastic rise in GABA levels. Not only does it kill the "physical anxiety" portion of SA, it also does away with the "phobic" part. More confident, more relaxed, more social, blah blah blah. BUT - Nardil has many problems, which it why it's not prescribed that often. First, there are risks of hypertensive crises with certain foods and meds. Also, it tends to decrease blood pressure, cause anorgasmia, may cause dizziness, temporary blurred vision, and a host of other things. Most of these side effects do go away after a couple of months, however.
>
> Anyway, to make a long story longer: I've tried many other drugs not listed above, but I say try KLONOPIN first and add something if necessary to battle the depression it can cause. If all else fails, try Nardil.
>
> Sorry for the novel. Good luck!
>
>
>
>
> Hi, Im new to this board which i have been reading over for a while with interest. Im male, 22 and from the UK. I would like some advice, to discuss or hear from anyone with regards to effective treatment or even just discussion about my illness which is social anxiety (and maybe other illnesses im not sure of but think i may have). Here are my symptoms : on going anxiety in social situations (almost all) with varying degrees of severity depending on the type of situation and setting. (For those unfamiliar with SAD the anxiety manifests itself in the visible physical symptoms of shaking, voice distortion, sweaty palms, red face, and non visible psycological symptoms of panic and in general severe uncomfortable feelings) Had this since i was about maybe 16 (or even less if memory serves me right) I am 22 now and have self diagnosed SAD which isnt that hard to do as you can imagine given the obvious. It is severe but i am not bad at disguising it and tend to avoid contact with people. Now i crave to be normal!! the encouraging reports of people having relief with medication or therapy on this board has inspired me to write this as i long to be cured - it's just no life at all living the way i do now and have for so many years. I CAN leave the house and even held down a job for four years that didnt require much contact with people. But what also inspired me to seek help is that i now have much worsening of the condition (or other things wrong with me i dont know if they are seperate or related to SAD) but i will try my best to describe them.... recently i have experienced short term memory loss which is more annoying than severe , I have lost a lot of self confidence (not that I had much to begin with but I am more easily led and have far reduced decision making skills even in small matters and when i speak inferiority prevails) I get paranoid thoughts when outdoors that people (even on the other side of the street) are looking at/listening to me all the time, I have a lack of emotion and it shows when speaking - I almost seem robotic, I am tired during the day which doesnt really bother me all that much, I have strong difficulty finding the right words or just any words for a conversation: im often asked what im thinking - and usually its nothing at all! or just what do i say next? I also feel that I am very mentally slow (I know im not stupid but i come across that way to people) , I have a lack of attention span, much decreased libido - about 3/10 (although im in my 20's now so maybe thats just natural with age) and FINALLY mild depression, It may sound hard to believe but I want to socialise and mix with people, I think my life would benefit greatly from increased social contact and as they say you can never have too many friends! which i dont have many of at the moment as you can imagine. I would be v. grateful if any members could contribute any thoughts, suggestions or treatments which they found most effective and especially thoughts from those who have suffered or are suffering identical or similar symptoms. I do not have any problems going to my doctor for anything else but for SAD i wish to self medicate (i do most of the time anyway) or see a specialist who has a better understanding of the condtion(s) as I beleive most Doctors (especially here in the UK) have little or no understanding of it at all!! . Thank You all
>
>Thanks EVERYONE who replied to my message and especially to *Michael* for his very imformative reply. I will no doubt find it useful there is PLENTY of info in there and you sound like you've been there, done it and wore the t shirt when it comes to treatment. It was also funny, LMAO at ....... NARDIL - 9 or 10 out of 10: Alrightythen. As many with SA can attest, NARDIL does not diminish SA. It does not alleviate SA. What it does is, it aims a nuclear warhead at SA and blasts the sh*t out of it. HE HE
I was considering a SSRI Paxil as my first choice since it is easily available and approved for the condition - untill you put the record straight so thanks again! Given you have suffered similarly as you say I am giving your reccomendations some serious consideration!! and you also sound like you know what your talking about which helps!
Posted by banga on February 15, 2005, at 7:53:04
In reply to Re: Social Anxiety HELP, posted by BobD on February 15, 2005, at 5:46:55
Good luck with this! (Do remember also though that Michael also reminded us that all of us are different--that he is giving great info, but who knows? meds may work slightly differently for you....)
