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Dr. Bob is Robert Hsiung, MD,
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Posted by LostBoyinNCBecksDark on November 18, 2008, at 15:57:48
In reply to Antipsychotics for Social Phobia, posted by Michael Bell on November 18, 2008, at 13:25:41
> Hi, I am just curious about what effects people with social phobia experience with the use of anti-psychotics. Do they work at all for you? Alone or in combo with something else? Do they help with sensitivity to rejection? Which ones have you tried? I am on risperdal right now and am trying to decide on a good mix of meds to best address the social phobia issue.
No anti-psychotic is FDA approved for social phobia. Anti-psychotics are FDA approved for 1) schizophrenia and 2)bipolar disorder. Off label usage of atypical anti-psychotics has been sharply curtailed in recent years due to the realization that all the atypical APs are strongly linked to causing type II diabetes and metabolic syndrome.
Have you tried plain old benzos or an SSRI for social phobia? Also psychotherapy is useful for shyness. An anti-psychotic is going overboard for social phobia...you are likely to mess yourself up with possible permanent side effects unless you also are dxed with schizo or mania.
LostBoyinNC
Posted by Michael Bell on November 18, 2008, at 16:24:13
In reply to Re: Antipsychotics are for psychosis, not SP, posted by LostBoyinNCBecksDark on November 18, 2008, at 15:57:48
Thanks for the reply. In my estimation, social phobia has a strong linkage to other disorders that have paranoia as one of the defining characteristics. Social phobes are generally always thinking that others are negatively evaluating them, feeling like they are always "on stage", and in bad cases, that others in public are looking at them and/or laughing at them/talking about them. They generally realize that these feelings are irrational, but the feelings exist nonetheless. Therefore social phobia is more than just the anxiety that one feels when anticipating a social event. There is a deep cognitive aspect that revolves around lack of trust of others, that others are a danger (even if just a "social danger") to them, interpersonal sensitivity, etc. At least in my case, there is a paranoid aspect to my social anxiety as well as some improper self-referencing issues. So I am wondering if the anti-psychotic action of neuroleptics have any effect on social phobia.
Posted by Michael Bell on November 18, 2008, at 16:24:54
In reply to Re: Antipsychotics for Social Phobia » Michael Bell, posted by Sigismund on November 18, 2008, at 14:49:58
> I think they are worse than useless, all things considered.
>
> For me, at any rate.Which ones did you try, and for how long?
Posted by whitmore on November 18, 2008, at 16:41:27
In reply to Re: Antipsychotics for Social Phobia » Sigismund, posted by Michael Bell on November 18, 2008, at 16:24:54
I found your analysis of social phobia being somewhere in the psychotic spectrum very interesting. I have a form of BDD which seems like the extreme social anxiety that you describe--with its attendant paranoia. In my case I assume that unless I look as perfect as I can, I'm being rejected for my looks and, believe me, I'm looking for slights. BDD is classified as being related to OCD, but my form seems more like SA. I've so far resisted my psychiatrist's attempts to have me try one of the atypicals despite his assurances that the side effect profiles are similar to SSRI's(that may say more about SSRI's than the atypicals). It's a line that I'm very reluctant to cross. SSRI's have provided me a fair amount of relief, but not complete by any means.
Posted by Sigismund on November 18, 2008, at 16:57:20
In reply to Re: Antipsychotics for Social Phobia » Sigismund, posted by Michael Bell on November 18, 2008, at 16:24:54
Which ones did I try?
Haloperidol, Mellerill, Stellazine, Anatensol, Largactil, but not for long.
>There is a deep cognitive aspect that revolves around lack of trust of others, that others are a danger (even if just a "social danger") to them, interpersonal sensitivity, etc. At least in my case, there is a paranoid aspect to my social anxiety as well as some improper self-referencing issues
How to forget that others were once a danger?
