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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by mattw84 on January 13, 2006, at 23:03:32
Hi all,
It has been a while since I have posted, hopefully all are well. =)
I have been treated for Soc. Anx. for the last 2 years or so. Moreso effectively with BZDs than anything else, but these are out of the question at the moment. (Psychiatrist just won't go for it...)
In Oct. I got a dui and when I told my psych, given my history with other abuse, she pulled me off of Valium. So now I have tried every antidepressant known, beta-blockers, GABA analogs, and anti-psychotics. To no avail... I am wondering where to look now? Or if there is even any other options for me?
Any input would be much appreciated! Thanks all!
Matt
Posted by blueberry on January 14, 2006, at 6:21:14
In reply to Social Anxiety -- Out of options..., posted by mattw84 on January 13, 2006, at 23:03:32
Maybe get a new doctor?
Posted by RobertDavid on January 14, 2006, at 11:51:45
In reply to Re: Social Anxiety -- Out of options..., posted by blueberry on January 14, 2006, at 6:21:14
Klonopin and or Nardil seem to be the frontline meds for Social Anxiety. You might need to find a new doctor to try them. People with Social Anxiety are not known to abuse benzo's even with substance abuse problems, but many doctors just are not aware of that. Good luck.
Posted by Tomatheus on January 14, 2006, at 15:41:30
In reply to Re: Social Anxiety -- Out of options..., posted by RobertDavid on January 14, 2006, at 11:51:45
mattw84,
I agree with RobertDavid.
Even though SSRIs are typically used in the first line of treatment of social anxiety disorder, the research studies published in the scientific literature consistently show Nardil to be the most effective medication for social anxiety. So, I understand the frustration of trying one medication after another with no success, but I would hardly say that you're "out of options" if you've never tried taking the medication that's been shown to be the most effective for your condition.
Tomatheus
Posted by mattw84 on January 14, 2006, at 15:55:56
In reply to Re: Social Anxiety -- Out of options..., posted by RobertDavid on January 14, 2006, at 11:51:45
Thanks RD,
I have wanted to see a new psych, I just have no health insurance so my options are pretty limited. My primary care won't prescribe any BZDs either. I have taken Xanax XR, Xanax, Klonopin, and ended up with Valium because it was pretty inexpensive and still effective. I am currently taking Cymbalta and just added Buspar to that, and I will probably have to wait a while to see if that works. I also like my psychiatrist, just don't like the fact that I am not getting any help. I can definately understand her hesitancy to prescribe them, but I haven't ever seen BZDs as anything to be abused...
She has made comments about being more willing if I would make some other lifestyle changes (quit smoking, start running, etc...) and saw another therapist or anxiety specialist. I don't really have the motivation to do any of this, and good intentions really don't cut it.
Is there any documentation or studies to back up that statement about people with Social Anxiety not being likely to misuse BZDs? This isn't the first time I have had to fight for BZDs, but am also willing to try others if there is anything worth it. Just seems like I am getting the run around at this point though.
Matt
Posted by RobertDavid on January 14, 2006, at 16:58:57
In reply to Re: Social Anxiety -- Out of options..., posted by mattw84 on January 14, 2006, at 15:55:56
Matt:
I know of many people that have tried benzo's for Social Anxiety, but some never take a dose strong enough for it to work. Klonopin for examaple which seems to be a go to benzo for Social Anxiety typically is dosed between 1 and 4 mgs. I don't know the dose you tried before, but it didn't start taking the full affect until I got to 2mgs which I take at night.
As far as info on non abuse of benzo's by people with addictions, it was my doctor that gave me that information. I'm lucky that he is one of the leading reaserchers on anxiety disorters in the world. I have also seen the same conclusion from various web searches, articles I found in years past.
I have an addictive personality. I have taken klonopin for 12 years. I have never increased my dose, though I have played with it to find maximum benefits and minimum dose. The sedation seems to fade, but the social anxiety relief has remained. Taking a full dose at night helps too, once a day.
I've gotten off of it a few times, but my social anxiety returned. If I were you (and I'm not) I'd do some web searches for social anxiety web sites and you'll probably find info on the lack of benzo abuse for those with social anxiety. Perhaps you can show that to your doctor.
Good luck......
