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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Jill K. on March 5, 2002, at 2:12:10
> Now were missing some pieces of the Jill K
> puzzle in these areas:
>
> 1) maybe a little more insight into your depression/anxietyI 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
Posted by JohnX2 on March 5, 2002, at 4:52:52
In reply to John X2, posted by Jill K. on March 5, 2002, at 2:12:10
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
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
Posted by Jill K. on March 5, 2002, at 7:07:58
In reply to Re: Social Phobia/Depression help, posted by JohnX2 on March 5, 2002, at 4:52:52
Posted by geno on March 5, 2002, at 16:28:53
In reply to Re: Social Phobia/Depression help, posted by JohnX2 on March 5, 2002, at 5:00:49
hello, im going to add my thoughts on social phobia, anxiety and depression. Iv been using ghb, well gbl every day for last 2 yrs. I have taken numerous days off, but i feel soo soo different. This drug really has a nasty nasty mental withdrawl. I called it my bitch. Like that feeling you get when you girlfriend or wife, leaves you for another guy, multilply it by 3 and thats g withdrawl. Over the moths i tapered the dose to like 12ml, but still some days i still use alot. finally its the 3rd day off this shit. IT is so dam good, its evil. For me it totally wipes all social anxiety, parinoia depression and instant happiness it does, its scary. some call it drinkable gold. Well with out benzos and remeron, i think id be dead. or have a nervous breakdown. its day 4 and i still dont feel right.
im on remeron 30mg at night
paxil 10mg at night
xanax .5mg at night
klonopin 1mg day time.so far keeps me calm, and focused, but still not happy go lucky. my doc said wait a week and he will up the paxil dose or remeron dose. anyone have any comments to help out. i still dont feel social and happy.
geno
Posted by JohnX2 on March 5, 2002, at 17:16:54
In reply to Re: Social Phobia/Depression help, posted by geno on March 5, 2002, at 16:28:53
Hi Geno,I like your goal of being "happy go lucky"!
I like your pdoc too, he seems very understanding
and workable.I've wondered how well this Remeron + SSRI combo could
be and it sounds like a lot of people do OK on Remeron for
the anxiety. People with social anxiety who start up SSRIs
often complain of increased anxiety , like Jill K. was
indicating with the Zoloft, probably due to a
serotonergic mechanism that you discussed earlier
at some receptors.Remeron blocking those nasty serotonin
receptors, and I think that a lot of people do well with
Zyprexa and maybe Seroquel add ons too for this,
seems to help alleviate that nasty start up anxiety.As far as the depression goes, 10 mg is pretty low
for paxil (20+ usually being therapeutic), 30 mg is in the
range of anti-depressant for Remeron. You probably just
need more time (don't we all). More Paxil/and or Remeron may help.
I think its really smart for pdocs to treat people with anxiety issues at
at lower starting dose of SSRIS, Wellbutrin etc just to
make sure they really don't throw things all out of control
for the person.BTW, Paxil on average ?seems? less aggrivating than
Zoloft/Prozac and other SSRIs and so a lot of pdocs like it for
social anxiety/panic just because they believe it may be less
likely to cause start up anxiety. Down side is it is more
likely to cause drowsiness (Offset potentially by high
dose Remeron norepinephrine boos in your case).Best wishes,
John> hello, im going to add my thoughts on social phobia, anxiety and depression. Iv been using ghb, well gbl every day for last 2 yrs. I have taken numerous days off, but i feel soo soo different. This drug really has a nasty nasty mental withdrawl. I called it my bitch. Like that feeling you get when you girlfriend or wife, leaves you for another guy, multilply it by 3 and thats g withdrawl. Over the moths i tapered the dose to like 12ml, but still some days i still use alot. finally its the 3rd day off this shit. IT is so dam good, its evil. For me it totally wipes all social anxiety, parinoia depression and instant happiness it does, its scary. some call it drinkable gold. Well with out benzos and remeron, i think id be dead. or have a nervous breakdown. its day 4 and i still dont feel right.
> im on remeron 30mg at night
> paxil 10mg at night
> xanax .5mg at night
> klonopin 1mg day time.
>
> so far keeps me calm, and focused, but still not happy go lucky. my doc said wait a week and he will up the paxil dose or remeron dose. anyone have any comments to help out. i still dont feel social and happy.
> geno
Posted by geno on March 5, 2002, at 20:10:58
In reply to Re: Social Phobia/Depression help » geno, posted by JohnX2 on March 5, 2002, at 17:16:54
yes john, i suspect my doc is going to either up the remeron to 45mg, or up the paxil to 20 mg in 2 weeks depending on how i feel. I use xanax/klonopin no more than 1mg a peice for anxiety, but need that "mood boost" dont foget 2 yrs of every day use of ghb, boy nasty nasty nasty moods!! and anxiety. If u do g, do it sparingly, i used to do it 24.7 and was a bitch to get off. Im telling you 4 different docts, numerous meds, finally finding a doc in florida who helped me get a close medication run. i still crave the shit. Very mentally addicting. First 3 days off it, you BEtter have xanax or klonopin or your introuble. just babbliing , but im on the rebound and dont need to jump back on the g train. need some powerful mood boosters. remeron just levels my mood. maybe the ssris will do the trick. NO DOPAMINE meds. OH god, welbutrin for g withdrawl. ERRRRRRRRRRRR,instant brain explosions! even nor meds, nada.
geno
Posted by JohnX2 on March 6, 2002, at 0:59:04
In reply to Thanks JohnX2, Your Heaven Sent! (nm), posted by Jill K. on March 5, 2002, at 7:07:58
Hi Jill,Thanks for note, please remember I'm not a doctor.
I'm just some stranger you met on the net.
Your relationship with your doctor is more important.
I hope you will be persistent and do well.Best Wishes,
John
Posted by geno on March 6, 2002, at 14:38:47
In reply to Re: Social Phobia/Depression help, posted by JohnX2 on March 5, 2002, at 4:52:52
Jill, i to suffer from severe social phobia, panic disorder and low mood, depression. For instance, i get in these moods that i dont wanna talk to anyone, not even my parents, and if i do its ok hi by. I dont wanna be in a large croud without being on ghb or half drunk. From what im reading klonopin/xanax are about the top meds for anxiety situation, though can be abused just like ghb and alcohol. GHB, is a wonder for me, but has consumed my life, so have to kick it.
Im on remeron, paxil 10mg, klonopin 1mg and xananx.5mg for panic situations. Im still nowhere near what i feel like on ghb. Still not social or anything,. mild depression no creativity. Either these meds are doing it or ghb really screwed my brain wiring up. 3 yrs of everyday use of g, may have.
geno
Posted by christophrejmc on March 6, 2002, at 15:45:50
In reply to Re: Social Phobia/Depression help, posted by geno on March 6, 2002, at 14:38:47
I hope you don't take this the wrong way, but you sound a lot better off g... Your posts are much clearer and organised. I hope you find something that works without making you feel like sh!t the day after.
Cheers,
Christophre
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
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