Posted by JohnX2 on March 5, 2002, at 5:00:49
In reply to Re: Social Phobia/Depression help, posted by JohnX2 on March 5, 2002, at 4:52:52
Jill,I didn't quite follow your Zoloft note.
Zoloft being of the more stimulating SSRIs
often causes startup agitation before the
anti-depressant effect kicks in. Were you
taking the ritalin concurrent? Also did you
feel you did get a full anti-depressant response
on Zoloft?One solution to this dilemma is to combine a
atypical AP like Zyprexa with a medicine like
Zoloft. Another route may be to add on a medicine
like Remeron or Serzone to help ease the agitation.
You might even find another SSRI like Celexa
completely benign with regards to agitation.Lots of choices. Individual results will vary,
you need to do the experiments. Which routes
do you feel comfortable with? Without knowing
too much about how well the neurontin is holding
up and what your pdocs feelings are, I may just
stick with his recommendation and start at a low
dose (100 mg), see how things go for a week, and
then reassess how you want things to progress.Just my 2c and then some.
-John
>
> Hi Jill,
>
> Seems this thread has made a few leaps. ;)
>
> I'm not a self proclaimed wizard on Social Phobia.
> I'm hoping others will post some of their own
> experiences as they read this.
>
> Curiously when I was a young child I did have
> social phobia symptoms and GAD, but it seems
> coincident with my teenage years and developing
> bipolar that most of it went away. I feel real
> at ease in group settings , but I do get nervous
> in one on one situations which sometimes really
> bugs me. Gets in the way of building close
> relationships to lean on. Kinda shitty. Hmm, lack of
> motivation and drive to get out and do things,
> meet people can't be making things any easier.
>
> Here are some thoughts I'll throw out about
> medication. I really don't think you've investigated
> too far down the AD route. I see relief.
>
> -) Your Klonopin depression problem.
>
> I had this problem too, and other people have noted
> it. Klonopin is a pretty strong anti-manic agent
> and can have depressant properties at higher dose.
> I'm really glad the Neurontin is working out, this
> is just fantastic!
>
> - would you be against giving another
> medicine like Effexor a trial? (a serotonergic
> medicine that also boosts norepinephrine). A lot
> of people that don't respond to one SSRI/SNRI respond
> to another. I stunk at Paxil but liked Zoloft.
> Ross on another thread was experimenting with
> Nardil an MAOI for social phobia, but didn't find
> it as effective as Effexor (which is also FDA
> approved for GAD).
>
> - Wellbutrin can definately help with your depression,
> motivation, confidence problems. It seems to have a coin toss effect on anxiety.
> In most studies of the medicine, it is indisputed
> that it inhibits firing of neurons in an anxiety
> center of the brain for those that respond well.
> (This is the norepinephrine action, much less controvery
> than the dopamine action).
> If you want to give that one a shot per your pdocs recommedation
> you might want to start at a low dose say 100 mg SR
> tablets and test the waters in terms of tolerability.
> If the neurontin is really doing wonders on the anxiety
> front then maybe wellbutrin is a good route. I can't
> predict what would happen, you'd have to give it a trial.
> If the anxiety stinks, you could go back to offsetting
> it with Klonopin or try another route. Again, ask your pdoc about the potential
> for reemergence of anxiety.
>
> - Atypical Anti-psychotics. Don't let the name scare
> you. These medicines like Zyprexa can have a pretty good
> anti-depressant effect and are great for anxiety (at
> the lower doses). At the really high doses they are more for
> bipolar/mania/psychosis. Slight risk of something called
> tardive dykinesia. I remember at least one person
> with Panic and Social phobia really touting the
> effectiveness of Zyprexa.
>
> - MAOIs. You really haven't gone hear yet.
> It seems the more prescribed medicine is Nardil.
> Parnate is also popular. Nardil gets more scripts
> because its a bit less agitating. Downside to these
> meds is that you have to follow a special diet.
> Selegiline and Parnate are good for atypical
> depression but can tend to cause agitation.
>
> - Less agitating stimulating Pstims like Provigil?
>
> Remember everyone's experiences are different.
> There are a lot of medicines you haven't tried
> and I think odds are with a couple expirements
> you will feel well.
>
> I have seen people do well on all these routes.
> I have also seen failures. Just need to go through
> the "wringer" so to speak and test it out. This
> is probably why your pdoc recommended Wellbutrin
> over going with another SSRI type medicine, just
> to change gears.
>
> Best wishes. Please hang in there.
> John
>
>
> > > Now were missing some pieces of the Jill K
> > > puzzle in these areas:
> > >
> > > 1) maybe a little more insight into your depression/anxiety
> >
> > I was shy and introverted growing up. I was always anxious in social situations. Last year in grad school I started getting panic attacks and I met my pdoc who started me on klonopin. With 0.5 mg, the panic left, with depression remaining.
> >
> > > Would you categorize it as Major Depression (feeling
> > > really empty inside, can't experience pleasure at all,
> > > think about dying)? Or are you primarily anxious and
> > > maybe lacking motivation, interest in life, fearful
> > > of social settings etc?
> >
> > I was primarily anxious and fearful of social settings. With the 0.5 mg klonopin, much of the anxiety is gone. Now with 200mg of neurontin three times a day, it is all gone. Now I am just depressed. Sleep when I get home and on weekends. All my hobbies and interests and friends I have dropped ... no energy or motivation.
> >
> >
> > > 2) What were all the medicines you tried in the past
> > > and what were the outcomes?
> > >
> > > Have you tried any of the default SSRIs (Zoloft,Celexa,etc).
> > > Failures?
> >
> > I tried zoloft to 200 mg, feel numb and remained depressed. I also tried lamictal with no benefit and ritalin which increased my anxiety and then crashed after six hours.
> >
> > >
> > > Tried MAOIs (Nardil is often prescribed for social phobiam
> > > Parnate, Deprynyl are other options)?
> >
> > No
> >
> > > Ever tried an atypical antipsychotic like
> > > Zyprexa/Geodon?
> >
> > No
> >
> > > What are your main concerns regarding starting a new
> > > medication? That it will have bad side effects, it won't
> > > effectively address your depression, etc?
> > >
> > > What kind of pain symptoms are you having?
> >
> > Pain is pure psychologic. I am so isolated and alone.
> >
> > > Of all your problems, were are you hurting most?
> > >
> > I think I have 2 main problems (1) panic/social anxiety (2) apathic depression. If I increase klonopin/neurontin no more anxiety, but more depression. When I tried ritalin and zoloft less depression, but HUGE anxiety.
> >
> > > Sorry for all the questions. But I think they
> > > really would help us to give you better support.
> > >
> >
> > No Problem. I love the fact that someone is helping me. If anyone can help me, I will owe then my life, because I haven't had a life for so many years.
> >
> > Your Friend,
> >
> > Jill
poster:JohnX2
thread:96450
URL: http://www.dr-bob.org/babble/20020301/msgs/96469.html