Rob
Posted by Phillipa on January 14, 2006, at 20:43:26
In reply to Re: Social Anxiety -- Out of options... » mattw84, posted by RobertDavid on January 14, 2006, at 16:58:57
Could you post some of the scientific basis your doc has provided you with. I'll probably need it next week when I see my new pdoc who thinks an AD can do what a benzo does ps they don't believe in them insist they depress you further. Fondly, Phillipa
Posted by Cairo on January 16, 2006, at 0:24:58
In reply to Social Anxiety -- Out of options..., posted by mattw84 on January 13, 2006, at 23:03:32
Do you get partial relief with SSRIs or anything else and have you tried various SSRIs? My daughter has social phobia and had about a 40% response with Lexapro. Adding Provigil helped both mood and social anxiety a bit more. She was then switched to Zoloft, which not only worked better for the SA, but also had less side effects. Adding low dose Seroquel has helped even more. We're going to try adding some Provigil now to see if we get more of a response for SA and attention.
I personally had anxiety relief from Neurontin when I was on it. I'm interested in trying pregablin to see if it will help. With me, social anxiety is due somewhat to chronic pain, so anything that helps pain makes me want to socialize more. Pain and fatigue just make the desire to socialize so not worth the effort.
cairo
Posted by mattw84 on January 16, 2006, at 1:28:52
In reply to Re: Social Anxiety -- Out of options..., posted by Cairo on January 16, 2006, at 0:24:58
Thanks a ton for the input!
I have tried these SSRI/SNRIs:
Prozac
Wellbutrin
Paxil
Lexapro
Zoloft
Effexor... and currently taking Cymbalta.
Cymbalta has helped a lot with my mood, but not so much with the Social Anxiety.
I have also tried:
Neurontin
Clonidine
Propanolol
AtenololOther than those BZDs have been the main route for treatment. Aside from the common, also much more effective -- perhaps I have been spoiled by such relief from my symptoms, but I am convinced nothing else compares. Perhaps I will ask my doctor to try and MAOI or Seroquel, she also mentioned remeron last time I was in.
Thanks for all the input everyone, hopefully I will have a leg to stand on next time I need.
Matt
Posted by Emily Elizabeth on January 16, 2006, at 10:17:13
In reply to Re: Social Anxiety -- Out of options... » Cairo, posted by mattw84 on January 16, 2006, at 1:28:52
How abt a TCA? Although I have GAD, not SA, Desipramine cut my anxiety some. It can be added to a combo or taken alone.
Best,
EE
Posted by Cairo on January 16, 2006, at 22:34:37
In reply to Re: Social Anxiety -- Out of options... » Cairo, posted by mattw84 on January 16, 2006, at 1:28:52
One thing I've thought about is that older pdocs who were around before SSRIs showed up may have had experience with BZDs, while younger ones only were breastfed with SSRIs in their training. My 50ish pdoc isn't afraid to prescribe them because he said he had extensive experience with them before many of the SSRIs came out and that some of his patients simply do better on them than SSRIs. Good guy who listens to his patients, not the drug reps.
The contrast is my daughter's FORMER pdoc, younger fellow, who rolled his eyes when I mentioned BZD for social anxiety as being a "gold standard". He wanted to know where I heard that and said that he hasn't had a patient who didn't respond to an SSRI. Poor chap musn't have had much of a practice load to come across those who don't respond to SSRIs. He rolled his eyes alot at many of my questions. If he does that with everybody, maybe his patients don't want to tell him they're not responding well to SSRIs 'cause they might get the 'ole eyeball treatment (makes you feel like you did something wrong or stupid).
We found an older female pdoc now who is more open in her prescribing habits, but appropriately cautious. It was actually my daughter who did not want to continue taking the Librium prescribed for her for social anxiety in an acute situation.
We've been through three pdocs for her. Someone once said on this forum that for every graduating medical class, remember that 50% are the LOWER half of the class. I'll add that pdocs are not immune to the same foibles as regular folks. Some don't listen, some are hard-headed.
Cairo
Posted by notfeelingthebest on January 20, 2006, at 12:44:44
In reply to Re: Older pdocs, posted by Cairo on January 16, 2006, at 22:34:37
I totally agree. Klonopin is the "gold standard." If you track down the people who are most involved in studying anxiety brought on by social situations, all you hear is clonazepam, clonazepam, and clonazepam.
Furthermore, they advocate life long use of it, whereas most docs are told that benzos should only be used for short periods.
I think the confusion arrises from the fact that most docs don't understand what the long term beneficial effects of clonezepam are, because they are actually among the list of side effects of the drug.
I'm no chemist, but I have been taking klonopin for about two or three years now. Initially, as with all benzos, you can actually feel the drug's effect and they give you considerable relief from anxiety. The anti-benzo "camp" seems to think that since this effect soon wears off, people are left dependent on a drug that has no use.
I personally feel that the side effects described as "clumbsiness" and "negative effect on motor skill function" (etc.) are actually what make the drug so effective over the long term. This seems to make sense since the drug is most commonly prescribed for epilepsy (which I've found confuses pharmacists when you go to fill you prescription, but don't have epilepsy).