Michael great information. My suffering is more from generalized rather than social anxiety, though there usually is a component of social anxiety mixed in. I too am curious as to what other problems can come with Nardil use.Also Bob if you haven't run across the site remedyfind.com, you might find useful hints there too, though it takes a little searching to find people who have suffered the same way you have described--meds that help anxiety do not necessarily help social anxiety. I find myself checking in there once in a while too, just to supplement info.
Posted by Ted_Brosnan on February 15, 2005, at 11:05:20
In reply to Re: Social Anxiety HELP » BobD, posted by Michael Bell on February 14, 2005, at 18:42:15
Hi Michael, What dose of Selegiline have you tried?!
At 10mg to 15mg I feel that I bocome more self conscious but I will wait and see how it will work at the 30 to 40 mg range. It might work on the opposite way and help my SA.
Take care,
Ted.> >
> Your symptoms are classic SA disorder. I don't want to speculate about the possibility of other conditions, but SA seems without a doubt to be the primary problem. Now, as someone who has experienced very similar symptoms as yourself, to the same degree of severity, let me give you a treatment rundown. Keep in mind, we all react to meds differently, but if SA is truly your primary/only diagnosis (try to get a Psychiatrist who SPECIALIZES in anxiety) then here's how I believe the following classes of drugs will affect you. By the way, I've tried all of the below:
>
> THEY'RE RATED ON A SCALE OF 1-10 (10 BEING BEST)
>
> SSRIs (4 OUT OF 10:(Zoloft, Paxil, Prozac etc.): can be somewhat helpful, but new studies show efficacy to be less than originally thought , somewhere in the 40% range if not lower. Usually increase anxiety for the first couple of weeks, then create a sort of numb feeling that works pretty well against anxiety but tends to cause low affect. Big problems with sexual function. I don't recommend them, but they're a billion dollar industry, so many psychiatrists may want you to try one first.
>
> SNRIs (reboxetine, etc.) 3 OUT OF 10: They inhibit the reuptake of norepinephrine. Not great for social anxiety, makes you feel removed from situations and somewhat less social. However, they don't seem to cause any increase in anxiety, not for me anyway. Cause problems with urinary retention, premature ejaculatory fluid (a.k.a messy sex, sorry but true).
>
> ST JOHN'S WORT - 5 OUT OF 10: worked incredibly well for about a couple months, then pooped out never to give quite the same effects again. Eventually cause flattening of mood like SSRIs do. However, much less anxiety provoking than SSRIs and without the sexual side effects.
>
> L-TYROSINE (1-3 OUT OF 10): amino acid precursor to dopamine creation. Can be beneficial as adjunct to other meds, but it is not good as monotherapy and has a rate-limiting effect that inhibits its effectiveness. DO NOT, I REPEAT, DO NOT COMBINE WITH DEPRENYL (SELEGILINE) TO TRY AND TREAT SA.
>
> OPIOIDS (buprenorphine, percocet, codeine) initially 8-9 OUT OF 10, then drops to about 5 OUT OF 10: may be beneficial in the short term, but there is the risk of addiction and tolerance. The tolerance issue may be alleviated by taking memantine at the same time, but that is an expensive combo. Problem is that Opioids lower GABA levels in the long run, and you do NOT want to do that when you suffer from SA. More of an explanation on that below. Overall, I didn't take well to opioids as long term therapy b/c the anxiety relief has a surreal aspect to it. On opioids, I just don't give a sh*t about anything at all.
>
> ATYPICAL ANTIPSYCHOTICS (Amisulpride, Mirapex, etc.)Range from 2 OUT OF 10 to 8 OUT OF 10: Hmmm... now these are strange drugs. At times they can seem a godsend and very effective for SA, alone or as an adjunctive drug. But... inconsistent results, big poopout factor, daytime sleepiness a big issue. As far as side effects go, they're very minor compared to some of the other devillish things out there. I recommend giving AMISULPRIDE a try and seeing if it works for you. Maybe you'll get consistent long term results.
