Posted by zeugma on April 28, 2005, at 17:36:11
In reply to Re: Seroquel and Social Anxiety, posted by Cairo on April 27, 2005, at 17:41:24
> Just came from an intense appointment with my daughter's psychiatrist. She's been on Lexapro 10mg + Provigil 200mg for Social Anxiety for over a year with only moderate success. Higher doses of Lex cause incredible fatigue and cognitive side effects which we cannot afford b/c she has learning and language disabilities and a chronic fatigue/fibromyalgia type thing going on. CBT doesn't generalize. >>
I take 200 mg Provigil along with nortriptyline, clonazepam and buspirone for narcolepsy, depression, ADD, and anxiety both social and generalized. I also have some learning disabilities. I tried CBT for five months and it didn't generalize for me either. I don't have fibromyalgia, but I do have chronic pain in the form of IBS, and the nortriptyline is very good for that, and so is clonazepam. Unfortunately, Provigil worsens my IBS and it also worsens my anxiety at the dose at which it becomes an effective stimulant (200 mg) although less so than Ritalin. Has your daughter tried a TCA or clonazepam? the sedation from the benzo dissipates over time, although not completely, and I've also found it effective for IBS-triggered pain, probably because it lowers the anxiety that pain normally provokes.
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> A pediatric Psychiatrist we saw at UPenn last summer suggested Seroquel as an add on to Lexapro for the anxiety, but said we need someone local to follow us up. We switched to someone new who headed the Anxiety clinic at our state Medical School and who tried her on Librium and added the Provigil. Provigil helped fatigue some and thereby, I think made her more prosocial. Low dose Librium helped only a little and she balked at needing to take a pill every "frickin' time I want to talk to someone". Increasing the dose is not an option and MAOIs aren't either.>>Clonazepam is fairly long acting though i have to take it twice a day.
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> We pressed him on the Seroquel and he said absolutely no way due to sedation, which is the last thing we need in her as she is underaroused and he hasn't heard of Seroquel being used for social anxiety. He wants to switch her to Zoloft, which I'm game to try, but I'm afraid we'll get only a partial response to that too. Dosing may be an issue as she's sensitive to side effects.
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> We'll give Zoloft a whirl, but after that we need referral to a pediatric clinic that specializes in social anxiety. Who is the best? Are there any places that do intensive CBT specifically for pediatric SP? Research on atypicals as adjuncts for SP?
>I have heard of seroquel for SP, in fact I've considered it myself because my SP is so severe. But I'm afraid of sedation too. The thing about CBT is that it is supposed to generalize. I suspect that those with CBT-resistant SP are also those with various comorbidities (such as fibro or narcolepsy or even ADD) that interfere with the learning process, not at the cognitive level, but at the 'automatic' level. CBT is a very top-down approach. It works well for those whose nervous systems are not in a state of disarray at lower than conscious levels. It made my anxiety worse because the failure to generalize was itself ego-dystonic because I was perfectly aware that something was going wrong at a level I could not control- and my CBT practitioner denied that there was anything I could not control. I am not aware of pediatric SP as a specific diagnosis- I had SP beginning at age five or so, in much the same form I have now (mid-to-late thirties).
-z
poster:zeugma
thread:490475
URL: http://www.dr-bob.org/babble/20050428/msgs/491096.html