![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by nutjob on March 30, 2006, at 4:43:42
I have an avoidant personality. It's so bad that I've never had a girlfriend, and I'm 24 years old. I've been on lots of meds but the only thing that helps is klonopin. Unfortunately I have severe attentional and memory impairment, and klonopin worsens this.
I've read good things here and there about Amisulpride being used in low doses to remedy social phobia. I would really like to give it a shot, but I live in the United States. Is there anyway my physician would be able to prescribe this drug to be sent to me from overseas? As pathetic as this sounds, I hope to God someone can advise me here.nutjob
Posted by MARTY on March 30, 2006, at 8:21:11
In reply to Avoidant Personality and Amisulpride, posted by nutjob on March 30, 2006, at 4:43:42
I'm sorry nutjob but I can't advise you...I have a question. What is avoidant personality ? I've been described like this when younger (age 17, now 27) and I'm not sure what it mean.
Marty
Posted by minimal on March 30, 2006, at 10:08:47
In reply to Avoidant Personality and Amisulpride, posted by nutjob on March 30, 2006, at 4:43:42
> Unfortunately I have severe attentional and memory impairment, and klonopin worsens this.
I know nothing about this disorder, but is it is in any way similar to social anxiety disorder? I find that low doses of adderall can significantly lessen social anxiety disorder, perhaps odd because stimulants are considered causes of anxiety.Given your ADD symptons, it may be worth talking about with your pdoc.
Posted by TomG on March 30, 2006, at 11:27:57
In reply to Re: Avoidant Personality and Amisulpride, posted by minimal on March 30, 2006, at 10:08:47
I live in the U.S. and I'm about to start 25mgs tommorrow morning.
My doctor and I agreed to try it, because I've been very treatment resistant for almost 10 years and amisulpride seems to be an exact match for my symptoms at low dose.
I'm getting it from Canada via Australia. I would tell you exactly where to purchase it, but based on the posting policies here I don't think that will fly. If you know how to use Google finding a decent overseas pharmacy shouldn't be a problem.
BTW, I'm trying to treat all the negative symptoms of schizophrenia - anhedonia, blunted flat emotions, social withdrawal, lack of expression, anergia etc.
Good Luck!
Tom
Posted by rjlockhart on March 30, 2006, at 11:42:59
In reply to Re: YES - Avoidant Personality and Amisulpride, posted by TomG on March 30, 2006, at 11:27:57
THis is the American Mental Health Description of the Disorder:
http://www.mentalhealth.com/dis1/p21-pe08.html
Usally Klonopin or Xanax is used for this disorder, i think to a longer extent MAOI's such as Nardil are used.
I have some charasterics, but i still present myself in social sitations, and force myself to talk. Its hard.
When i was in high school, i used to take (adderall) 60mg and felt so talkative, i wasnt scared of anything.. and plus i did my work good.
Well thats my put i hope you seek some therpy about this because Avoidant personality disorder, I posted about this a long time ago, like 2003, if i had it? i dont rerember the responses but i know i dont.
It can severely imparir social, emotianal, mental, health. And can cause bad depression.
Take Care
Matt
Posted by med_empowered on March 30, 2006, at 11:57:07
In reply to Re: Avoidant Personality, posted by rjlockhart on March 30, 2006, at 11:42:59
hi! I've been "suspected" of having this b/c of chronic, severe social phobia. For me, low-dose Abilify was pretty helpful for a short time...I imagine super-low doses of amisulpride could do something similar, but without the dulling effects of Abilify. Have you tried any other benzos? Ativan seems like it might be helpful...its pretty "clean," so you don't get much in the way of cognitive dulling (or euphoria/mood-elevation), which makes it less likely to cause problems than, say, Xanax.