>
> NOOTROPICS (Adrafinil, Modafinil, etc.) 4 OUT OF 10, higher rating as adjunctive med: Don't let the websites fool you. No one knows how these drugs really work. But they very well for some people, while for others it's like taking a sugar pill. My experience - very inconsistent results. When they do work, they tend to wipe out SA completely for several hours and be very prosocial. But the effects are fleeting. ADRAFINIL + AMISULPRIDE is a pretty good combo. Again, maybe the effects will last for you.
>
>
> NOW WE GET TO THE SERIOUS SA DRUGS!!!
>
> BENZODIAZEPINES (Klonopin, Ativan, Xanax) 8-9 OUT OF 10: I give that rating based on my long-term experience with Klonopin. The following is a fact - for most SA sufferers, KLONO DESTROYS SOCIAL ANXIETY!! Let no one tell you differently... Benzodiazepines, particularly Klonopin, should be the FIRST LINE OF DEFENSE for social anxiety disorder. And don't get scared by some of the literature, b/c KLONO DOES NOT CAUSE ADDICTION! Especially if you truly suffer from an anxiety disorder. There may be some tolerance issues, but most reach an effective dose that lasts a very long time. They work by binding to the benzodiazepin sub-receptors, causing the GABA receptors to change shape and allowing more efficient transmission of GABA. HOWEVER - long term benzo use eventually causes the body to produce less GABA, hence rebound anxiety and tolerance may occur. Additionally, KLONO tends to cause low grade depression even in people who never experienced depression before.
>
> Which is why I moved on to NARDIL (an MAOI):
>
> MAOIs: there are three main ones out there. In simplistic terms, they inhibit the enzyme that breaks down neurotransmitters, making more of them available for the brain to use:
> 1) DEPRENYL - 1 OUT OF 10: Inhibits MAO-B at dosages under 10 mg/day and increases dopamine and PEA levels. Sounds good, right? Hell no! Stay AWAY from this drug as monotherapy for SA! Trust me, don't do it. Taking the similarity of your symptoms into consideration, I can guarantee that it will cause increased paranoia, increased anxiety, jitters. Bad drug for SA, period.
>
> 2) PARNATE - Inhibits MAO-A, creates more norepinephrine, serotonin, dopamine and GABA. Never had experience with this one, but you should do a Google search to find out what others have to say
>
> 3) NARDIL - 9 or 10 out of 10: Alrightythen. As many with SA can attest, NARDIL does not diminish SA. It does not alleviate SA. What it does is, it aims a nuclear warhead at SA and blasts the sh*t out of it. Add in a small dose of daily KLONO, and it's all over folks! Assuming the effects lasts, of course. It works similarly to PARNATE, but has the added affect of inhibiting the enzyme that breaks down GABA in the brain, creating a drastic rise in GABA levels. Not only does it kill the "physical anxiety" portion of SA, it also does away with the "phobic" part. More confident, more relaxed, more social, blah blah blah. BUT - Nardil has many problems, which it why it's not prescribed that often. First, there are risks of hypertensive crises with certain foods and meds. Also, it tends to decrease blood pressure, cause anorgasmia, may cause dizziness, temporary blurred vision, and a host of other things. Most of these side effects do go away after a couple of months, however.
>
> Anyway, to make a long story longer: I've tried many other drugs not listed above, but I say try KLONOPIN first and add something if necessary to battle the depression it can cause. If all else fails, try Nardil.
>
> Sorry for the novel. Good luck!
