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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by psycho D on August 24, 2003, at 23:05:17
I am a young adult who suffers from several mental illnesses. Probably the one that bothers me the most is a social phobia. I've been on paxil CR, zoloft, celexa, adderall, ritalin, and dexedrine. None of the SSRI's really seemed to help with the SP and made it hard to sleep so i discontinued use. On the stimulants, the extra dopamine felt good but i wonder if it was correcting anything or if it was just giving me a 'high' so to speak. It also had the tendancy to make me very edgy, impatient and serious. I'm currently on the Celexa and dex to tide me over till my first appointment with a psychiatrist. Any suggestions or experiences with meds that successfully treated Social Phobia? I've heard good things about Nardil and am considering that but my doctor is "affraid" of anyhthing that isn't an SSRI. Any help at all would be very much appreciated!
Posted by Ame Sans Vie on August 25, 2003, at 0:39:43
In reply to SP, ADD, depression: ANY GOOD MED COMBOS?, posted by psycho D on August 24, 2003, at 23:05:17
Posted by Caleb462 on August 25, 2003, at 0:49:33
In reply to SP, ADD, depression: ANY GOOD MED COMBOS?, posted by psycho D on August 24, 2003, at 23:05:17
> I am a young adult who suffers from several mental illnesses. Probably the one that bothers me the most is a social phobia. I've been on paxil CR, zoloft, celexa, adderall, ritalin, and dexedrine. None of the SSRI's really seemed to help with the SP and made it hard to sleep so i discontinued use. On the stimulants, the extra dopamine felt good but i wonder if it was correcting anything or if it was just giving me a 'high' so to speak. It also had the tendancy to make me very edgy, impatient and serious. I'm currently on the Celexa and dex to tide me over till my first appointment with a psychiatrist. Any suggestions or experiences with meds that successfully treated Social Phobia? I've heard good things about Nardil and am considering that but my doctor is "affraid" of anyhthing that isn't an SSRI. Any help at all would be very much appreciated!
Nardil is a highly respected SP medication. Do a little researching on the net, and bring your doc some literature on it.
Benzos, like Ame said, also work great for a lot of people.
I seem to be in the small minority of folks who benzos don't work for, however.
Posted by Tepiaca on August 25, 2003, at 10:13:08
In reply to SP, ADD, depression: ANY GOOD MED COMBOS?, posted by psycho D on August 24, 2003, at 23:05:17
Ive been 1.5 weeks on nardil and my SP is going away slowly . None of the SSRI could do that in 4 years , (Zoloft , Effexor , etc...)
Anyway I dont know what is gonna happen , is too soon to speak .
Maybe this could help a little
Good Luck
Tepiaca
Posted by btnd on August 25, 2003, at 13:47:10
In reply to SP, ADD, depression: ANY GOOD MED COMBOS?, posted by psycho D on August 24, 2003, at 23:05:17
> I am a young adult who suffers from several mental illnesses. Probably the one that bothers me the most is a social phobia. I've been on paxil CR, zoloft, celexa, adderall, ritalin, and dexedrine. None of the SSRI's really seemed to help with the SP and made it hard to sleep so i discontinued use. On the stimulants, the extra dopamine felt good but i wonder if it was correcting anything or if it was just giving me a 'high' so to speak. It also had the tendancy to make me very edgy, impatient and serious. I'm currently on the Celexa and dex to tide me over till my first appointment with a psychiatrist. Any suggestions or experiences with meds that successfully treated Social Phobia? I've heard good things about Nardil and am considering that but my doctor is "affraid" of anyhthing that isn't an SSRI. Any help at all would be very much appreciated!
As a first line treatment I would suggest trying Klonopin. It is extremely effective in social phobia. Then you can try adding other things to help you out with motivation/sociability/depression etcSome good combinations are: Klonopin+Buspar, Klonopin+Amisulpride or a stimulant (Dexedrine/Adderall). Also there are many reports on Ultram and Enada NADH helping people out - NADH takes care of dysthymic mood, Ultram mostly works as an anti-depressant, takes care of OCD and increases sociability with Klonopin in my experience.
Posted by Psycho D on August 25, 2003, at 23:44:53
In reply to Re: SP, ADD, depression: ANY GOOD MED COMBOS? » psycho D, posted by btnd on August 25, 2003, at 13:47:10
Thanks for the suggestions. I researched some of the benzodiazpines including klonopin and it seems to have a high efficacy raiting. But i've read that you can develope a tolerance to it. I also read that it is sedating and can dull mental sharpness, which wouldn't be good seeing as i already have ADD-like symptoms and some fatigue. However, I've also heard that ADD is linked to anxiety, and in that case sedatation might be beneficial. My Practioner said it was potentially addictive.Are these draw-backs to Klonopin true? rare? myths?? How effective is Klonopin for long term treatment of Social anxiety.. like after it is discontinued?
