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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 Lisa2712 on April 21, 2010, at 19:42:00
Hi,
I have social anxiety and agoraphobia and I'm on Lexapro 15 mg ( I couldn't tolerate 20 mg) and Clonazepam .25 mg twice daily and more taken if needed ( I couldn't tolerate .5 mg twice a day). I still have a lot of anxiety and problems and I don't go out of the house unless I have to because I get very uncomfortable when I'm in public. I've tried many medications (all the SSRI's, Effexor, Wellbutrin, Tegretol- made me feel sick, Lamictal- too stimulating for me, Trileptal, Depakote- made me gain a lot of weight and very tired, Abilify- made my heart race and gave me restlessness), and I just saw a psydoc who made it sound like she didn't know what else to give me.
I also have a lot of social problems, like I've never been able to make friends or maintain them (since elementary school).I had one friend when I was 11, and since then I haven't been able to make any friends and I've never had a boyfriend (I'm almost 27). I think that my lack of any kind of friends or social support and connection growing up has a lot to do with my mental problems and the rut I'm in now.My question is- are there other medicines out there that can help someone like me with my anxiety problems , other than the ones I've already tried?
Thanks
Posted by tensor on April 22, 2010, at 3:58:00
In reply to Severe anxiety and other problems, posted by Lisa2712 on April 21, 2010, at 19:42:00
> Hi,
> I have social anxiety and agoraphobia and I'm on Lexapro 15 mg ( I couldn't tolerate 20 mg) and Clonazepam .25 mg twice daily and more taken if needed ( I couldn't tolerate .5 mg twice a day). I still have a lot of anxiety and problems and I don't go out of the house unless I have to because I get very uncomfortable when I'm in public. I've tried many medications (all the SSRI's, Effexor, Wellbutrin, Tegretol- made me feel sick, Lamictal- too stimulating for me, Trileptal, Depakote- made me gain a lot of weight and very tired, Abilify- made my heart race and gave me restlessness), and I just saw a psydoc who made it sound like she didn't know what else to give me.
> I also have a lot of social problems, like I've never been able to make friends or maintain them (since elementary school).I had one friend when I was 11, and since then I haven't been able to make any friends and I've never had a boyfriend (I'm almost 27). I think that my lack of any kind of friends or social support and connection growing up has a lot to do with my mental problems and the rut I'm in now.
>
> My question is- are there other medicines out there that can help someone like me with my anxiety problems , other than the ones I've already tried?
>
> ThanksWhy didn't you tolerate 0.5mgx2, too seadating? That usually wears off in a couple of weeks, clonazepam in the range 1-4mg is often very effective.
You could add pregabalin(Lyrica) to your current regime and see if it helps.If the above doesn't help, there are 'heavier' drugs to try, e.g. Nardil, Parnate and moclobemide. These are often effective but I have no personal experience of them but there are a lot of people on this board that have.
Kind regards,
Mattias
Posted by Lisa2712 on April 22, 2010, at 9:29:50
In reply to Re: Severe anxiety and other problems » Lisa2712, posted by tensor on April 22, 2010, at 3:58:00
I was on .5 mg twice daily for about 6 months; it made me very agitated and angry and I pulled my hair out while on this dose; when I saw a new psydoc she told me to get off the Klonopin and take it only as needed. It wasn't sedating for me.
I'll ask my psydoc about Lyrica and the other drugs.Thank you,
Lisa2712
Posted by stargazer2 on April 22, 2010, at 22:23:33
In reply to Severe anxiety and other problems, posted by Lisa2712 on April 21, 2010, at 19:42:00
Hi Lisa,
Do you have any other medical problems? I saw you were on a few seizure meds, i.e. Trileptal, Tegretol.Do you also have depression?
How long have you have agorophobia for? Have any meds helped at all for any symptoms you have?
Nardil can be very good for social anxiety but many docs will not prescribe it because of it's side effects and special dietary restrictions.
When you say you only had one friend at age 11, was this seen as a problem in the school system or by your family? I'm just curious and hope I don't come across as being too nosey, but often times things like this are overlooked or ignored. I guess if it was identified as a problem then it could have been addressed at the time.
Were you able to finish school or ever work?
I'm sure some people here will have some ideas but we all ask lots of questioons to try and get to the root of the issues. It is part of the process to figure some of this stuff out. It is not an easy thing to do and unfortunately even the best doctors can miss the obvious, sad, but true. I'm still looking for answers and I started meds in 1987, so it can be a long hard road to figure this stuff out.
Do you have access to doctors in a major medical center or a large city? Some times that is a good thing as you could get another opinion if you have only seen one doctor for your treatment.
