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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by backofclass on January 5, 2003, at 19:00:56
I don't know if any people are going through the same problems as me but here is my story. I will try to keep this as simple as possible. I have had ADHD my entire life, no doubt about it, as clear as it comes. I blame it on complications at birth and a family history. As a young-adult, I get very agitated, anxious and have "all" the mental problems you would associate with ADHD. Regardless, I am very smart, have been labeled the smartest of my two older brothers, who are straight A students, but I could not get an A in school even if it were my life's mission, with exception to me being interested in the subject. On top of this I have developed a severe form of social phobia. I have been told I have a nice personality but throw anxiety in the mix, I tend to come across as arrogant, timid and seem vulnerable. I will always “second guess” anything I say. This is because ADHD makes my mind go haywire and the anxiety exacerbates this by making me self conscious. It makes no since to me either? This makes me come across as very serious. Put it simply, anxiety prevents me from being who I naturally am, even with the ADHD. This was mainly caused by a teacher who, because of my ADHD, made me sit up to the front of the class facing all the other students all year long. This teacher actually “liked” me and felt that this would make me be a better student but it initiated a lifetime of problems. The social phobia had become so bad that I dropped out of school and now social phobia effects every part of my life, even outside of school. It is so debilitating that I will feel the anxiety just by thinking about the anxiety. This may be a form of post traumatic stress disorder? I have gone into a severe state of depression and hopelessness but always seem to rebound by doing something that is stimulating, but this never has anything to do with friends! It is a miracle that I have made it to college, long story but just as depressing, but class is a living hell. In class I am paralyzed over the thought of people scrutinizing my every move. I literally can't move, unlike many with anxiety who shake. I do sweat profusely. Also, I can't concentrated because of both my anxiety and ADHD combined.
I have shunned medication my whole life, thinking that they would do no good, but I have recently reached a breaking point. I had a psychiatrist who wanted to put me on Risparal, which I never took. Another put me on Paxil and Ritalin, which I tried but experience a huge panic attack and quite cold turkey. Recently I got a hold of 1mg of Ativan and that helped with my social anxiety a lot. I know that Klonopin is suppose to work better! By the way, I will again be seeing a psychologist about this hopefully next week, but my concern is that that the psychiatrist may not understand my problem and have a good solution. I hear that it is impossible to have social phobia and ADHD comorbid because they counteract each other. That may be true in that even though I have lived an "isolated" life for about 10 years I have still find pleasure in living. That may be why I have avoided help for so long. What I have learned is that ADHD responds to “uppers” like Dexadrine and Ritalin while anxiety responds to “downers” like Klonopin. Would this not cancel out each other out? It would be nice to know that I just need a stimulant and a Benzo to solve the problem, but I hate to push these medications without knowing if they are effective when combined. Does anyone have a better solution when treating social phobia and ADHD?
Posted by jonh kimble on January 5, 2003, at 21:12:57
In reply to ADHD + Social Phobia?, posted by backofclass on January 5, 2003, at 19:00:56
Dont take this the wrong way, but it is good to see someone with a similar problem. I too have severe sp (social withdrawl, extreme hypersensitivity to criticism, low self esteem despite the fact that I few myself as a very good person) and add, although not in the slightest bit hyperactive, just the opposite. It would be my guess that the two combined could imply dopamine dysfunction, considering both problems share this as common dysfunctional neurotransmitter. although the fact that you responded well to ativan makes me hesitant to jump to conclusions.
anyway, for most people with social anxiety, around 2mgs of klonopin/day can be very helpful (usually more so than ativan or other benzos)also an antidepressant called nardil (maoi) can be very helpful usually without the possible tolerance issues that klono holds, however the side effects for most people can be pretty bad, where as klonos side effect profile is low. dexadrine and ritalin are proven helpful for attention, and help some with sp as well. oh and I just remembered two very similar meds called adrafinil and provigil. they are mild stimulants that maintain there effect throughout the day and also have minor side effect profiles. furthermore, many people consider them to be quite helpful for both concentration and sociability. (I belive they are ne agonists) so theres your best bets for the meds, and of course therapy can help alot too, but this is a med board. hope this helps!
Posted by viridis on January 5, 2003, at 22:34:02
In reply to ADHD + Social Phobia?, posted by backofclass on January 5, 2003, at 19:00:56
Although I don't have SP, I do have serious anxiety problems and panic disorder, as well as ADD. I do well on a combination of low-dose Klonopin and low-dose Adderall. They definitely don't cancel each other out -- if you have ADD/ADHD, stimulants have a good chance of making you feel more relaxed and focused, as they do for me. However, if you suffer from severe anxiety, I'd start with a benzodiazepine (like Klonopin) first, then try the stimulants once the benzo is controlling your anxiety.
I've also tried Provigil with Klonopin, and although it was energizing (and didn't cause anxiety), it didn't give me the same abiility to focus as Adderall. However, my psychiatrist says that some people with attention disorders do seem to respond well to Provigil -- apparently it's kind of hit-or-miss. He also prefers Adderall to Ritalin for ADDers with anxiety problems, although apparently it's very individual-specific.