Clonazepam has never made me more "pro-social," but it slows my system down. The anticipatory dread of social obligations, going to work/school, etc. is greatly diminished (and continues to be). I don't know why there is so much fuss about people abusing the stuff - I don't how the hell you would possible get high of it. I often forget to take it because I can't even tell that I'm on it; I only notice when I'm not on it.
There is this common line you hear about how benzos are bad, because once you're on them, you find it hard to cope without them. I don't see why its so hard for so many doctors to grasp that you weren't coping in the first place - that's what led you start taking them. If you stop, of course the old symptoms are going to come back.
What's my motto? Benzos for life (or even president).
P.S. Clonazepam isn't a cure for the clumbsily titled "social anxiety disorder" ("social phobia" r.i.p?). I personally think that we are just a segment of the population who have in common, to varying degrees, certain abnormal pathologies (don't you hate when pdocs counter "what's your idea of normal?").
Anyway, I guess the "no-such-thing-as-pure-disorders" argument is a bit redundant. My point is: clonazepam hasn't necessarily made me a happier person. I'm no more socially successful, and I don't feel any less different, but it removes an enormous amount of stress from my life. And I say with absolutely no professional qualifaction that the expensive seretonin bubble inhibitors/encouragers/shifters, etc. that idiots are just dying for you to try don't work.
Posted by RobertDavid on January 20, 2006, at 13:36:00
In reply to Re: Older pdocs, posted by notfeelingthebest on January 20, 2006, at 12:44:44
Great post! I agree 100%
Posted by cecilia on January 21, 2006, at 3:06:58
In reply to Re: Older pdocs, posted by notfeelingthebest on January 20, 2006, at 12:44:44
I'm definitely not anti-benzo, I've been taking clonazepam for 5 years, but truthfully I do often wonder if any initial effects have worn off and I am dependent on a drug that has no use. Maybe there are some effects, but if so they're so subtle it's hard to know. I guess the only way to know is to bite the bullet and wean off it, but I'm not even sure how that would tell me, how do you know if there's actually more anxiety (because believe me, I still have plenty) or whether it's just withdrawal effects? I know I had a lot more anxiety when I weaned off Celexa, but I never felt it had the slightest beneficial effect when I was taking it. Cecilia
Posted by Paulbwell on January 21, 2006, at 5:03:01
In reply to Re: Clonazepam, posted by cecilia on January 21, 2006, at 3:06:58
> I'm definitely not anti-benzo, I've been taking clonazepam for 5 years, but truthfully I do often wonder if any initial effects have worn off and I am dependent on a drug that has no use. Maybe there are some effects, but if so they're so subtle it's hard to know. I guess the only way to know is to bite the bullet and wean off it, but I'm not even sure how that would tell me, how do you know if there's actually more anxiety (because believe me, I still have plenty) or whether it's just withdrawal effects? I know I had a lot more anxiety when I weaned off Celexa, but I never felt it had the slightest beneficial effect when I was taking it. Cecilia
Get off the sh*t, a dickhead secipted me 2mg tabs 2-3 daily, n yr brain adapts ok?
get on Valium n taper off!!
Posted by yxibow on January 21, 2006, at 17:35:09
In reply to Re: Clonazepam » cecilia, posted by Paulbwell on January 21, 2006, at 5:03:01
> Get off the sh*t, a dickhead secipted me 2mg tabs 2-3 daily, n yr brain adapts ok?
>
> get on Valium n taper off!!
Hmm... should I touch this one too or will I also be slapped...?Different people, different bodies.
I've been consistently on a higher script than that of Klonopin, and yes, I tapered to Valium. So far its performed about the same as Klonopin maybe with the added value that it has a slightly longer half life and will eventually be easier to taper off.You can taper off any benzodiazepine if you must, although "the anti-benzo camp" says otherwise. It just takes time. Sometimes weeks, sometimes months. Time that can be spent productively ignoring this annoying but truthful fact and looking future forward at the rest of your life and what other choices you will make.
Posted by cecilia on January 21, 2006, at 23:08:56
In reply to Re: Clonazepam » Paulbwell, posted by yxibow on January 21, 2006, at 17:35:09
I have no doubt whatsoever that I could taper off it, I'm only taking 1.5 mg/day, and like I said I'm not really sure its's doing anything at all. But I don't understand the bad effects the anti benzo people talk about, as far as I'm concerned it's harmless, just like various vitamins and supplements I take, thinking maybe this will help a little. And since i'm trying a new med (Marplan)(actually very old but new to me), which completely wrecks your sleep schedule and then will be facing a couple of surgeries in the next few months, I'm hesitant at the moment to mess with any slight anti-anxiety effect it may be having. Cecilia
This is the end of the thread.
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