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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by dnuk on June 9, 2001, at 15:40:52
Hi,
I've been lurking here for a while, and am impressed with the kind,helpful, & thoughtful responses given by most folks.
I apologize in advance for any undue background, but since I'm learning that we're all different (to various levels) in how we react to therapy/medications etc, comments & advice will probably be dictated by how similar (or not) you're experiences/symptoms are to mine. Therefore, some background.
First of all (and what seems odd to me), is the fact that I'm not really shy. In fact, those that know me best think I'm fairly outgoing. And, in many situations, I crave attention (immature, I know!) and seek it. I'm told I'm stubborn & fairly strong-willed (good and bad, I suppose), and have gone to great lengths to "hide" my problems even from the closest of friends.
Probably around age 15/16 (about 15 years ago), I started having problems with anxiety. In high school classes where I'd have to give a speech, share a project/paper with the class, read something out loud, or get called on, I would suffer immensely until it was over. Not simple stagefright. I wouldn't be able to sleep for days/weeks before. My heart would race, not for a few minutes, but through the whole class/situation until it was over. My hands would sweat. I didn't feel like I could breathe. I saw a psychologist about it. We "visualized" success in those situations, worked on breathing techniques for several years. (this was in the 1980s). Despite his good intentions, it was a total waste of time (as a result, and from putting myself, with extreme discomfort, in anxiety provoking situations to "overcome" the problem, I'm not a believer in "talk/encounter" therapy).
Soon, I found myself in college (1990). On the first day of the first class, I freaked out. Almost had to run out of the class, but the fear of doing poorly in the class/school forced me to stay. I was just sitting there in a room of 200 people, completely anonymous. Racing heart, felt like I'd pass out, thought I'd have a heart attack, thought I was going insane. I told the psychologist, who concluded I was schizophrenic (not sure on the spelling) & referred me to a psychiatrist. He disagreed, and informed me it was panic disorder (something I'd never heard of). He put me on Xanax & Pamelor (low doses), which was an absolute miracle for the panic disorder (but not social phobia situations). I took those until sometime 1993, told him I'd like to try going off the meds, and I did without any significant problems. At the time, he said I was the only person with PD he knew who stopped the meds w/o any real reoccurrence. In 8 years, I've only had about 2 PD attacks, thank God!
Over the years, though, the social anxiety symptoms continued. I finished college & started graduate school, and found myself in many of these trigger situations (in school, organizations, church groups...everything). It became worse and worse. Before one presentation, a friend asked what was wrong; he told me I looked sick & tremendously nervous (which I was, and I had barely slept over the previous week). The fact that he "noticed" made it even worse.
Eventually, I found myself skipping classes (something I never did; I otherwise enjoyed school and took it seriously), and anxiety provoking situations as much as I possibly could. I felt tremendously guilty about it, but really, really just couldn't take it anymore. It seemed like the only time I wasn't overly agitated and anxious was when I slept. So, I found myself sleeping way too much and drinking more than usual.
Unsure what to do (about 1999 now), I sought help for the situation with the university counseling clinic. Once every month, you could see a psychiatrist who would proscribe medications. He diagnosed me as having social phobia (also something I'd never heard of). He prescribed Prozac, which absolutely drove me out of my mind! I was a nervous wreck! It wasn't mild; it was like I drank 4 pots of coffee. Meanwhile, in order to see him, they forced me to see a graduate student (who God Bless him, but was younger than me, gave me the same old breathing techniques to try (which I did, with a positive attitude, still no success) and wasted huge amounts of time talking about my childhood, relationship with my father, and feelings of abandonment. They meant well, but it was a complete waste of time. I quit going after 7 weeks or so.
Still suffering as much as ever (or more), I found a pscychiatrist in town and made an appointment. I explained what was going on, and he agreed that it was social phobia. He said Prozac was not the solution, and said that he couldn't believe the dosage the "school doc" had put me on, especially immediately starting me on the full dosage. He put me on 20mg of Paxil a day and gave me a very small amount of Xanax to use "as needed." It helped, a little, but I was still anxiety-ridden about going to classes and went to great lengths to avoid situations where I would be required to ask questions, volunteer comments, make presentations, or suffer like that anymore.
Within two months, I graduated and found myself working and living in a new state in a temporary position that doesn't involve too many social stressors (except for dealing with a few superiors, which I have trouble standing up to (even when they're out of line) and speaking with (I get nervous & tongue-tied).
