Posted by AndrewB on March 31, 2001, at 13:06:23
In reply to Treatment for Social Phobia w/o MAOI ,benzo, SSRI?, posted by jb on March 28, 2001, at 15:41:39
There seems to be different 'flavors' of social anxiety and these different flavors in general may respond to different groups of meds or med combos. Yes some respond to SSRIs, some to Benzes, some to alpha andrenergic agonists. Some people have exotic subtypes that respond yet other med.s (i.e. tianeptine, adrafinil, buprenophine, methadone). Many people respond to MAO-Is like Nardil, but it is my belief that there are substitutes for a drug like Nardil, and Nardil is to be avoided if possible due to the side effects.
I have completely treated my flavor of social anxiety (without any side effects) and others using variations on this med combo I use also have been able to free themselves of social anxiety.
My social anxiety is centered on low self esteem and the idea that the world is full of eyes that if they discovered who I really am would be disgusted and come down hard on me. My head is filled with self critical thoughts. Often I just hide out in my apartment or wherever and avoid all contact. I envision this type of social anxiety equivalent to being on the bottom of the social pecking order. If you observed a group of baboons, you might see the one at the bottom in order of dominance exhibiting similar behavior.
As I said, I have found complete relief. The med.s I have used are dopamine centered. Indeed research indicates that people with social anxiety and detachment have hypofunction at certain D2 dopamine sites.
My drug combination is low dose amisulpride, low dose selegiline, adderall, and memantine.
When amisulpride works it makes people feel more socially open, less threatened. It is like the world seems friendlier. It also takes away that self critical internal talk. I have an inf. piece on amisulpride that I can email to you (andrewb@seanet.com). Sulpiride, a cousin of amisulpride, has much the same effect. Some studies have been showing sulpiride’s effectiveness for social anxiety. I suspect that Mirapex might help some in a similar way with social anxiety.
For me and others though, they find that amisulpride by itself may not be enough. You feel good but you may still lack motivation and confidence----you lack that feeling that the world and the future is yours to ‘take and make’ and you want to ‘take that tiger by its tail’.
Selegiline taken at 5mgs/day can improve motivation. One study showed it to have a modest effectiveness for social anxiety. I believe, however, as an adjunct it can be very useful. It took 30 days for it to take effect on me. For some its effects are almost immediate, for others it may take 45 days.
I also take adderall, an amphetamine. It gives me confidence and motivation and extra sociableness. Some may find dexedrine or adrafinil will provide motivation. There are options, in other words.
Adderall pooped out in me after about 3 days use and I would have to take a vacation of about 2 days off it to regain its effects. My impression is that many people are like me and find that the confidence and motivation of adderall wears off after a few days.
Enter memantine- it is a NMDA antagonist that I have taken for over a month. It prevents this adderall poop out. The benefit I get from adderall is constant and steady. Eventually I will write a post on memantine, since this is a little known med, and this is a novel use for it.
Anyway, your probably thinking, this is too complicated. But I would like to emphasize that it is worth the effort to pursue one’s ideal med regimen. The effects can be dramatic. My life of dread has been replaced by one that I cherish. As Bob Dylan once said, “the change in weather can be extreme”.
Best wishes,
AndrewB
poster:AndrewB
thread:57815
URL: http://www.dr-bob.org/babble/20010327/msgs/58222.html