Posted by bleauberry on November 18, 2008, at 17:10:33
In reply to Antipsychotics for Social Phobia, posted by Michael Bell on November 18, 2008, at 13:25:41
I was on 5mg Zyprexa for 8 years and it was amazing for social phobia. 20mg Prozac by itself got me about halfway where I wanted to be, but the addition of Zyprexa was a total cure.
It not only worked as a maintenance therapy, but at times when I was not on it and needed some quick relief in a crowd but didn't want to go the xanax route, zyprexa had me comfortable and at-ease in that crowd in about 1 to 2 hours after dosing.
Seroquel sort of worked, but not really. I never took more than 50 and only took it a few times as-needed, not continuously, so I can't judge it fairly. The way seroquel worked was by basically making me so drugged I didn't know or care what was going on around me.
More than ten years ago I tried low dose amisulpride for a few weeks. It increased social phobia at first, but in short time it was excellent at ridding social phobia.
So anyway, my experience with antipsychotics on social phobia have been very positive, but I am mostly giving credit to Zyprexa, and secondarily to Amisulpride. I can't speak much of the others.
Posted by desolationrower on November 18, 2008, at 19:38:03
In reply to Re: Antipsychotics for Social Phobia, posted by bleauberry on November 18, 2008, at 17:10:33
I think it depends on what one's social anxiety is like. I think a few people have a sort of paranoid, self-centered way of seeing things that could be helped by antipsychotic. The general sedative nature could also be slightly helpful, like hydrazine. I think for many people though, myself included, they are very bad, in addtion to any side effects. For me, social anxiety isn't about everyone looking at me, its about not feeling central. The antidopaminergic action is exactly what isn't needed. It magnifies the feeling of unimportance and lowness. Acting out this social role is to be avoidant. I think this is bourne out by research on dopamine function and social interaction. (the exception would be something like sulpiride.)
-d/r
Posted by HyperFocus on November 18, 2008, at 19:38:08
In reply to Antipsychotics for Social Phobia, posted by Michael Bell on November 18, 2008, at 13:25:41
I've been trying sulpiride for a while. I used to take it in the AD dosage range (50mg - 150mg) but now I'm up to 400mg. I might go down again if I feel it may be better. It's too early to talk about the long-term effacy of it for me. If you search the archives you'll find a lot of experiences of sulpiride/amisulpiride with SA. Oh yeah, I agree with you on the psychosis/paranoia aspect of SA. It's something that I also theorized. Interestingly this article sees some SA as a component of Bipolar - http://www.psycheducation.org/depression/Anxiety.htm#social
> Hi, I am just curious about what effects people with social phobia experience with the use of anti-psychotics. Do they work at all for you? Alone or in combo with something else? Do they help with sensitivity to rejection? Which ones have you tried? I am on risperdal right now and am trying to decide on a good mix of meds to best address the social phobia issue.
Posted by LostBoyinNCBecksDark on November 18, 2008, at 20:11:17
In reply to Re: Antipsychotics are for psychosis, not SP » LostBoyinNCBecksDark, posted by Michael Bell on November 18, 2008, at 16:24:13
> Thanks for the reply. In my estimation, social phobia has a strong linkage to other disorders that have paranoia as one of the defining characteristics. Social phobes are generally always thinking that others are negatively evaluating them, feeling like they are always "on stage", and in bad cases, that others in public are looking at them and/or laughing at them/talking about them. They generally realize that these feelings are irrational, but the feelings exist nonetheless. Therefore social phobia is more than just the anxiety that one feels when anticipating a social event. There is a deep cognitive aspect that revolves around lack of trust of others, that others are a danger (even if just a "social danger") to them, interpersonal sensitivity, etc. At least in my case, there is a paranoid aspect to my social anxiety as well as some improper self-referencing issues. So I am wondering if the anti-psychotic action of neuroleptics have any effect on social phobia.