As for getting stuff overseas...I think the FDA still allows for supervised importation of foreign pharmaceuticals through some sort of "compassionate use" clause...basically, you talk to your doc, who talks to the drug company, papers are filed, and then your meds arrive. I don't know how often docs here are willing to try it, but that is an option for you. Of course, there are also websites that will hook you up with amisulpride kind of semi-legally...the upshot of that is that it requires less paperwork. Maybe if you imported your own amisulpride, your doc could agree to supervise your use of it? Anyway...talk to your doc about your options; I'm sure he/she will be flexible with someone like you, who has a rather severe disorder and limited success in treatment (thus so far).
Good luck!
Posted by nutjob on March 30, 2006, at 12:22:45
In reply to Re: Avoidant Personality and Amisulpride, posted by minimal on March 30, 2006, at 10:08:47
Yes, it is essentially "social anxiety disorder," which I had been previously diagnosed with several years ago. But just recently I underwent extensive neuropsychological testing, and they redefined the problem as an Axis II Personality Disorder. I don't know why they make this distinction, though from what I've read Avoidant Personality Disorder is thought to be more pervasive and harder to treat. In any case, for me, it is crippling.
I know what you mean about the psychostims being helpful. The instant release formulations make me even more anxious, but 15 mgs of Dexedrine ER helps a good deal. Unfortunately I cannot take psychostims because even at tiny doses they make my heart race and I develop an overwhelming urge to journal and document all of my thoughts--sometimes for 16+ hours straight. This reaction led my therapist to conclude that not only do I have an avoidant personality, a severe attention impairment (I scored in the 82nd percentile on the CCPT), and a memory problem (which she attributes to the ADHD), I also have what she calls "Bipolar NOS" (not otherwise specified). In other words, according to her, I don't meet the criteria for Bipolar disorder because I do not display symptoms when I am unmedicated, however I do have manic-like reactions to certain medications (namely the stims, Prozac, and Geodon).
Posted by nutjob on March 30, 2006, at 12:43:07
In reply to Re: Avoidant Personality, posted by rjlockhart on March 30, 2006, at 11:42:59
Yes, Klonopin is quite helpful. However, my attentional impairments are intensified by this med. This combination of Avoidant Personality and ADHD (inattentive type) have crippled me to such a degree that not only do I not have much of a social life, I have not held a job in several years and I consistently fail my college classes. My life is absolutely miserable. In spite of all this I am not suicidal. I continue to have hope and I found a good therapist at the university I attend who is teaching me time management strategies and organizational skills, and I am making definite progress in this way. And so it is my hope that if at the least I can treat the social anxiety without further blunting my cognition, then perhaps I will be able to deal with the ADHD with non-pharmacological interventions. This is my hope, and after years of research and med trials I am convinced this is the best approach.
> THis is the American Mental Health Description of the Disorder:
>
> http://www.mentalhealth.com/dis1/p21-pe08.html
>
> Usally Klonopin or Xanax is used for this disorder, i think to a longer extent MAOI's such as Nardil are used.
>
> I have some charasterics, but i still present myself in social sitations, and force myself to talk. Its hard.
>
> When i was in high school, i used to take (adderall) 60mg and felt so talkative, i wasnt scared of anything.. and plus i did my work good.
>
> Well thats my put i hope you seek some therpy about this because Avoidant personality disorder, I posted about this a long time ago, like 2003, if i had it? i dont rerember the responses but i know i dont.
>
> It can severely imparir social, emotianal, mental, health. And can cause bad depression.
>
> Take Care
>
> Matt
Posted by nutjob on March 30, 2006, at 12:50:26
In reply to Re: YES - Avoidant Personality and Amisulpride, posted by TomG on March 30, 2006, at 11:27:57
TomG,
I am convinced that this med stands a good chance of helping me. I have researched it extensively and read countless testimonials regarding its prosocial effects at low-doses. The symptoms you describe are very much like the ones I exhibit.
I have tried searching for an online pharmacy that provides this med but have failed at every turn.
I go to see a psychiatrist in a week or two and I intend to inform him of this drug and provide documentation regarding its use.