Posted by Lisa2712 on April 23, 2010, at 15:41:19
In reply to Re: Severe anxiety and other problems, posted by stargazer2 on April 22, 2010, at 22:23:33
A psychiatrist I saw a while ago told me I had bipolar disorder and mania and she put me on Tegretol; I didn't like the medicine so I went to another psydoc and she tried me on Trileptal and Lamictal.
A few days ago I tried Concerta 36 mg because I explained to my psydoc that I felt I might have ADD and I had a very bad reaction to it and I'm going off it now.
I think I also have depression that's caused by my anxiety, but my problem is mostly severe anxiety.
I've been very nervous and uncomfortable around classmates and people since middle school, and it got worse as I got older (I'm almost 27). Now I rarely go out of the house.
Yes, the SSRI's have helped a lot and the Klonipin has helped a lot also. I've been told to wean off the Klonopin and take it only as needed by my new psydoc. When I was taking it regularly (morning and night) I had side effects like feeling agitated, I was pulling out my hair, and being very irritable. This was on .5 mg twice a day. The Lexapro and Klonopin help but my anxiety is still very bad.
I don't think my parents noticed my social problems, at least not until I was in high school. I think the schools knew but they overlooked it.
I finished high school (but it was very hard) and I went through 2 years of college and then dropped out because of my anxiety and social problems.
I worked only one time for 2 weeks as a secretary and I had a lot of trouble doing that job, and the boss realized this and she let me go from that job after only 2 weeks.
I've seen about 6 psydocs, and I lost my insurance I had under my parents a few years ago so I don't have access to a lot of doctors. But this psydoc I just saw told me she didn't know what else to give me other than what I was already on, so I'm going to try to see another psydoc.Thank you,
Lisa2712
Posted by desolationrower on April 23, 2010, at 17:50:53
In reply to Re: Severe anxiety and other problems, posted by Lisa2712 on April 23, 2010, at 15:41:19
that sounds quite familiar to me. here are some ideas:
nardil would be the best option for the anxiety aspect.
try a different benzo, you might not have the bad reaction. probably alprazolam, though it can cause more dependance so if you think that is a risk for you, a standard one like lorazapam.
the bad reaction might be from depression not under control - i know from before i was on an antidepressant, i would try drinking large volumes to reduce social anxiety, and it just caused me to get very dysphoric. benzos can be similar, known as 'disinhibition' where the negative feels you were able to control with higher brain functions are unmasked by a drug that 'shuts off' part of your brain. if this is the case, a better antidepressant might help you tolerate a sufficient dose of a benzo to treat the anxiety.
if you have ADD (which is why i stopped taking an maoi, it is common with social anxiety), just adding a stimulant or antidepressant that is similar could help. adderal, dexedrine, ritalin, nortryptaline, bupropion could all help. also nicotine lozenges.
guanfacine also can help with ADD, and it can help reduce anxiety and agitation, so that could be useful to try too.
therapy, maybe group therapy, is helpful for some.
you mentioned mania. do you find your anxiety goes away? is it 'fun' mania or mostly dysphoric?
also, though not usually enough to really 'fix' things, good nutrition/exercise/meditation/sleeep stuff like that probably helps things too.
good luck
-d/r
Posted by Lisa2712 on April 24, 2010, at 11:01:37
In reply to Re: Severe anxiety and other problems, posted by desolationrower on April 23, 2010, at 17:50:53
I don't think I have ADD, but I do have symptoms like it (like problems focusing, mind racing, impatience, feeling like a motor is running full speed in me, going fast, talking, walking and writing fast, squirming in seat, and others) , which is why I asked my psydoc if I could try a med for ADD and see if it helped. She put me on 36 mg of Concerta and I had a very bad reaction to it, it felt like my heart was going to explode, and I stopped taking it. Maybe the starting dose was too high.
A psychiatrist told me I had mania and bipolar disorder because when I talked to her I rambled on and made no sense, I couldn't hold a conversation with anyone, my mind was going all over the place, and other symtoms that she interpreted as mania symptoms. Yes, I think my anxiety does go away, and I think it's more fun, but my symptoms are like ADD-like symptoms.
I'm going to look into therapy for my anxiety.Thank you,
Lisa
Posted by desolationrower on April 24, 2010, at 22:47:12
In reply to Re: Severe anxiety and other problems, posted by Lisa2712 on April 24, 2010, at 11:01:37
> I don't think I have ADD, but I do have symptoms like it (like problems focusing, mind racing, impatience, feeling like a motor is running full speed in me, going fast, talking, walking and writing fast, squirming in seat, and others) , which is why I asked my psydoc if I could try a med for ADD and see if it helped. She put me on 36 mg of Concerta and I had a very bad reaction to it, it felt like my heart was going to explode, and I stopped taking it. Maybe the starting dose was too high.