Social phobia is a twenty dollar word psychiatry word for shyness. Medications FDA approved to treat social phobia are certain SSRIs...thats it. Any AP use for SP is off label use and hitting rock bottom.Social phobia is NOT paranoia. Paranoia is an aspect of some forms of psychosis. Trying to link social phobia to paranoia is quite of a stretch. Perhaps what you really desire is total anesthesia...where you are numb to the outside world? Anti-psychotics can do that to a person. So can lobotomy. So can a head injury.
Encouraging APs for social phobia is psychiatric malpractice and shouldnt be encouraged here or anywhere else.
LostBoyinNC
Posted by Phillipa on November 18, 2008, at 20:19:02
In reply to Re: SP is not paranoia, posted by LostBoyinNCBecksDark on November 18, 2008, at 20:11:17
Can we agree to disagree as for me benzos worked for 37 years and sometimes didn't even need them especially when busy so keep busy most of the time. Antipsycotics agree it's over kill unless paranoid. But that is just my personal opionion we are all different. Phillipa
Posted by Michael Bell on November 18, 2008, at 20:39:52
In reply to Re: SP is not paranoia, posted by LostBoyinNCBecksDark on November 18, 2008, at 20:11:17
The fact that you just said "Social phobia is a twenty dollar word psychiatry word for shyness" completely undermines anything else you have to say on this subject. Social Phobia is, by definition, not mere shyness. Ask anyone with social phobia. Thanks for your input though.
> > Thanks for the reply. In my estimation, social phobia has a strong linkage to other disorders that have paranoia as one of the defining characteristics. Social phobes are generally always thinking that others are negatively evaluating them, feeling like they are always "on stage", and in bad cases, that others in public are looking at them and/or laughing at them/talking about them. They generally realize that these feelings are irrational, but the feelings exist nonetheless. Therefore social phobia is more than just the anxiety that one feels when anticipating a social event. There is a deep cognitive aspect that revolves around lack of trust of others, that others are a danger (even if just a "social danger") to them, interpersonal sensitivity, etc. At least in my case, there is a paranoid aspect to my social anxiety as well as some improper self-referencing issues. So I am wondering if the anti-psychotic action of neuroleptics have any effect on social phobia.
>
>
> Social phobia is a twenty dollar word psychiatry word for shyness. Medications FDA approved to treat social phobia are certain SSRIs...thats it. Any AP use for SP is off label use and hitting rock bottom.
>
> Social phobia is NOT paranoia. Paranoia is an aspect of some forms of psychosis. Trying to link social phobia to paranoia is quite of a stretch. Perhaps what you really desire is total anesthesia...where you are numb to the outside world? Anti-psychotics can do that to a person. So can lobotomy. So can a head injury.
>
> Encouraging APs for social phobia is psychiatric malpractice and shouldnt be encouraged here or anywhere else.
>
> LostBoyinNC
>
Posted by LostBoyinNCBecksDark on November 18, 2008, at 20:50:37
In reply to Re: SP is not paranoia » LostBoyinNCBecksDark, posted by Michael Bell on November 18, 2008, at 20:39:52
> The fact that you just said "Social phobia is a twenty dollar word psychiatry word for shyness" completely undermines anything else you have to say on this subject. Social Phobia is, by definition, not mere shyness. Ask anyone with social phobia. Thanks for your input though.
>When the drug companies started getting SSRIs approved for "social phobia" a lot of people were skeptical. There was a lot of "wow now a drug for shyness." SP IS SHYNESS!
There is nothing in the DSM-IV about social phobia having anything to do with paranoia or other psychotic symptoms. Read it for yourself if you dont believe me.
Social phobia is a personality trait, not a major mental illness. If you dont want to be afraid of social situations and not be introverted anymore, you should probably ask your parents if they could have married someone else before they had you.
Good luck when you f*ck yourself all up with TD or EPS or type II diabetes from messing with anti-psychotics for social phobia! I almost want to say, hey, you deserved it!