There's a tendency to think of benzos (like Klonopin, Xanax, Ativan etc.) as "downers", and stimulants such as Ritalin and Adderall as "uppers". But it really isn't that simple for people with complex disorders. I don't find Klonopin a downer at all, nor do I find Adderall an upper. I just find that they work well together to stabilize me, reduce anxiety, and help me think more clearly.
One other thing -- there's a promising new drug called Straterra (atomoxetine) coming out this month that is supposed to be very useful for ADD/ADHD, and isn't controlled like many of the other stimulants. My psychiatrist is quite enthusiastic about it, and I'll probably try it soon. So, that's another option that you might discuss with your pdoc.
Good luck!
Posted by comftnumb on January 6, 2003, at 1:07:37
In reply to ADHD + Social Phobia?, posted by backofclass on January 5, 2003, at 19:00:56
I have very similar SP to you in that it makes me very serious. And I was struck by when you said "I always second guess myself." That couldn't have described me better. I have improved dramatically since starting medication therapy.
2mg of Klonopin daily has made a world of a difference. The overpowering anxiety that ruined my life is held at bay. It isn't completely gone, but is enough so that I can live my life in relative peace.
The only trouble with it is that I feel apathetic and sloppy on it: it affects memory and motivation. To treat this side-effect, I would take a stimulant like Ritalin or Adderall. The use of such stimulants is counterindicated with MAOIs, however, and I have just started Nardil for SP.
I think your treatment could work wonderfully if you mixed Klonopin with a stimulant. You'd be treating the side-effects of the Klonopin at the same time as your ADD. Klonopin and Ritalin don't cancel each other out and in fact many people benefit from their combined use. So get to a doctor and demand your prescription! And keep researching... The more you know, the less power a shitty doctor will have over you.
Peace,
comftnumb
Posted by Ritch on January 6, 2003, at 10:09:45
In reply to ADHD + Social Phobia?, posted by backofclass on January 5, 2003, at 19:00:56
>... I have shunned medication my whole life, thinking that they would do no good, but I have recently reached a breaking point. I had a psychiatrist who wanted to put me on Risparal, which I never took. Another put me on Paxil and Ritalin, which I tried but experience a huge panic attack and quite cold turkey. Recently I got a hold of 1mg of Ativan and that helped with my social anxiety a lot. I know that Klonopin is suppose to work better! By the way, I will again be seeing a psychologist about this hopefully next week, but my concern is that that the psychiatrist may not understand my problem and have a good solution. I hear that it is impossible to have social phobia and ADHD comorbid because they counteract each other. That may be true in that even though I have lived an "isolated" life for about 10 years I have still find pleasure in living. That may be why I have avoided help for so long. What I have learned is that ADHD responds to “uppers” like Dexadrine and Ritalin while anxiety responds to “downers” like Klonopin. Would this not cancel out each other out? It would be nice to know that I just need a stimulant and a Benzo to solve the problem, but I hate to push these medications without knowing if they are effective when combined. Does anyone have a better solution when treating social phobia and ADHD?Hi, you said you had a "huge" panic attack when you were given Ritalin+Paxil. Did you try either med separately to determine which one for sure caused the panic? What you might look into is the new med Straterra combined with some Ativan or Klonopin. Also, if you are sure it was the Ritalin that made you panic, was it spontaneous panic or was it situational? Some ADD'ers find a different stimulant to be calming. Have you tried dexedrine?
Posted by Saragram on January 6, 2003, at 11:33:07
In reply to ADHD + Social Phobia?, posted by backofclass on January 5, 2003, at 19:00:56
Hi -- don't feel alone, I don't think it's that uncommon for ADD and SP to occur in the same person! I am a 58-year-old female, currently taking 10 mg Lexapro for depression (situational) and occasional Xanax for anxiety/insomnia. I have recently been diagosed by my psychotherapist as having ADD. It's more common WITHOUT the hyperactivity component in women and girls than it is in guys.
I've suspected that I had ADD for years, and have always suffered from shyness and a feeling of being watched and judged, too. This causes me to be somewhat socially avoidant, which I sometimes attempt to self-medicate with alcohol. Even though I'm female, I can identify the guy on this board who signs himself as "3 Beer Effect" - it DOES work, but of course has negative side effects.
I have reacted badly in the past to stimulants (caffeine in coffee or medications, diet pills) so am a bit fearful of them, but am going to a new GP this afternoon and will probably give Ritalin or Adderal a try. My main symptoms are disorganization on the job and at home -- many, many unfinished projects, constant chaos, no idea where to start, and a feeling of panic when deadlines approach.
Good luck with your medications and therapy!