Anyone had any good experiences with MAOI's such as Nardil or Parnate w/ social anxiety? I have grown rather partial to these types of drugs from what i have read. A friend of mine tried Nardil and said he loved it. What is the likely hood that someone could develop a tolerance to these?
Posted by Ame Sans Vie on August 26, 2003, at 2:07:53
In reply to Re: SP: info concerning Klonopin and MAOI's???, posted by Psycho D on August 25, 2003, at 23:44:53
> Thanks for the suggestions. I researched some of the benzodiazpines including klonopin and it seems to have a high efficacy raiting. But i've read that you can develope a tolerance to it.
Tolerance is rare when taken as directed by your physician, and when it does occur, it occurs *very* slowly. I've been taking benzodiazepines for years with no development of tolerance. Consider it a non-issue.
>I also read that it is sedating and can dull mental sharpness, which wouldn't be good seeing as i already have ADD-like symptoms and some fatigue. However, I've also heard that ADD is linked to anxiety, and in that case sedatation might be beneficial.
Those side effects dissipate after several weeks of continuous use, though yes, cognitive dulling can be a longterm effect while taking benzos. I'd suggest supplementing with gingko biloba, though I personally find my mental sharpness *increased* on Klonopin, as I can concentrate more on the tasks at hand, rather than the anxiety. Oh, and I might add that I also have ADD, currently treated with Dexedrine Spansules.
>My Practioner said it was potentially addictive.
It's only addictive if you abuse it. It does, however, cause physical and psychological dependence after being taken regularly for a period of time (usually a few months), though that is certainly nothing to worry about. First of all, you'll likely take the Klonopin (or whichever benzo ends up working best for you) the rest of your life anyway (and don't be concerned at all about lifetime use of benzodiazepines -- they're astoundingly benign drugs). Also, should you ever decide to discontinue, there *are* painless methods of doing this (i.e. methods that completely bypass most, if not all, withdrawal symptoms).
>How effective is Klonopin for long term treatment of Social anxiety.. like after it is discontinued?
Typically Klonopin is most effective when taken indefinitely, though there is this study that suggests it may be helpful even if only used short-term:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8994456&dopt=Abstract
A 2-year follow-up of social phobia. Status after a brief medication trial.
Sutherland SM, Tupler LA, Colket JT, Davidson JR.
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
Although social phobia is thought to be a chronic disorder, little is known about its long-term course in patients who engage in brief treatment studies. We, therefore, conducted a follow-up study of social phobics who had participated in a brief, placebo-controlled treatment trial of clonazepam. Of the original 75 subjects, 56 were assessed through telephone interview and self-report questionnaires that evaluated current social phobia symptoms. Information was also gathered about treatment received in the 2-year interval since the initial pharmacotherapy trial. The group as a whole showed maintenance of the gains acquired during initial treatment. On a number of symptom scales, subjects initially treated with clonazepam exhibited significantly less severe scores compared with placebo subjects. This study provides evidence of long-term benefit for social phobics when treated with a brief medication trial.
> Anyone had any good experiences with MAOI's such as Nardil or Parnate w/ social anxiety? I have grown rather partial to these types of drugs from what i have read. A friend of mine tried Nardil and said he loved it. What is the likely hood that someone could develop a tolerance to these?I didn't respond to Nardil *one bit*, even at the quite high dose of 120mg/day. Hey, if they work for you, great. But if benzodiazepines work just as well, why not stick to them and avoid the dietary/drug restrictions? Tolerance does occasionally occur with MAOIs (especially Parnate), and the poop-out effect is rather common after several years (or less) on the drugs. I probably come off as sounding anti-MAOI, but I am absolutely not... just giving you the facts.
Posted by Viridis on August 26, 2003, at 5:51:05
In reply to SP, ADD, depression: ANY GOOD MED COMBOS?, posted by psycho D on August 24, 2003, at 23:05:17
As Ames said, benzos like Klonopin are very safe and effective. I recommend Klonopin highly, and have found that it combines very well with Adderall and Strattera, which I take for ADD. For most people, the initial side effects of benzos (sleepiness etc.) disappear quite quickly, but the anti-anxiety effects do not. I've been on the same dose of Klonopin for over two years without needing an increase, and my pdoc says he's had patients on the same dose for many years.
Like many, many other drugs, benzos are likely to cause medical dependency, which is very different from addiction, even though many people (including doctors!) use the terms interchangeably. Dependency means that if you decide to discontinue the med, you need to do so slowly. This is also the case with most antidepressants (which actually cause worse withdrawal than benzos for many people), some blood pressure meds etc. Once your system gets used to a medication, it can be dangerous to stop taking it suddenly, so you need to reduce the dose gradually. This is standard procedure, and nothing to worry about.
If you do fall into the very small minority who actually enjoy benzos and start taking more and more, obsessing about the drug, abusing it such that it interferes with your life, etc., then that's addiction. But this is rare with benzos, especially for the people who really need them. The goal is simply to feel normal, and that's what Klonopin does for me. I can't imagine abusing it, any more than I would want to take extra aspirin etc.
This is the end of the thread.
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