LostBoyinNC
>
Posted by desolationrower on November 18, 2008, at 20:51:08
In reply to Re: SP is not paranoia » LostBoyinNCBecksDark, posted by Michael Bell on November 18, 2008, at 20:39:52
Nah i agree social anxiety is another word for shyness. and crazy is a word for schizophrenia, fat is a word for obese. Most people have a basic understanding of mental illness; and we have words to describe it. This doesn't mean the average person understands the disorders as well as a psychologist would. We shouldn't write off all cultural understanding of the mind just because there is a more accurate scientific language available.
And relying on FDA approval for deciding what meds to take is at least as bad of an idea as taking APs.
-d/r
Posted by Michael Bell on November 18, 2008, at 20:58:18
In reply to Re: SP is not paranoia, posted by LostBoyinNCBecksDark on November 18, 2008, at 20:50:37
> > The fact that you just said "Social phobia is a twenty dollar word psychiatry word for shyness" completely undermines anything else you have to say on this subject. Social Phobia is, by definition, not mere shyness. Ask anyone with social phobia. Thanks for your input though.
> >
>
> When the drug companies started getting SSRIs approved for "social phobia" a lot of people were skeptical. There was a lot of "wow now a drug for shyness." SP IS SHYNESS!
>
> There is nothing in the DSM-IV about social phobia having anything to do with paranoia or other psychotic symptoms. Read it for yourself if you dont believe me.
>
> Social phobia is a personality trait, not a major mental illness. If you dont want to be afraid of social situations and not be introverted anymore, you should probably ask your parents if they could have married someone else before they had you.
>
> Good luck when you f*ck yourself all up with TD or EPS or type II diabetes from messing with anti-psychotics for social phobia! I almost want to say, hey, you deserved it!
>
> LostBoyinNC
> >Wow. Just... wow.
Posted by Deputy Dinah on November 18, 2008, at 21:03:20
In reply to Re: SP is not paranoia, posted by LostBoyinNCBecksDark on November 18, 2008, at 20:50:37
> I almost want to say, hey, you deserved it!
While I realize you've been blocked on another board of this site, I want to remind you when you come back to please follow site guidelines regarding not posting anything that could lead others to feel accused or put down.
Dinah, acting as deputy to Dr. Bob
Posted by X-ray on November 19, 2008, at 1:34:27
In reply to Antipsychotics for Social Phobia, posted by Michael Bell on November 18, 2008, at 13:25:41
Hi,
Lyrica might be a good drug for social phobia.
Best regards,
X-ray
Posted by mav27 on November 19, 2008, at 6:49:09
In reply to Antipsychotics for Social Phobia, posted by Michael Bell on November 18, 2008, at 13:25:41
I havn't had much luck stayng on anti-psychotics because they either knock me out cold or make me feel really wierd. One i do tolerate is low dose of amisulpride and it worked quite well for my social phobia. Quite a while ago i was on melleril and it worked although it took a while.. it's no longer available in AUS though so i don't take it anymore. A low dose of stellazine gives me a bit of a kick so i suspect it may be helpfull. I've been busy trying to find an anti-depressant that works for me so have been staying off the AP's for now.
Posted by Racer on November 19, 2008, at 8:51:26
In reply to Antipsychotics for Social Phobia, posted by Michael Bell on November 18, 2008, at 13:25:41
It's hard to say what worked best for me -- but I know it wasn't an A/P... (I've never been able to stay on any more than a couple of weeks -- feel too weird, and they tend to increase my depression.)
Lately, the best thing has been Provigil, because as I get that sense of wellness, of strength, it comes with confidence, which brings along far more ease in social situations. Now, that's me, and Provigil is the best anti-depressant I've ever been on -- even though it's not known to be an anti-depressant. (And, since benzos cause agitation, some SSRIs increase my depression, etc, that doesn't mean that it will be helpful for ANY OTHER human being on the planet.) (I also take Wellbutrin XL and Trileptal, and Vyvanse.) That leads me to suspect that many people with intense social anxiety would respond well to a non-agitating anti-depressant -- and to a bit of self-coaching. (Or even just plain coaching.)