Is there any way you and I could establish communication in private (perhaps via email), so that you could direct me to this pharmacy? Would this violate the rules of the board?nutjob
> I live in the U.S. and I'm about to start 25mgs tommorrow morning.
>
> My doctor and I agreed to try it, because I've been very treatment resistant for almost 10 years and amisulpride seems to be an exact match for my symptoms at low dose.
>
> I'm getting it from Canada via Australia. I would tell you exactly where to purchase it, but based on the posting policies here I don't think that will fly. If you know how to use Google finding a decent overseas pharmacy shouldn't be a problem.
>
> BTW, I'm trying to treat all the negative symptoms of schizophrenia - anhedonia, blunted flat emotions, social withdrawal, lack of expression, anergia etc.
>
> Good Luck!
> Tom
Posted by TomG on March 30, 2006, at 13:20:44
In reply to Re: YES - Avoidant Personality and Amisulpride, posted by nutjob on March 30, 2006, at 12:50:26
You can open your babblemail and send me a message that way if you would like. I'm not sure how to turn it on though.
Also if you want to maybe do what med_empowered said and maybe have your doc contact the drug company directly and see if they can possibly supply you with the drug.
I contacted Sanofi-Aventis, the maker of amisulpride (Solian) in the U.K. and they told me that a special arrangement could be made. This was awhile back, and I never followed up the call. Like I said I got enough for a pretty long trial through Canada by way of Australia on an online pharmacy. However, with this particular pharmacy you DO need a prescription from your doctor. If ami proves a useful med I will more than than likely be contacting the drug company again to see if I can be supplied directly. I like the fact that I would be getting it direct instead of it being imported by myself with no assurance of having my supply cut off or other unforeseen problems. I had a huge green sticker on my package when I got it that said 'Inspected by Department of Homeland Securtiy'. The lady in the U.K. told me also there are currently no plans to bring Solian to the U.S. in the near future, but I guess that could always change. Here is the contact page for Sanofi-Aventis:
http://www.sanofi-aventis.co.uk/index.htmlAlso get your babblemail up and running and you will be able to anonymously contact me through email.
Tom
Posted by TomG on March 30, 2006, at 13:43:11
In reply to Re: YES - Avoidant Personality and Amisulpride, posted by nutjob on March 30, 2006, at 12:50:26
Also here is the Solian Australian prescribing insert for your doctor:
Posted by med_empowered on March 30, 2006, at 14:05:31
In reply to Re: YES - Avoidant Personality and Amisulpride » nutjob, posted by TomG on March 30, 2006, at 13:43:11
hi. From the sounds of things, a low-dose neuroleptic might be helpful; for some reason, they can be kind of "pro-social" in low doses w/o causing too many undesirable side effects. Have you considered maybe trying very low-dose Abilify? In my limited personal experience, very low doses seemed to smooth things over for a bit, so I was able to function. It was really one of the most positive experiences I've had on medication--the only downside is that it is still very much an antipsychotic, so all the fun neuroleptic side effects crept up after a while. Also..some people apparently benefit from as-needed use of antipsychotics. I can see how extreme psychic tension and anxiety that only partially responds to other methods could be helped by intermittent use of neuroleptics; perhaps that, too, is an option.
Have you tried Provigil? It might help with attentional stuff and help counteract ill effects on cognition from anything you choose to take.
Posted by ed_uk on March 30, 2006, at 15:18:34
In reply to Re: Avoidant Personality, posted by nutjob on March 30, 2006, at 12:43:07
NJ,
Have you ever tried Nardil or Parnate?
Ed
Posted by nutjob on March 30, 2006, at 17:19:20
In reply to Re: YES - Avoidant Personality and Amisulpride, posted by med_empowered on March 30, 2006, at 14:05:31
Here's the meds I've tried over the past 5 years in various doses and combinations:
Prozac, Zoloft, Celexa, Lexapro, Effexor, Paxil, Geodon, Zyprexa, Abilify, Seroquel, Guanfacine, Adderall, Concerta, Dexedrine, Strattera, Provigil, Remeron, Depakote, Lithium, Klonopin, Xanax, Ativan, and probablly others I can't even think of right now.