Posted by Tepiaca on January 7, 2003, at 0:05:52
In reply to Re: ADHD + Social Phobia?, posted by Saragram on January 6, 2003, at 11:33:07
hi , I also have the same problem you have.I go to the school and I feel like everybody is looking at me , its so horrible , every move I make I feel like one thousand eyes looking at me and thinking something about me . I dont have a normal life , I dont like my life .I am taking Zoloft and Solian , I cant still have a normal life , maybe I have to look for others medicines .
Fish oil has really help me , but I still want a
better quality of life. By the way what is that of
ADD or ADHD ? Sorry Im from Mexico
Posted by backofclass on January 7, 2003, at 8:40:55
In reply to Re: Very similar prob, posted by jonh kimble on January 5, 2003, at 21:12:57
I took the Ativan only one time and coincidently enough it was before I gave a group presentation in my class. It is interesting, I have read some of your other posts and like you, I don't experience as much anxiety while giving a formal presentation. I can experience less then by just being observed with my mouth closed. It is as if talking in front of a group energizes me! I have my guesses? Maybe because people expect me to be nervous or I feel in control. The Benzo may have seemed like it had a bigger effect then it did. It is hard to say for sure, but I am anxious to use it again. I had heard of those other medications that you mentioned and was planning to discuss them with my doctor. It is good to know that they will work when combined.
Posted by backofclass on January 7, 2003, at 9:11:46
In reply to Re: ADHD + Social Phobia?, posted by Ritch on January 6, 2003, at 10:09:45
I had taken both Ritalin and Paxil seperatly with no problems besides the fact that it was when I was younger and did not like taking medications, so I would sometimes miss a day or two before taking a pill. I had later taken the Ritalin on top of the Paxil and it caused my heart to beat really fast and I felt like I was going to die. It was not during anxiety. I am curious to know how they would have effected me if I have taken them on a regular bases. Regardless, considering my negitive reaction to them they are not my prefered choice of medications. That other med looks like it has some great potential!
Posted by Ritch on January 7, 2003, at 9:46:58
In reply to Re: ADHD + Social Phobia?, posted by backofclass on January 7, 2003, at 9:11:46
> I had taken both Ritalin and Paxil seperatly with no problems besides the fact that it was when I was younger and did not like taking medications, so I would sometimes miss a day or two before taking a pill. I had later taken the Ritalin on top of the Paxil and it caused my heart to beat really fast and I felt like I was going to die. It was not during anxiety. I am curious to know how they would have effected me if I have taken them on a regular bases. Regardless, considering my negitive reaction to them they are not my prefered choice of medications. That other med looks like it has some great potential!
Oh, I think I know what happened to you with the Paxil+Ritalin! Pstims potentiate SSRI effects (and vice versa) in a big way with many people. I had some personal experience with Dexedrine+Celexa. I was just taking 2.5mg (half a tab) of dexedrine 2x daily (afternoon/evening) and was taking my usual tiny dose of Celexa (at the time 1.25-2.5mg/day) and the two combined was really overwhelming. I found I could withdraw from the Celexa without any SSRI withdrawal effects whatsoever and just take the dexedrine. I'm bipolar as well, and I missed the mild "high" from the Celexa and would take a tiny bit of it every few days or so, otherwise I just felt alert and flat on the dex with my other non-AD meds.
Posted by wingedcat on January 8, 2003, at 4:54:05
In reply to ADHD + Social Phobia?, posted by backofclass on January 5, 2003, at 19:00:56
ADD and Social Phobia don't contradict each other at all, in my opinion. I think it happens often, I am one! Thanks for posting, it helps to read that there are other people out there with similar issues who can give a different perspective.
Paxil gave me panic attacks - maybe that's why you had one, not the Ritalin. I'm glad you tried Ativan and that it helps with your anxiety... maybe you can ask for a prescription for that? I have a very addictive personality so I know it's better for me not to request a prescription for either the benzos or ADD stimulants. Wellbutrin has worked well for me for the ADD for two years, although lately it's lost some of its potency. Wellbutrin is stimulating, but stimulants calm me down and reduce anxiety, personally.
Try some things out, it's not worth living with feeling like that. Wellbutrin and Strattera are two ADD meds that aren't controlled substances. You are wise for being doubtful about some medications. Withdrawal can be nasty.
Posted by Saragram on January 8, 2003, at 13:10:34
In reply to Re: ADHD + Social Phobia? » backofclass, posted by wingedcat on January 8, 2003, at 4:54:05
Wingedcat wrote: "Wellbutrin has worked well for me for the ADD for two years, although lately it's lost some of its potency. Wellbutrin is stimulating, but stimulants calm me down and reduce anxiety, personally.... Try some things out, it's not worth living with feeling like that. Wellbutrin and Strattera are two ADD meds that aren't controlled substances."
To winged cat et al.:
I took Wellbutrin for several months a little over a year ago, hoping it would help with ADD symptoms as well as depression, and the only improvement ADD-wise I noticed is I stopped my compulsive shopping -- caused me to miss some real bargains, too (LOL). As for getting things done and projects finished, I just vegged in bed reading all weekend, with the only difference from my unmedicated state being that I didn't feel guilty about it!
Sara
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