I found a regular doctor, explained my problems (despite the usual overwhelming embarrassment), and he agreed to continue prescribing 20mg of Paxil a day. By this time, I started seeing all the tv ads about Paxil & social phobia. Would you believe the ads bothered me, made me embarrassed? Not that anyone knew the truth about me. Still. Anyway, I saw some improvement, not great, but sufficent for the fairly low stress environment I was in. Enough improvement to function. Naturally, I put on about 30 lbs, and experienced the typical sexual side effects (the weight, though, was the only thing that really bothered me. I don't care, so long as the anxiety goes away). About 6 months ago, I decided the Paxil really wasn't doing too much and quit cold-turkey. I became really depressed for about two-months. Lost interest in going out, parish activities, cooking, most everything. I became lazy. Started watching tv instead of reading or going out, ate fast food, slept a lot, drank a little too much, became irritable, kind of isolated myself. After 3 months of that, I went back on the Paxil, and the depression-type symptoms went away (although the social anxiety issues largely remained). I remain on 20mg a day of the Paxil to this day.
Now, that position has ended, and I'm about to take a new job in a new city, one requiring frequent presentations and oral input. Of course, I tried to find a job not involving these stressors (even though it would be much more boring), but somehow this was all that worked out. Naturally, I'm scared.
Determined to not be thwarted and to do something about it, I've called the original no-nonsense psychiatrist who helped me with the panic disorder. I haven't seen him in 8 years. I'm going next week, and am a little embarrassed to be, shall we say, a repeat customer. Regardless, I'm going to do what I have to do. I once told one of the two people that know that I have this that I'd trade 5 years of my life to never have it again, and I meant it. I realize nobody's life is perfect, but I cannot take the constant anxiety/sleepless nights anymore!!!
So (and thanks for reading this far. Sorry, I really am), any advice on what meds (or anything else) & such realy work for this? (and I do love cheese and the occasional beer, so prefer to avoid strange diet restrictions if at all possible). As I said, I just am not a believer in "talk therapy" and "breathing techniques" as I've tried all this, and for me, it was a waste of time (moreover, my schedule is not condusive to frequent encounter therapy appointments).
Will increasing the dosage of Paxil do it? What about other SSRI's? Anything new? I've read a post about Klonopin, and heard some negative comments, but am skeptical as I was on Xanax, albeit a low dosage, for PD for over 3 years once with no problems whatsoever. Anything with long-term and close to complete relief?
Thanks so much, and God bless you!
Posted by Ed on June 9, 2001, at 19:34:51
In reply to social phobia/long term relief sought (long), posted by dnuk on June 9, 2001, at 15:40:52
Sooner or later, you'll try Nardil. It'll work like nothing else for you. I ate most cheeses on Nardil, with no trouble. I did have trouble once, after eating gorgonzola cheese. But run-of-the-mill cheddar, etc., should be no problem. And I certainly drank enough beer without incident.
> Hi,
>
> I've been lurking here for a while, and am impressed with the kind,helpful, & thoughtful responses given by most folks.
>
> I apologize in advance for any undue background, but since I'm learning that we're all different (to various levels) in how we react to therapy/medications etc, comments & advice will probably be dictated by how similar (or not) you're experiences/symptoms are to mine. Therefore, some background.
>
> First of all (and what seems odd to me), is the fact that I'm not really shy. In fact, those that know me best think I'm fairly outgoing. And, in many situations, I crave attention (immature, I know!) and seek it. I'm told I'm stubborn & fairly strong-willed (good and bad, I suppose), and have gone to great lengths to "hide" my problems even from the closest of friends.
>
> Probably around age 15/16 (about 15 years ago), I started having problems with anxiety. In high school classes where I'd have to give a speech, share a project/paper with the class, read something out loud, or get called on, I would suffer immensely until it was over. Not simple stagefright. I wouldn't be able to sleep for days/weeks before. My heart would race, not for a few minutes, but through the whole class/situation until it was over. My hands would sweat. I didn't feel like I could breathe. I saw a psychologist about it. We "visualized" success in those situations, worked on breathing techniques for several years. (this was in the 1980s). Despite his good intentions, it was a total waste of time (as a result, and from putting myself, with extreme discomfort, in anxiety provoking situations to "overcome" the problem, I'm not a believer in "talk/encounter" therapy).
>
> Soon, I found myself in college (1990). On the first day of the first class, I freaked out. Almost had to run out of the class, but the fear of doing poorly in the class/school forced me to stay. I was just sitting there in a room of 200 people, completely anonymous. Racing heart, felt like I'd pass out, thought I'd have a heart attack, thought I was going insane. I told the psychologist, who concluded I was schizophrenic (not sure on the spelling) & referred me to a psychiatrist. He disagreed, and informed me it was panic disorder (something I'd never heard of). He put me on Xanax & Pamelor (low doses), which was an absolute miracle for the panic disorder (but not social phobia situations). I took those until sometime 1993, told him I'd like to try going off the meds, and I did without any significant problems. At the time, he said I was the only person with PD he knew who stopped the meds w/o any real reoccurrence. In 8 years, I've only had about 2 PD attacks, thank God!