Abilify at 7.5 mgs left me zombified and virtually catatonic.
Seroquel at 25 mgs knocked me out for 15 hours, and then when I awoke and the hangover wore off I felt enraged and agitated for no apparent reason. When I took my standard dose of dexedrine these feelings disappeared.
Geodon at 20 mgs made me extremely hyperactive, agitated...I found myself frantically pacing around my house for hours. I literally couldn't stop moving. Again I took some dexedrine and the problem subsided.The best social anxiety relief I ever found was when I took a combination of Prozac at 60 mgs and 1 mg klonopin twice daily. However I became extremely impulsive, prone to rages, and completely out of control. The doctor augmented this combination with Zyprexa, but immediately my social anxiety returned and I began to stutter and mispronounce words a great deal.
The second best combination I have found for social anxiety is dexedrine and klonopin, but only when taken a certain way: 1 or 2 mgs of klonopin before bed, which seems to linger on into the following morning, and then 15 mgs dexedrine ER in the morning. However the effects varied from day to day and over time I couldn't tolerate the autonomic nervous system overstimulation from the dexedrine.
Provigil and Strattera both increase my heart rate, and make my breathing rapid and labored, give me terrible insomnia...further, they actually WORSEN my focus and memory.
Remeron, which I understand to be noradrenergic and serotonergic, eased some of the side effects of the stims, but actually made me irritable around people and generally unsociable. And over time, in spite of increasing the dose, it no longer remedied the stim-induced insomnia.
The SSRI's have never done a damned thing for me, with the exception of Prozac which induced mania.
From all this it seems that for me increasing noradrenaline is bad. Decreasing dopamine is bad. Altering serotonin has neutral effects for the most part. And so my crude hypothesis is, perhaps if I increase dopamine levels in isolation from all other neurotransmitters I might get some relief.It's a shot in the dark, but my life is miserable, and I have to keep trying.
> hi. From the sounds of things, a low-dose neuroleptic might be helpful; for some reason, they can be kind of "pro-social" in low doses w/o causing too many undesirable side effects. Have you considered maybe trying very low-dose Abilify? In my limited personal experience, very low doses seemed to smooth things over for a bit, so I was able to function. It was really one of the most positive experiences I've had on medication--the only downside is that it is still very much an antipsychotic, so all the fun neuroleptic side effects crept up after a while. Also..some people apparently benefit from as-needed use of antipsychotics. I can see how extreme psychic tension and anxiety that only partially responds to other methods could be helped by intermittent use of neuroleptics; perhaps that, too, is an option.
>
> Have you tried Provigil? It might help with attentional stuff and help counteract ill effects on cognition from anything you choose to take.
Posted by nutjob on March 30, 2006, at 17:22:06
In reply to Re: Avoidant Personality » nutjob, posted by ed_uk on March 30, 2006, at 15:18:34
Truthfully the MAOI's frigthen me. Though if amisulpride doesn't work for me I am going to try Nardil. My only concern is that it might further blunt my cognition.
Posted by yxibow on March 31, 2006, at 0:31:43
In reply to Re: Avoidant Personality » ed_uk, posted by nutjob on March 30, 2006, at 17:22:06
> Truthfully the MAOI's frigthen me. Though if amisulpride doesn't work for me I am going to try Nardil. My only concern is that it might further blunt my cognition.
If you've been through that laundry list, which I'm sorry you have -- I've been through a lot of medications, actually ECT at least here has had some success for treatment resistant conditions, which my pdoc has mentioned in passing. The whole thought of it horrifies me but its very controlled today.