> A psychiatrist told me I had mania and bipolar disorder because when I talked to her I rambled on and made no sense, I couldn't hold a conversation with anyone, my mind was going all over the place, and other symtoms that she interpreted as mania symptoms. Yes, I think my anxiety does go away, and I think it's more fun, but my symptoms are like ADD-like symptoms.
> I'm going to look into therapy for my anxiety.
>
> Thank you,
> Lisathis site http://www.psycheducation.org/depression/Anxiety.htm is a good read, describing bipolar with anxiety disorder. other pages on the side might give you a sense of what bipolar is like. maybe it sounds familiar.
i went and looked, i had written this before, http://www.dr-bob.org/babble/20090313/msgs/885392.html so i guess you tried some mood stabilizers but the side effects were the problem? weight gain especially with social anxiety would be frustrating. did you notice any benefit with them? and sometimes just starting at a lower dose and gradually moving onto a drug can make the side effects tolerable.
topiramate is sometimes used for bipolar, has a bit of evidence for social phobia, and tends to cause weight loss.
lithium does a lot of stuff and is probably worth a try. pregabalin or gabapentin can be anxiolytic and might work better for you than the benzo. and other things, like nac.
re: concerta - i don't know that physical side effects means its wrong for your brain. a try on d-amphetamine could be worth doing.
but it does sound more like mixed state bipolar than ADD, really. i guess if benzos do help with the anxiety, reducing the depression so you can tolerate a higher dose might be the thing to focus on.
-d/r
Posted by Lisa2712 on April 25, 2010, at 12:44:05
In reply to Re: Severe anxiety and other problems, posted by desolationrower on April 24, 2010, at 22:47:12
I had tried Lamitrogine for a few days only- it was too stimulating for me; maybe the brand name Lamictal is different? I haven't tried the brand name yet but I found the generic to be very stimulating for me. I don't know if there would be any difference.
I tried Tegretol for a few months a few years ago and I remember feeling sick the whole time I was on it. I recently tried generic Depakote for about 4 months and it made me extremely tired and I gained a lot of weight on it. I also tried Trileptal in the past- I don't remember it helping me. Yes, with the Depakote my mind wasn't as racy. I was on the lowest dose with Depakote- 500 mg's I think.
I was told by a few people that lithium causes weight gain and I'm already really overweight so I'm really hesitant to go on it.
Yes, I had a lot of scary side effects from the 36 mg Concerta I just tried, especially with the heart pain and racing, and I think that dose was too high, my psydoc should have tried me on the lowest dose first, which is 18 mg.Thank you,
Lisa
Posted by stargazer2 on April 26, 2010, at 9:42:06
In reply to Re: Severe anxiety and other problems, posted by Lisa2712 on April 25, 2010, at 12:44:05
I would stay away from any of the stimulant meds for ADD, that doesn't sound like what you have anyway. All of your symptoms sound as if from bipolar, still not treated effectively yet. A combo of an AD and mood stabalizer is the best route for that...trials of medications can take years to get it right unfortunately.
Do you keep a mood diary to see what meds have helped at what doses, etc. YOu have to do this to see if anything works and if so at what dose. Tweaking doses and combinations of meds is very complicated. Most docs do not keep all of that straight withth number of patients they are seeing, who could. Psychiatry is much more complicated than medicine as there are no tests to follow, just what the patient says and I don't remember anything that happens to me unless I write it down. The docs can only go on what we tell them. I would think the best docs have their patients keep records of these things else it is not very productive of anyone's time.
Therapy is always a good thing if you can afford it or have insurance that will pay for it. Even better may be a psych APRN (Advanced Practice RN) that can do therapy and prescribe meds for you.
Posted by SLS on April 26, 2010, at 11:58:24
In reply to Re: Severe anxiety and other problems, posted by stargazer2 on April 26, 2010, at 9:42:06
This is a pretty good mood chart in PDF format:
http://www.psychiatry24x7.com/content/backgrounders/psychiatry24x7-nd.emea_com/blank_chart.pdf
- Scott
Posted by desolationrower on April 27, 2010, at 2:09:58
In reply to Re: Severe anxiety and other problems, posted by Lisa2712 on April 25, 2010, at 12:44:05
> I had tried Lamitrogine for a few days only- it was too stimulating for me; maybe the brand name Lamictal is different? I haven't tried the brand name yet but I found the generic to be very stimulating for me. I don't know if there would be any difference.
> I tried Tegretol for a few months a few years ago and I remember feeling sick the whole time I was on it. I recently tried generic Depakote for about 4 months and it made me extremely tired and I gained a lot of weight on it. I also tried Trileptal in the past- I don't remember it helping me. Yes, with the Depakote my mind wasn't as racy. I was on the lowest dose with Depakote- 500 mg's I think.