>
> Over the years, though, the social anxiety symptoms continued. I finished college & started graduate school, and found myself in many of these trigger situations (in school, organizations, church groups...everything). It became worse and worse. Before one presentation, a friend asked what was wrong; he told me I looked sick & tremendously nervous (which I was, and I had barely slept over the previous week). The fact that he "noticed" made it even worse.
>
> Eventually, I found myself skipping classes (something I never did; I otherwise enjoyed school and took it seriously), and anxiety provoking situations as much as I possibly could. I felt tremendously guilty about it, but really, really just couldn't take it anymore. It seemed like the only time I wasn't overly agitated and anxious was when I slept. So, I found myself sleeping way too much and drinking more than usual.
>
> Unsure what to do (about 1999 now), I sought help for the situation with the university counseling clinic. Once every month, you could see a psychiatrist who would proscribe medications. He diagnosed me as having social phobia (also something I'd never heard of). He prescribed Prozac, which absolutely drove me out of my mind! I was a nervous wreck! It wasn't mild; it was like I drank 4 pots of coffee. Meanwhile, in order to see him, they forced me to see a graduate student (who God Bless him, but was younger than me, gave me the same old breathing techniques to try (which I did, with a positive attitude, still no success) and wasted huge amounts of time talking about my childhood, relationship with my father, and feelings of abandonment. They meant well, but it was a complete waste of time. I quit going after 7 weeks or so.
>
> Still suffering as much as ever (or more), I found a pscychiatrist in town and made an appointment. I explained what was going on, and he agreed that it was social phobia. He said Prozac was not the solution, and said that he couldn't believe the dosage the "school doc" had put me on, especially immediately starting me on the full dosage. He put me on 20mg of Paxil a day and gave me a very small amount of Xanax to use "as needed." It helped, a little, but I was still anxiety-ridden about going to classes and went to great lengths to avoid situations where I would be required to ask questions, volunteer comments, make presentations, or suffer like that anymore.
>
> Within two months, I graduated and found myself working and living in a new state in a temporary position that doesn't involve too many social stressors (except for dealing with a few superiors, which I have trouble standing up to (even when they're out of line) and speaking with (I get nervous & tongue-tied).
>
> I found a regular doctor, explained my problems (despite the usual overwhelming embarrassment), and he agreed to continue prescribing 20mg of Paxil a day. By this time, I started seeing all the tv ads about Paxil & social phobia. Would you believe the ads bothered me, made me embarrassed? Not that anyone knew the truth about me. Still. Anyway, I saw some improvement, not great, but sufficent for the fairly low stress environment I was in. Enough improvement to function. Naturally, I put on about 30 lbs, and experienced the typical sexual side effects (the weight, though, was the only thing that really bothered me. I don't care, so long as the anxiety goes away). About 6 months ago, I decided the Paxil really wasn't doing too much and quit cold-turkey. I became really depressed for about two-months. Lost interest in going out, parish activities, cooking, most everything. I became lazy. Started watching tv instead of reading or going out, ate fast food, slept a lot, drank a little too much, became irritable, kind of isolated myself. After 3 months of that, I went back on the Paxil, and the depression-type symptoms went away (although the social anxiety issues largely remained). I remain on 20mg a day of the Paxil to this day.
>
> Now, that position has ended, and I'm about to take a new job in a new city, one requiring frequent presentations and oral input. Of course, I tried to find a job not involving these stressors (even though it would be much more boring), but somehow this was all that worked out. Naturally, I'm scared.
>
> Determined to not be thwarted and to do something about it, I've called the original no-nonsense psychiatrist who helped me with the panic disorder. I haven't seen him in 8 years. I'm going next week, and am a little embarrassed to be, shall we say, a repeat customer. Regardless, I'm going to do what I have to do. I once told one of the two people that know that I have this that I'd trade 5 years of my life to never have it again, and I meant it. I realize nobody's life is perfect, but I cannot take the constant anxiety/sleepless nights anymore!!!
>
> So (and thanks for reading this far. Sorry, I really am), any advice on what meds (or anything else) & such realy work for this? (and I do love cheese and the occasional beer, so prefer to avoid strange diet restrictions if at all possible). As I said, I just am not a believer in "talk therapy" and "breathing techniques" as I've tried all this, and for me, it was a waste of time (moreover, my schedule is not condusive to frequent encounter therapy appointments).