The behavioral aspects are what I find most important, though. For me, NOTHING would make any difference whatsoever if I didn't take behavioral action, as well. Reminding myself that everyone else also felt some shyness, telling myself I could approach someone else the way I'd like to be approached, repeating the message my mother used to give me, "why would anyone be looking at you, Dear? They're all too worried about how they look themselves" -- those messages help me more than any drug. (Especially since any somewhat sedating drug will make me much more anxious in those situations. Anxious enough I can smell it in my sweat.)
So, for me, a combination of effective anti-depressant medication and behavioral intervention made a huge difference.
Posted by bleauberry on November 19, 2008, at 17:38:36
In reply to Re: Antipsychotics for Social Phobia » Michael Bell, posted by Racer on November 19, 2008, at 8:51:26
I would like to agree with Racer that lifestyle efforts need to be made to combat social phobia, in addition to meds. Meds can help get the comfort and confidence to do that.
Some of the best times to retrain your mind however are when your symptoms are the worst. I had the worst massive phobia, but I had no choice but to enter the huge group of crowded people at a convention; and I had no choice but to walk through 300 people to get up on stage at church to play my guitar...and in both situations I had blown right past plain social phobia into near panic attack.
Anyway, I did my best, I did a fake job, it was hard, it was a determined effort, literally one 5-second segment at a time. Extremely unbearably uncomfortable and extremely draining.
But, after all was done, I realized nothing bad happened. All the social phobia was for not. Sure, it feels real as can be, but it is not based on reality. It is based on some genetic or neurotransmitter flaw. Or an exaggerated form of shyness. Or a mild flavor of paranoia, or a mild flavor of schizophrenia, or a mild flavor of bipolar, or something. Doesn't matter. All that matters is that it comes from somewhere we cannot point to, but that we can force ourselves through it. Aint fun, but we can do it.
After it is done, there is obviously a huge sense of relief. But in addition to that, there is a slight sense of accomplishment. A slight boost in confidence. So the next time around, it will still be terrifying, but a tad less terrifying than the time before. Over time with these repeated purposeful exposures, symptoms can be cut in half, and things can be much more tolerable, and we can at least have some control over the feelings, even though we can't make them go away by will.
Medications that do the job, awesome if you find the right one. But even with the wrong one or an unsatisfactory one, do not wait for a cure to begin curing oneself. Force yourself into those uncomfortable situations and retrain. It really works. I agree, it aint easy, but whoever said life was. It does however make a better and stronger person out of you, a person less controlled by the invisible illness, a person who says to the social phobia monster, "I am the boss of you, you are not the boss of me."
Posted by Michael Bell on November 19, 2008, at 20:29:54
In reply to Re: Antipsychotics for Social Phobia, posted by bleauberry on November 18, 2008, at 17:10:33
Thanks for the feedback. I am wondering, what aspects of social anxiety did Zyprexa have an effect on? And also, did that combo affect your desire to socialize?
> I was on 5mg Zyprexa for 8 years and it was amazing for social phobia. 20mg Prozac by itself got me about halfway where I wanted to be, but the addition of Zyprexa was a total cure.
>
> It not only worked as a maintenance therapy, but at times when I was not on it and needed some quick relief in a crowd but didn't want to go the xanax route, zyprexa had me comfortable and at-ease in that crowd in about 1 to 2 hours after dosing.
>
> Seroquel sort of worked, but not really. I never took more than 50 and only took it a few times as-needed, not continuously, so I can't judge it fairly. The way seroquel worked was by basically making me so drugged I didn't know or care what was going on around me.
>
> More than ten years ago I tried low dose amisulpride for a few weeks. It increased social phobia at first, but in short time it was excellent at ridding social phobia.
>
> So anyway, my experience with antipsychotics on social phobia have been very positive, but I am mostly giving credit to Zyprexa, and secondarily to Amisulpride. I can't speak much of the others.