> I was told by a few people that lithium causes weight gain and I'm already really overweight so I'm really hesitant to go on it.
> Yes, I had a lot of scary side effects from the 36 mg Concerta I just tried, especially with the heart pain and racing, and I think that dose was too high, my psydoc should have tried me on the lowest dose first, which is 18 mg.
>
> Thank you,
> Lisaso is it the social anxiety the only symptom that is actually bothering you? or do the symptoms of bipolar bother you, outside of social interactions?
tegretol and trileptal are similar, so if one didn't help its not unusual for the other not to either.
Most things that help anxiety/racy thoughts also make you fat. fish oil and topiramate are probably the only things that are good for weight loss and reducing mania both. So I think increasing a benzo for the anxiety once you find something to help with agitation is the best approach.
you haven't tried topiramate? That tends to cause weight loss, so i'd do that, and lithium might be the second option.
Lithium is more often the best for classic bipolar, with clear mania and depression. it sounds like you have most mixed states; depakote is usually the best for that, but it sounds like it didn't help you much. for thinking about what to try, it helps to separate side effects of a medication from how helpful it was. did you find it actually helpful (like, less anxiety, easier to talk to people, good for being productive, etc) and just not worth the side effects, or was the less racing thoughts not actually useful?
i think i would try lithium (after topiramate), at least a moderate dose.
This study indicates lithium causes thirst which causes liquid calories intake, which is what causes hte weight gain. http://www3.interscience.wiley.com/journal/120064093/abstract
but maybe it will be neutral for you. did the depakote not help you much? that is, if it didn't have side effects, would you have been doing well? or did it not really make a big difference.a low dose antipsychotic could help with agitation and negative thoughts, probably risperidone (not over 1mg)
Thats a lot of things to try, i think. i' probably rank them
switch to alprazolam
switch to or add gabapentin/pregabalin
add topiramate
add lithium
maybe try risperdone here
try nardil (this probably will cause some weight gain. if you didn't find depakote much help, maybe try tranylcypromine, which isn't quite as strong against social anxiety)getting enough omega-3, magnesium, and zinc can be done right away
-d/r
Posted by Lisa2712 on April 28, 2010, at 12:05:04
In reply to Re: Severe anxiety and other problems, posted by desolationrower on April 27, 2010, at 2:09:58
The social anxiety and the 'going fast' symptoms bother me;
I haven't tried Topamax yet, I'll ask my psydoc about it.
Depakote did help in some ways, but I couldn't take the constant extreme tiredness and the weight gain. I still had anxiety on it, but it helped a little with being around people but the side effects weren't worth the small amount of benefits I got from it. Actually the Depakote didn't really help that much, and even if it did help, the side effects wouldn't have been worth it.
I've just been prescribed a lot dose AP (Geodon, 20 mg once a day). My psydoc told me its weight neutral usually.Thank you,
Lisa
Posted by floatingbridge on April 29, 2010, at 19:17:02
In reply to Re: Severe anxiety and other problems, posted by SLS on April 26, 2010, at 11:58:24
I like this chart--just printed it out.
I was going to send you a hello babblemail and see your mail is turned off.
I was wondering how you have been. I see your posts more frequently--always welcomed by me.
fb
Posted by SLS on April 30, 2010, at 6:31:10
In reply to Scott: Severe anxiety and other problems » SLS, posted by floatingbridge on April 29, 2010, at 19:17:02
Hi!
> I was wondering how you have been. I see your posts more frequently--always welcomed by me.
Emotionally, I am not doing very well, although I have been worse. Biologically, I think I have been through the worst of the withdrawal rebound depression that followed my discontinuation of Savella (milnacipran). I have a prescription for Marplan. I need to wait 10 more days before starting it.
I have not been very motivated to post the way I used to. It might be time for me to take a break. We'll see. Maybe not. This place is an invaluable source of information and understanding. Very bright people hang out here - yourself included.
- Scott
Posted by floatingbridge on April 30, 2010, at 10:45:01
In reply to Re: Scott: Severe anxiety and other problems » floatingbridge, posted by SLS on April 30, 2010, at 6:31:10
I'll be looking for your posts around then--hope to see them.
Best to you,
fb
Posted by Hombre on May 6, 2010, at 1:54:34
In reply to Re: Scott: Severe anxiety and other problems » floatingbridge, posted by SLS on April 30, 2010, at 6:31:10
Lisa,
First of all, I'm very sorry to hear about your anxiety and ADD symptoms and trouble with medications. It must be doubly hard to seek treatment when it is damn near impossible to leave the house. I've been there.
How's your sleep? Do you have any trouble falling asleep or maintaining sleep?
Are you able to get any exercise?
What kind of foods do you eat on a regular basis? Are you taking any supplements or alternative treatments (e.g. herbs)?
This is the end of the thread.
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