One also has to evaluate and look back as to how long one "stuck out" a medicine trial. 3 days? 1 week? A month? Often medicine is pitched in the trash after days due to I admit unpleasant side effects. Transmitters take a while to adjust to medications, as opposed to ECT which is fairly immediate, and some antipsychotics. Your experience with Geodon was probably akathisia EPS. Its somewhat potent in that direction.
Tidings
- J
Posted by minimal on March 31, 2006, at 3:27:00
In reply to Re: Avoidant Personality » nutjob, posted by yxibow on March 31, 2006, at 0:31:43
Not that this helps you at all, but I just wanted to tell you that I am very sorry that you are suffering from such a debilitating illness, despite such extensive attempts to confront this problem with pharmaceuticals.
I am reading about your experience, and although I don't know you, I am shaking my head and it pains me to know that you are suffering so much. I hope you can find a space where you can at least "function".
Posted by ed_uk on March 31, 2006, at 15:09:03
In reply to Re: Avoidant Personality » ed_uk, posted by nutjob on March 30, 2006, at 17:22:06
Hi NJ
Nardil is one of the best treatments for avoidant personality disorder/severe social phobia. Whether or not Nardil is a safe medication depends strongly on whether you (and your doctor) are knowledgeable about MAOIs. With MAOIs, knowledge is power. You need to learn in detail about the dietary restrictions and drug interactions. In the right hands, MAOIs can be remarkably safe.
Ed
Posted by psychopharmacon on March 31, 2006, at 23:12:49
In reply to Re: YES - Avoidant Personality and Amisulpride, posted by nutjob on March 30, 2006, at 12:50:26
I have Avoidant Personality Disorder, and amisulpride has been great for me. I prefer it over clonazepam.
Posted by summerflowers on April 2, 2006, at 4:19:41
In reply to Re: Avoidant Personality » nutjob, posted by ed_uk on March 31, 2006, at 15:09:03
> Hi NJ
>
> Nardil is one of the best treatments for avoidant personality disorder/severe social phobia. Whether or not Nardil is a safe medication depends strongly on whether you (and your doctor) are knowledgeable about MAOIs. With MAOIs, knowledge is power. You need to learn in detail about the dietary restrictions and drug interactions. In the right hands, MAOIs can be remarkably safe.
>
> EdI have avoidant personality disorder.It was thought to be bipolar but the depression is more caused by the way I live life,and the ups are myself trying to save myself from the depression.I am against all SSRIs and anti psychotics,but am interested in other treatments.MAOIs seem OK.Im curious did these drugs actually help you get out there and live more of a life?Did they help you connect more with people,relax more?Also were you on MAOIs alone or mixed?also did they work for long? Sorry about all the questions.
Posted by ShaunW on April 2, 2006, at 6:26:44
In reply to Re: Avoidant Personality, posted by summerflowers on April 2, 2006, at 4:19:41
Hello NJ, i struggled with social anxiety for 17 yrs along the way i collected various labels including BPII, panic disorder, ADD (passive), and obsessive personality. Essentially though i think everyone is "normal" it's just some of their charactoristics are extreme compared with others. I wouldn't own any label as the only use it has is to give the Doc a starting point with which to begin treating symptoms. In reallity it's all shades of grey.
I've been happy and stable for quite some time now. Though i've had to be my own doctor in order to get here. Which i think is the case with many people. Don't give up mate, i believe 100% improvement is definately achievable.
The Amisulpride is a good place to start at around 25 to 100mg with 50mg being the usual optimum. Then i would give Adderal another chance but not alone, i would only use it with a drug like memantine which can be effective in preventing tolerance and rebound anxiety. Another potentially very effective med,is Lamotrigine, slow titration up to 200mg to smooth out your mood without numbing the emotions like the ssris can. I think it would be very worth while reseaching these meds, it could really make a difference. Best of luck my friend, Shaun.