>
>
>
>
> Hi, Im new to this board which i have been reading over for a while with interest. Im male, 22 and from the UK. I would like some advice, to discuss or hear from anyone with regards to effective treatment or even just discussion about my illness which is social anxiety (and maybe other illnesses im not sure of but think i may have). Here are my symptoms : on going anxiety in social situations (almost all) with varying degrees of severity depending on the type of situation and setting. (For those unfamiliar with SAD the anxiety manifests itself in the visible physical symptoms of shaking, voice distortion, sweaty palms, red face, and non visible psycological symptoms of panic and in general severe uncomfortable feelings) Had this since i was about maybe 16 (or even less if memory serves me right) I am 22 now and have self diagnosed SAD which isnt that hard to do as you can imagine given the obvious. It is severe but i am not bad at disguising it and tend to avoid contact with people. Now i crave to be normal!! the encouraging reports of people having relief with medication or therapy on this board has inspired me to write this as i long to be cured - it's just no life at all living the way i do now and have for so many years. I CAN leave the house and even held down a job for four years that didnt require much contact with people. But what also inspired me to seek help is that i now have much worsening of the condition (or other things wrong with me i dont know if they are seperate or related to SAD) but i will try my best to describe them.... recently i have experienced short term memory loss which is more annoying than severe , I have lost a lot of self confidence (not that I had much to begin with but I am more easily led and have far reduced decision making skills even in small matters and when i speak inferiority prevails) I get paranoid thoughts when outdoors that people (even on the other side of the street) are looking at/listening to me all the time, I have a lack of emotion and it shows when speaking - I almost seem robotic, I am tired during the day which doesnt really bother me all that much, I have strong difficulty finding the right words or just any words for a conversation: im often asked what im thinking - and usually its nothing at all! or just what do i say next? I also feel that I am very mentally slow (I know im not stupid but i come across that way to people) , I have a lack of attention span, much decreased libido - about 3/10 (although im in my 20's now so maybe thats just natural with age) and FINALLY mild depression, It may sound hard to believe but I want to socialise and mix with people, I think my life would benefit greatly from increased social contact and as they say you can never have too many friends! which i dont have many of at the moment as you can imagine. I would be v. grateful if any members could contribute any thoughts, suggestions or treatments which they found most effective and especially thoughts from those who have suffered or are suffering identical or similar symptoms. I do not have any problems going to my doctor for anything else but for SAD i wish to self medicate (i do most of the time anyway) or see a specialist who has a better understanding of the condtion(s) as I beleive most Doctors (especially here in the UK) have little or no understanding of it at all!! . Thank You all
>
>
Posted by Michael Bell on February 15, 2005, at 18:04:52
In reply to Re: Social Anxiety HELP, posted by Ted_Brosnan on February 15, 2005, at 11:05:20
Hey Ted,
10 mg of selegeline alone was hands down the worst med I've ever taken for social phobia. It increased anxiety, but more than that, it made me feel even more like I was under a microscope and that everyone was watching my every movement and analyzing me. Worse, combined with Tyrosine it began giving me delusions, I mean true delusions where I began thinking police sirens were meant for me and that my friends were scheming against me and my girlfriend was cheating on me. I've never experienced delusions before, and they abruptly stopped after discontinuing the deprenyl. I don't want to bust your bubble, so I really hope upping the dosage enough to inhibit MAO-A will prove helpful. Just watch out for possible hypertension. Keep us posted. Good luck!
Posted by Michael Bell on February 15, 2005, at 18:40:47
In reply to Nardil question for Michael, posted by enjay on February 15, 2005, at 1:15:42
>
Hey Enjay, I'll try to answer your questions: 1) yeah the effectiveness of Nardil seems to be dose dependent based on severity of symptoms. For many there is a bright line dosage that upgrades Nardil from a semi-effective med to a social phobia killer. 60 - 90 mg/day seems to be the effective range for most people. 2) the side effects are definitely less at the lower range. Unfortunately, so too is the efficacy of the drug. For example, 30 mg/day increased my sex drive and orgasm pleasure. No dizziness, blurred vision or urinary retention, either. But not super effective for SP. Once I ramped it up to 75 mg/day, SP was eliminated entirely but I started having short bouts of mild dizziness, blurred vision and complete anorgasmia. Key is to find the perfect dose, if such exists. Maybe I didn't give 60 mg/day a long enough trial period. 3) Other than dietary restrictions, most side effects are supposed to diminish after 2-3 months, including anorgasmia. Unfortunately, the longest I've been on Nardil at a time is about 6 weeks, so I can't speak to that personally. 4) Took 1 week to start kicking in, about 3 weeks to kick in big time.Hi MIchael
> Found your info on the various med options very interesting. Several questions on Nardil:
>
> -Is the effective dosage of Nardil in direct
> proportion to the severity of SA you have ?
> i.e a low dose will fix not too severe SA
> -Are the expected side effects of lesser
> intensity at a lower dosage ?
> -Aside from the dietary restrictions- are there
> any s/e that generally won't go away after a
> couple of months ?
> -How long does it take to work ?