>
> Will increasing the dosage of Paxil do it? What about other SSRI's? Anything new? I've read a post about Klonopin, and heard some negative comments, but am skeptical as I was on Xanax, albeit a low dosage, for PD for over 3 years once with no problems whatsoever. Anything with long-term and close to complete relief?
>
> Thanks so much, and God bless you!
Posted by dnuk on June 10, 2001, at 10:42:45
In reply to Re: social phobia/long term relief sought (long) » dnuk, posted by Ed on June 9, 2001, at 19:34:51
> Sooner or later, you'll try Nardil. It'll work like nothing else for you. I ate most cheeses on Nardil, with no trouble. I did have trouble once, after eating gorgonzola cheese. But run-of-the-mill cheddar, etc., should be no problem. And I certainly drank enough beer without incident.
Thanks Ed! I'll surely ask about it. Just curious, how long have you been taking/having success with it? Take long to see results? Do you take the Nardil in tandem with Xanax or Klonopin or some other mild tranquilizer or by itself? Does it react to Prilosec?
Posted by gilbert on June 10, 2001, at 22:38:50
In reply to Re: social phobia/long term relief sought (long), posted by dnuk on June 10, 2001, at 10:42:45
I have taken everything under the sun for panic and social phobia. The ssris work if you can tolerate life without sex....for most. Prozac and celexa started at a reasonable dose will not be so freaky. prozac at 5mg per day every other day. Klonopin would be my choice overall. Very calming blanket coverage from sun up to sun down. I had to stay on xanax because the klonopin also made me somewhat impotent. I still use xanax for lack of a better choice nefver tried nardil i have mild hypertension and don't want to risk it. I think you will find that tolerance will develope to some drugs and not others. It is very individual....some can stay on an ssri at same dose forever.....some can't. Some can stay on maintenace benzos at same dose at other can't. I would try klonopin monotherapy first......if that doesn't work I would try prozac at super low doses.....nardil would be down the list for me.
Gil
Posted by Ed on June 11, 2001, at 16:41:56
In reply to Re: social phobia/long term relief sought (long), posted by dnuk on June 10, 2001, at 10:42:45
I took it for several years, before weight gain and poop out caused me to quit it. For me, it was like spinach for Popeye, or like Superman threw away the Kryptonite rock someone sewed into his costume. It was THAT GOOD.
>
> Thanks Ed! I'll surely ask about it. Just curious, how long have you been taking/having success with it? Take long to see results? Do you take the Nardil in tandem with Xanax or Klonopin or some other mild tranquilizer or by itself? Does it react to Prilosec?
Posted by dnuk on June 11, 2001, at 22:48:20
In reply to Re: social phobia/long term relief sought (long) » dnuk, posted by Ed on June 11, 2001, at 16:41:56
> I took it for several years, before weight gain and poop out caused me to quit it. For me, it was like spinach for Popeye, or like Superman threw away the Kryptonite rock someone sewed into his costume. It was THAT GOOD.
1. I asked about Nardil, which it became clear he wasn't a fan of. Didn't rule it out, but wants try other stuff first, I guess. Didn't like the Paxil b/c I've put on 30 lbs & have had pretty heavy sexual side-effects. Also asked about the Klonopin which is tricky. I mentioned it, but didn't push it real hard b/c I know some people make up stuff to get tranquilers, plus (and maybe a big one) my brother is a drug addict...the type that makes life hell for everyone with real problems & fakes pain/anxiety (kidney stones once) to get demerol/xanax & the like...and the pdoc knows it (although my brother is hundreds of miles away, I have only contact with through the occasional letter, and, shall we say, is "incapacitated" for the time being). I don't know whether my brother entered into the calculation or not (I mean, I was on xanax for 4 years once from this guy & never EVER abused it or gave it to anyone else). I'm going back in 3 weeks, I guess to evaluate this med & how I'm doing facing my new situation; I don't think he'd rule out adding something else if needed (can you take Nardil or Klonopin with Pamelor?)2. From talking with me, he thought I experience "depression" & "generalized anxiety." He asked if I obsess a lot. I said, "you mean like folks that lock the door 400 times or wash their hands like crazy?" He said, "no. Do you play "what if games all the time. Even if you know you're not being entirely logical, "what if I do this & people don't like it? What will they say? What if this happens? What then? etc etc." I, truthfully, responded "all the time. I play out a million different scenerios in my head & worry about them...all that never come to pass." And, in my case, he says, often these involve the social/performance situations. Don't know if this called for the Pamelor or not.
3. He's putting me gradually up to 50mg of the P. Don't know if that's much. Could this work? Could he be right that I have some sort of hodge-podge of things? Will it all get better?
Thanks again!
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