Posted by nutjob on April 2, 2006, at 15:56:06
In reply to Re: Avoidant Personality, posted by ShaunW on April 2, 2006, at 6:26:44
Shawn,
First of all, thanks for the encouraging words. And that goes for everyone else who has posted in this thread too. I'm feeling much more hopeful about the situation.
It's interesting that you were given that combination of diagnostic labels--because those are EXACTLY the labels I was just given two weeks ago after undergoing an extensive neuropsych evaluation. ADHD (w/out hyperactivity), Avoidant Personality/Social Anxiety, and Bipolar NOS (not otherwise specified).
What particular medications are you taking at this time? Is your quality of life much improved?
job
> Hello NJ, i struggled with social anxiety for 17 yrs along the way i collected various labels including BPII, panic disorder, ADD (passive), and obsessive personality. Essentially though i think everyone is "normal" it's just some of their charactoristics are extreme compared with others. I wouldn't own any label as the only use it has is to give the Doc a starting point with which to begin treating symptoms. In reallity it's all shades of grey.
> I've been happy and stable for quite some time now. Though i've had to be my own doctor in order to get here. Which i think is the case with many people. Don't give up mate, i believe 100% improvement is definately achievable.
> The Amisulpride is a good place to start at around 25 to 100mg with 50mg being the usual optimum. Then i would give Adderal another chance but not alone, i would only use it with a drug like memantine which can be effective in preventing tolerance and rebound anxiety. Another potentially very effective med,is Lamotrigine, slow titration up to 200mg to smooth out your mood without numbing the emotions like the ssris can. I think it would be very worth while reseaching these meds, it could really make a difference. Best of luck my friend, Shaun.
Posted by nutjob on April 2, 2006, at 15:58:43
In reply to Re: Avoidant Personality » ShaunW, posted by nutjob on April 2, 2006, at 15:56:06
Oh, and I forgot to mention, they also described me as having "obsessive-compulsive personality features."
> Shawn,
>
> First of all, thanks for the encouraging words. And that goes for everyone else who has posted in this thread too. I'm feeling much more hopeful about the situation.
>
> It's interesting that you were given that combination of diagnostic labels--because those are EXACTLY the labels I was just given two weeks ago after undergoing an extensive neuropsych evaluation. ADHD (w/out hyperactivity), Avoidant Personality/Social Anxiety, and Bipolar NOS (not otherwise specified).
>
> What particular medications are you taking at this time? Is your quality of life much improved?
>
> job
>
> > Hello NJ, i struggled with social anxiety for 17 yrs along the way i collected various labels including BPII, panic disorder, ADD (passive), and obsessive personality. Essentially though i think everyone is "normal" it's just some of their charactoristics are extreme compared with others. I wouldn't own any label as the only use it has is to give the Doc a starting point with which to begin treating symptoms. In reallity it's all shades of grey.
> > I've been happy and stable for quite some time now. Though i've had to be my own doctor in order to get here. Which i think is the case with many people. Don't give up mate, i believe 100% improvement is definately achievable.
> > The Amisulpride is a good place to start at around 25 to 100mg with 50mg being the usual optimum. Then i would give Adderal another chance but not alone, i would only use it with a drug like memantine which can be effective in preventing tolerance and rebound anxiety. Another potentially very effective med,is Lamotrigine, slow titration up to 200mg to smooth out your mood without numbing the emotions like the ssris can. I think it would be very worth while reseaching these meds, it could really make a difference. Best of luck my friend, Shaun.
>
>
Posted by ShaunW on April 3, 2006, at 2:06:07
In reply to Re: Avoidant Personality, posted by ShaunW on April 2, 2006, at 6:26:44
I currently take 50mg amisulpride, 60mg dexampthetamine, 200mg lamotrigine, 20mg memantine. I also take 25-50mg quietapine (seroquel)for sleep. I live in Australia and we don't have adderal but i think it would be a good choice for you. Memantine is quite expensive and will need to be prescribed off label as will the Lamotrigine. Regards Shaun.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.