>
> Thanks in advance
> Enjay
Posted by temoigneur on February 15, 2005, at 19:39:06
In reply to Re: Nardil question for Michael » enjay, posted by Michael Bell on February 15, 2005, at 18:40:47
Hi Michael, that was a sound list you wrote out re: social anxiety. My problem is GAD, SP, PD, and OCD, But Klonopin really helps, for a while, I feel euphoric, then it wears off.
I've given nearly every pharmaceutical indicated for anxiety a therapeutic run. When i was on nardil, they were just changing from the 'Old' - - lustre sugar - coated tablets to the new lack-luster version with an alleged longer shelf life. I had two questions - Tricyclics turn me into a zombie, I'm on clomipramine right now, the OCD and anxiety is certainly gone, but I just want to sleep all day, I have little/no drive of any sort - until i take Klonopin, at when it kicks in about 2 hrs later or so, I feel good, but it doesn't last long, maybe 1-2 hours, and it's not entirely consistant. Meaning a pill in the evening might not work like one in the morning. I just wish there was a slow release version . ALL stimulants I'm aware of exacerbate my OCD horribly; ritalin, dex. provigil.
Do you think the 'old' Nardil is different enough from the New version, that it could react drastically different with a person's system. When I started on the old nardil I was on a very low dose, and didn't raise it until the new nardil came out.I've never tried selegiline or Parnate, but I'm afraid they'll exacerbate my anxiety. is Amisulpride avail. in Canada, I don't think so, I've heard it can be good for OCD when other antipsychotics are overwhelming, anyways I've meandered, thanks for any imput
Ben
Posted by sabre on February 16, 2005, at 3:19:58
In reply to Re: Social Anxiety HELP » BobD, posted by Michael Bell on February 14, 2005, at 18:42:15
Hi Michael
Thanks for the list! It is great when posters provide a summary of the theory or drugs.Do you think that all social phobics have the same biochemical cause for their problems? You read SSRI studies that proclaim that SA can be treated 'safely and effectively' and yet many are driven up the wall with anxiety using them. Some believe Moclobemide in high doses is great others find it useless and others hate it... It goes on and on.
Do social phobes fit into discrete subtypes (I just don't mean generalised or specific) or is there just a huge spectrum filled with people who have varied glitches associated with their neurotransmitters, receptors, enzymes etc and who have huge variations in dosage tolerances. Perhaps there are no two social phobes that are alike, eg St Johns Wort did nothing for me while Tyrosine, has helped the panic associated with SA. SSRIs..Paxil, Lexapro and Tryptophan got a big fat zero.
I would add Beta blockers to the list. They are certainly better than nothing. They do little for the mental symptoms but by controlling the physical side of anxiety, they often enable you to pretend that you are ok and to survive.I just get the feeling you can be damned lucky to find one of these drugs that work and for many of the sufferers that haunt these pages it is just a long torturous experiment.
sabre
Posted by Michael Bell on February 16, 2005, at 21:10:34
In reply to 'different' Nardils - q. for Michael/Ace.., posted by temoigneur on February 15, 2005, at 19:39:06
>
Hey Ben,
I may be one of the few people who prefers the new Nardil over the old Nardil. The old Nardil was like a sledgehammer that crushed social anxiety, but the side effects were also more brutal and kicked in around 30 mg/day for me. The new Nardil is like a lighter hammer, it is very effective but requires a higher dosage. Also, the side effects are definitely not as apparent, though they do exist. For me the new Nardil allows the ability to play with the dosage as far as finding a happy medium between efficacy and side effects. Course, I haven't quite pinpointed that happy medium yet, but I know it's somewhere between 60 - 75 mg/day.Regarding Amisulpride, it's available online and that's all I can say about it for fear of being banned. It can be very helpful for SA though, but may cause excessive daytime sleepiness.
I have no experience with Parnate, but some people have found tremendous relief from it. And as for selegiline - my best advice is run, run far away and don't look back. Horrible med.
Hi Michael, that was a sound list you wrote out re: social anxiety. My problem is GAD, SP, PD, and OCD, But Klonopin really helps, for a while, I feel euphoric, then it wears off.