Posted by Michael Bell on November 19, 2008, at 20:32:13
In reply to Re: Antipsychotics for Social Phobia, posted by X-ray on November 19, 2008, at 1:34:27
I actually take high dose lyrica right now, which is pretty good for social phobia. But the mind fog is too much to bear sometimes, and it can make you feel buzzed and somewhat hypomanic at times.
> Hi,
>
> Lyrica might be a good drug for social phobia.
>
> Best regards,
> X-ray
Posted by paddo on November 19, 2008, at 23:54:44
In reply to Antipsychotics for Social Phobia, posted by Michael Bell on November 18, 2008, at 13:25:41
Posted by desolationrower on November 20, 2008, at 22:55:43
In reply to Re: Antipsychotics for Social Phobia, posted by bleauberry on November 19, 2008, at 17:38:36
> After it is done, there is obviously a huge sense of relief. But in addition to that, there is a slight sense of accomplishment. A slight boost in confidence. So the next time around, it will still be terrifying, but a tad less terrifying than the time before. Over time with these repeated purposeful exposures, symptoms can be cut in half, and things can be much more tolerable, and we can at least have some control over the feelings, even though we can't make them go away by will.
>
> Medications that do the job, awesome if you find the right one. But even with the wrong one or an unsatisfactory one, do not wait for a cure to begin curing oneself. Force yourself into those uncomfortable situations and retrain. It really works. I agree, it aint easy, but whoever said life was. It does however make a better and stronger person out of you, a person less controlled by the invisible illness, a person who says to the social phobia monster, "I am the boss of you, you are not the boss of me."Sorry, this is simply false for some people.
-d/r
Posted by HyperFocus on November 22, 2008, at 1:57:53
In reply to Re: Antipsychotics for Social Phobia, posted by desolationrower on November 20, 2008, at 22:55:43
Agreed. I have SP and it has nothing to do with performance anxiety - personally I would feel less anxiety standing to give a spech anywhere, than I do when crossing the street. SP is about not going to class because you can't stand the microsecond everyone's eyes will be on you as you walk into class late. It's about not being able to say Good Evening to your neighbour simply from the fear of the awkwardness. CBT combined with meds is the only treatment for it. Some people, including me, have no conscious ability to fight SP.
>
> Sorry, this is simply false for some people.
>
> -d/r
Posted by bleauberry on November 22, 2008, at 18:16:25
In reply to Re: Antipsychotics for Social Phobia, posted by HyperFocus on November 22, 2008, at 1:57:53
The kind of SP you described is exactly the kind I have. Somehow readers interpreted a crowd and guitar and automatically assumed performance anxiety. Wrong diagnosis. Bad example on my part though which probably led to the faulty diagnosis by both of you.
The point is, if you are afraid of everyone's eyes being on you, then forcefully get in a situation where that happens. Avoiding the situation only compounds and reinforces the illness, gives it fuel to affect your life even more. If you're afraid to say HI to the neighbor, force one foot in front of the other, step by step, a little close to that neighbor, and with a great deal of purposeful effort, say "HI". Nothing more, nothing less. A light movement of the lips. That is a TON better than draggin one's head into seclusion without making an effort to fight back against the SP monster. The next time will still be hard, but a slight tad bit less hard. That is called retraining the mind. In no way is it a cure, but it is a positive direction in handling one's handicap.
A lot of psychotherapy has to do with this very topic. Avoiding the problem is not conducive to healing.
> Agreed. I have SP and it has nothing to do with performance anxiety - personally I would feel less anxiety standing to give a spech anywhere, than I do when crossing the street. SP is about not going to class because you can't stand the microsecond everyone's eyes will be on you as you walk into class late. It's about not being able to say Good Evening to your neighbour simply from the fear of the awkwardness. CBT combined with meds is the only treatment for it. Some people, including me, have no conscious ability to fight SP.
>
>
> >
> > Sorry, this is simply false for some people.
> >
> > -d/r
>
>
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