> I've given nearly every pharmaceutical indicated for anxiety a therapeutic run. When i was on nardil, they were just changing from the 'Old' - - lustre sugar - coated tablets to the new lack-luster version with an alleged longer shelf life. I had two questions - Tricyclics turn me into a zombie, I'm on clomipramine right now, the OCD and anxiety is certainly gone, but I just want to sleep all day, I have little/no drive of any sort - until i take Klonopin, at when it kicks in about 2 hrs later or so, I feel good, but it doesn't last long, maybe 1-2 hours, and it's not entirely consistant. Meaning a pill in the evening might not work like one in the morning. I just wish there was a slow release version . ALL stimulants I'm aware of exacerbate my OCD horribly; ritalin, dex. provigil.
> Do you think the 'old' Nardil is different enough from the New version, that it could react drastically different with a person's system. When I started on the old nardil I was on a very low dose, and didn't raise it until the new nardil came out.
>
> I've never tried selegiline or Parnate, but I'm afraid they'll exacerbate my anxiety. is Amisulpride avail. in Canada, I don't think so, I've heard it can be good for OCD when other antipsychotics are overwhelming, anyways I've meandered, thanks for any imput
>
> Ben
Posted by Michael Bell on February 16, 2005, at 21:28:07
In reply to Re: Social Anxiety HELP-Michael, posted by sabre on February 16, 2005, at 3:19:58
Sabre, it's a difficult topic to nail down, especially in light of the fact that many people have more than one disorder. But as far as generalized social phobia is concerned, I don't think the cause is very complex (relatively speaking, of course). I don't think there are multiple problems with multiple neurotransmitters, subreceptors and hormones all going on at the same time and adding together to give a large percentage of the population such similar symptoms. Rather, I think there is a major disfunction of one or two transmitter/hormone systems that throws the whole equilibrium off. This is NOT to say that there's a one pill solution to the problem.
Now, I could go on and on about the role of GABA in anxiety, serotonin, CCK-B and fear response, dopamine receptor binding, etc., but it would take pages. The bottom line for me is this - for the majority of social phobia sufferers, the most effect meds tend to be, in no particular order: GHB, Benzos, Nardil and alcohol. So although these are vastly different meds with a variety of effects, there is a similar mechanism of action between all of them that is for some reason extremely effective for social anxiety. That's where the the ball starts rolling for me...
> Hi Michael
> Thanks for the list! It is great when posters provide a summary of the theory or drugs.
>
> Do you think that all social phobics have the same biochemical cause for their problems? You read SSRI studies that proclaim that SA can be treated 'safely and effectively' and yet many are driven up the wall with anxiety using them. Some believe Moclobemide in high doses is great others find it useless and others hate it... It goes on and on.
>
> Do social phobes fit into discrete subtypes (I just don't mean generalised or specific) or is there just a huge spectrum filled with people who have varied glitches associated with their neurotransmitters, receptors, enzymes etc and who have huge variations in dosage tolerances. Perhaps there are no two social phobes that are alike, eg St Johns Wort did nothing for me while Tyrosine, has helped the panic associated with SA. SSRIs..Paxil, Lexapro and Tryptophan got a big fat zero.
> I would add Beta blockers to the list. They are certainly better than nothing. They do little for the mental symptoms but by controlling the physical side of anxiety, they often enable you to pretend that you are ok and to survive.
>
> I just get the feeling you can be damned lucky to find one of these drugs that work and for many of the sufferers that haunt these pages it is just a long torturous experiment.
>
> sabre
Posted by enjay on February 16, 2005, at 23:25:21
In reply to Re: Nardil question for Michael » enjay, posted by Michael Bell on February 15, 2005, at 18:40:47
Thanks for your reply Michael
Much appreciated
Enjay
Posted by Ted Brosnan on February 17, 2005, at 17:21:07
In reply to Re: Deprenyl - I hope it works for you, but... » Ted_Brosnan, posted by Michael Bell on February 15, 2005, at 18:04:52
Hi Micheal.
I agree at the low doses 5 or 10mg it can make things worse. I am still climping up toward 30 or 40. Today I took 20mg. The strange thing is that the worsening is less apparent than what I got at 10mg. Even I noticed that i felt some inner peacfulness and improved mood and thus less anxiety and more openess.
It can be that the reason is that the MAO-A inhibition that occurs at highter doses would counteract the excitatory effects of the MAO-B inhibition.
Personally my SA is about avoidance and black mind and self consciousness. I have no whatsoever sympathetic symptoms (heart rate, sweating and so on...), guess this why selegiline is milder on me.
I will update, of course. BTW many view Selegiline at high doses similar to Parnate. So it might help SA.
Posted by sabre on February 18, 2005, at 2:25:14
In reply to Re: Social Anxiety HELP-Michael » sabre, posted by Michael Bell on February 16, 2005, at 21:28:07
Michael, do you think noradrenaline has a role to play in SA?
sabre
Posted by sabre on February 18, 2005, at 2:35:31
In reply to Re: Deprenyl - I hope it works for you, but... » Michael Bell, posted by Ted Brosnan on February 17, 2005, at 17:21:07
Hello Ted,
I'm surprised. I just assumed all social phobes felt the sympathetic symptoms.I thought the avoidance was about escaping the both the mental and physical symptoms and then the depression (dark mind?) followed the frustration, inadequacies, fatigue, loneliness etc
How does everyone else experience it? Does anyone else not feel the physical panic?
As I asked Michael in an earlier post do soc. phobes belong to discrete gps or are they spread out on a spectrum?
sabre
Posted by sfy on February 18, 2005, at 11:36:22
In reply to Re: Social Anxiety HELP-Ted, posted by sabre on February 18, 2005, at 2:35:31
> Hello Ted,
> I'm surprised. I just assumed all social phobes felt the sympathetic symptoms.
>
> I thought the avoidance was about escaping the both the mental and physical symptoms and then the depression (dark mind?) followed the frustration, inadequacies, fatigue, loneliness etc
>
> How does everyone else experience it? Does anyone else not feel the physical panic?
>
> As I asked Michael in an earlier post do soc. phobes belong to discrete gps or are they spread out on a spectrum?
>
> sabreI have very few, if any, physical symptoms from my SA. At most, I might get a bit of racing heart and some butterflies in my stomach but nothing approaching panic. (In fact, I've only had one panic attack in my life and it was only barely SA-related.)
My lifelong SA is based primarily on sheer avoidance and my lack of comfort/knowledge/experience/finesse in social situations (particularly one-on-one). I avoid because it's easier than facing the uncertainty and doubt that fill my head in such situations.
Posted by sabre on February 18, 2005, at 22:34:03
In reply to Re: Social Anxiety HELP » sabre, posted by sfy on February 18, 2005, at 11:36:22
Thanks sfy,
That's intriguing.
So have you tried cbt?
Surely the biochemical basis for each of these social anxiety types must be different?
What drugs have you used in the past?
Have you had any success?
What other problems have you e.g depression?
sabre
Posted by sfy on February 21, 2005, at 12:17:52
In reply to Re: Social Anxiety HELP, posted by sabre on February 18, 2005, at 22:34:03
> Thanks sfy,
> That's intriguing.
> So have you tried cbt?
> Surely the biochemical basis for each of these social anxiety types must be different?
> What drugs have you used in the past?
> Have you had any success?
> What other problems have you e.g depression?
> sabreYes, I've had CBT (including a course of therapy with CBT SA pioneer Richard Heimberg's group). It definitely has helped but due to my issues with anhedonia/dysthymia, I hit a plateau that I can't seem to get beyond. And being stable on meds helps when I'm getting started with CBT.
SA is not one discrete condition but is more of a continuum along physical, psychological, and biochemical spectrums. Biochemistry plays a role along with one's own psychological history. In the case of someone like me who has had a lifelong battle with SA, one's upbringing comes into play. Studies have shown that all shy, highly-reactive infants are not destined to be that way as adults. How one turns out depends, in part, on how parents help (or hinder) a child in dealing with these issues. My parents had no clue how to deal so I never developed the skills to deal effectively with my SA. (Note also that psychological factors, including environment and therapy, can have a measurable impact on biochemistry so it's all connected.)
The most efffective combo of meds for me was Nardil and Klonopin. It didn't result in some dramatic epiphany but had noticeable effects on my sociability and avoidance. The meds also put me in a position to make greater gains in CBT. Unfortunately, due to some serious insomnia issues (as well as my progress after 2 years), I went off this combo.
As I have a history of major depression and dysthymia, I've tried many an anti-depressant. Prozac worked wonders on my depression but did little for my SA. Serzone, Effexor, Wellbutrin, Remeron, Selegiline, Dexedrine, among others, did little to nothing for my SA. As always, YMMV.
Posted by sabre on February 21, 2005, at 15:00:27
In reply to Re: Social Anxiety HELP » sabre, posted by sfy on February 21, 2005, at 12:17:52
SFY have you tried tyrosine, phenylalanine, glutamine or Reboxetine for the anhedonia/dysthymia?
sabre
Posted by Phillipa on February 21, 2005, at 16:40:22
In reply to Re: Social Anxiety HELP, posted by sabre on February 21, 2005, at 15:00:27
Can you explain how these supplements work for social anxiety, without having the Thread redirected? I too, am having difficulty with this problem. Thanks, Fondly, Phillipa
Posted by Ted Brosnan on February 21, 2005, at 19:27:18
In reply to Re: Social Anxiety HELP » sabre, posted by sfy on February 21, 2005, at 12:17:52
> > Thanks sfy,
> > That's intriguing.
> > So have you tried cbt?
> > Surely the biochemical basis for each of these social anxiety types must be different?
> > What drugs have you used in the past?
> > Have you had any success?
> > What other problems have you e.g depression?
> > sabre
>
> Yes, I've had CBT (including a course of therapy with CBT SA pioneer Richard Heimberg's group). It definitely has helped but due to my issues with anhedonia/dysthymia, I hit a plateau that I can't seem to get beyond. And being stable on meds helps when I'm getting started with CBT.
>
> SA is not one discrete condition but is more of a continuum along physical, psychological, and biochemical spectrums. Biochemistry plays a role along with one's own psychological history. In the case of someone like me who has had a lifelong battle with SA, one's upbringing comes into play. Studies have shown that all shy, highly-reactive infants are not destined to be that way as adults. How one turns out depends, in part, on how parents help (or hinder) a child in dealing with these issues. My parents had no clue how to deal so I never developed the skills to deal effectively with my SA. (Note also that psychological factors, including environment and therapy, can have a measurable impact on biochemistry so it's all connected.)
>
> The most efffective combo of meds for me was Nardil and Klonopin. It didn't result in some dramatic epiphany but had noticeable effects on my sociability and avoidance. The meds also put me in a position to make greater gains in CBT. Unfortunately, due to some serious insomnia issues (as well as my progress after 2 years), I went off this combo.
>
> As I have a history of major depression and dysthymia, I've tried many an anti-depressant. Prozac worked wonders on my depression but did little for my SA. Serzone, Effexor, Wellbutrin, Remeron, Selegiline, Dexedrine, among others, did little to nothing for my SA. As always, YMMV.
>
Have you tried Parnate? How would you compare it to Nardil?
Posted by sabre on February 22, 2005, at 1:49:26
In reply to Re: Social Anxiety HELP » sabre, posted by Phillipa on February 21, 2005, at 16:40:22
Hi Phillipa
The only supplement I have found useful for SA is tyrosine in that it reduces the full panic and adrenalin rush when you are socially stressed. I also use beta blockers and magnesium for this effect too. But of course it depends on what is causing your SA.The tyrosine is not consistently helpful though. Larry Hoover mentioned that you should go on and it and off it in the 3:1 ratio (I think -check the alternative pages for his great advice). I am now only using it the days I go to work. It is a precursor to dopamine and noradrenaline.
I am going to ask for Reboxetine this week because I just need a lot stronger effect though. Just hope the NA will be enough to hit the SA on the head.Other people have claimed success with glutamine but I found it over stimulating. Theanine, glycine and taurine might be worth a try too.
I know you are unable to work now. Is this because of the SA, Phillipa? I know I'd be in the same boat if it hadn't been for beta blockers. I still suffer fear etc but I have overcome agoraphobia with them and can go to work.
sabre
Posted by sfy on February 22, 2005, at 10:54:25
In reply to Re: Social Anxiety HELP, posted by sabre on February 21, 2005, at 15:00:27
> SFY have you tried tyrosine, phenylalanine, glutamine or Reboxetine for the anhedonia/dysthymia?
>
> sabreI tried phenylalanine in concert with the Selegiline to no effect. I haven't tried any of the others.
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