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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 43. This is the beginning of the thread.
Posted by Justusphung on December 6, 2015, at 4:16:48
My doc has prescribed me 2.5mg Abilify and 50mg Pristiq for my social anxiety. I used to take 50mg amisulpride for 4 years which worked quite well for me at the first year of administration, but the effects popped off these few years.
the new combo treatment began 2 weeks ago; however, I still didn't notice any improvement for my anxiety. I'm going to ditch amisulpride and ask for upping the dosage of pristiq.
Do you think it is a wise move?
Posted by SLS on December 6, 2015, at 7:24:44
In reply to Ability and Pristiq for Social Anxiety, posted by Justusphung on December 6, 2015, at 4:16:48
> My doc has prescribed me 2.5mg Abilify and 50mg Pristiq for my social anxiety. I used to take 50mg amisulpride for 4 years which worked quite well for me at the first year of administration, but the effects popped off these few years.
>
> the new combo treatment began 2 weeks ago; however, I still didn't notice any improvement for my anxiety. I'm going to ditch amisulpride and ask for upping the dosage of pristiq.
>
> Do you think it is a wise move?I think that is the logical move. There are never any guarantees, though, so don't feel bad if it shouldn't work out. I have seen people respond to Pristiq best at 100 mg/day.
There are many alternatives. Of course, I don't know what you have tried so far. If you responded so well to one treatment for four years, I think the chances of your responding to something new are pretty good.
Phidippus (Eric) would be a better person to talk to about this than me.
I'm sure you know that Nardil is quite potent for treating social anxiety. If you haven't tried it, I would consider placing it on your list. My guess is that a combination of Nardil + Klonopin would have a good chance of working if nothing else will. Believe it or not, Emsam (transdermal selegiline) often works for social anxiety.
You might want to see how things go with the Pristiq first before being showered with alternative treatments. I will make one observation, though. Of the SSRIs, Paxil is the most effective for treating anxiety disorders.
Perhaps you can provide a list of the treatments you have tried thus far.
Good luck.
- Scott
Posted by Justusphung on December 6, 2015, at 8:48:11
In reply to Re: Ability and Pristiq for Social Anxiety » Justusphung, posted by SLS on December 6, 2015, at 7:24:44
I've tried selegiline before at 5mg with no success. Its patch form as well as Nardil is not available here in my area.
I had been taking low dose amisulpride since 2012. It greatly eliminated irrational thoughts like frequently worrying about doing something embarrassing in front of people; or being aware of people around me, thinking that they may recognize my anxiety symptoms. Before then, my heart was beating and my palms were sweating whenever I took public transportation or in a crowded area, though I still had some difficulty to stay with people or to have a comfortable conversation with others even I was on amisulpride.
Other medications I did try without positive response are
citalopram 20-30mg
remeron 15-30mg
deanxitAnd I also have a record of abusing benzodiazepine, such as taking 1mg lorazepam and 5mg diazepam daily for a year. Tolerance built up at last and I had to quit the drugs painfully.
Posted by rjlockhart37 on December 6, 2015, at 13:01:54
In reply to Re: Ability and Pristiq for Social Anxiety » Justusphung, posted by SLS on December 6, 2015, at 7:24:44
i'm not specialized on this, but prisiq is not really the best, and i've read it's more a stimulant like antidepressant and can cause some anxiety, yet it's parent drug Effexor is used often for anxiety, but i googled it, Prisiq doesnt look like the best for anxiety, it increases Norepinephrine
http://www.drugs.com/comments/desvenlafaxine/for-anxiety.htmlAbilify is for mood and can in some way improve mood, but not sure about anxiety. And that is a vary low dose of abilify.
There are the SSRI's such as Luvox and Lexepro known to be good for anxiety, but you would have to work with your doctor on that, we can't change it.
Yea there's a poster here Phidippus that may could give some more insight on that.
Posted by rjlockhart37 on December 6, 2015, at 13:12:59
In reply to Ability and Pristiq for Social Anxiety, posted by Justusphung on December 6, 2015, at 4:16:48
It's parent drug Effexor is used widely for anxiety for some reason, yet i don't understand because it increases noephrinephine, and it increases wakefulness, and attention.You could add nuerontin or lyrica those are well known non addictive anxiety meds
Posted by Christ_empowered on December 6, 2015, at 14:13:50
In reply to Ability and Pristiq for Social Anxiety, posted by Justusphung on December 6, 2015, at 4:16:48
I dunno. There are more calming, anti-anxiety ADs out there. Abilify can help w/ depression in some people, but low doses can sometimes be "activating" and cause a worsening of anxiety, at least in short run, early on in treatment. There's also typical AP/AAP side effects to deal with, plus a high rate of akathisia.
Posted by SLS on December 6, 2015, at 14:24:50
In reply to Re: Ability and Pristiq for Social Anxiety, posted by rjlockhart37 on December 6, 2015, at 13:12:59
> It's parent drug Effexor is used widely for anxiety for some reason, yet i don't understand because it increases noephrinephine, and it increases wakefulness, and attention.
Effexor increases seroronin much more than norepinephrine, although it is conceivable that norepinephrine is important for some people.
It is a good point to recognize that Effexor is proven effective and indicated for anxiety disorders while Pristiq is not. However, Pristiq may be just as good, if not better, for anxiety disorders. Time will tell. Perhaps Justusphung's doctor and his doctor's colleagues have had success with Prisiq.
> You could add nuerontin or lyrica those are well known non addictive anxiety meds
That's a good suggestion. Lyrica in particular has been found to be effective for social anxiety disorder, particularly at higher dosages. I would even consider using it as an adjunct to other treatments.
- Scott
Posted by SLS on December 6, 2015, at 14:46:12
In reply to Re: Ability and Pristiq for Social Anxiety, posted by Christ_empowered on December 6, 2015, at 14:13:50
> I dunno. There are more calming, anti-anxiety ADs out there. Abilify can help w/ depression in some people, but low doses can sometimes be "activating" and cause a worsening of anxiety, at least in short run, early on in treatment. There's also typical AP/AAP side effects to deal with, plus a high rate of akathisia.
Is the rate of akathisia greater for people with anxiety disorders?
I wonder how well low dosages of Seroquel would work for social anxiety disorder (SAD). From what I understand, the FDA concluded that it was effective for generalized anxiety disorder (GAD). However, they didn't feel the safety profile justified its use. I would have to disagree with this assessment, especially in light of their approving Seroquel as adjunctive treatment for major depressive disorder (MDD).
I know of someone who had great success with Zyprexa to treat his GAD, but the weight gain was deemed unacceptable. When he was switched to Phenergan (promethazine), he did very well. I don't recall his having any extrapyramical side effects (EPS).
- Scott
Posted by Zyprexa on December 6, 2015, at 20:34:00
In reply to Ability and Pristiq for Social Anxiety, posted by Justusphung on December 6, 2015, at 4:16:48
Abilify made my anxiety worse. I took it for 6 months. Zyprexa on the other hand has worked really well for the last 18 years. And recently I've started CBD oil (canabidiol), which works great for social anxiety. I like the combination of the 2.
Posted by SLS on December 6, 2015, at 22:28:06
In reply to Re: Ability and Pristiq for Social Anxiety » Justusphung, posted by Zyprexa on December 6, 2015, at 20:34:00
> Abilify made my anxiety worse. I took it for 6 months. Zyprexa on the other hand has worked really well for the last 18 years. And recently I've started CBD oil (canabidiol), which works great for social anxiety. I like the combination of the 2.
Interesting combination.
Was the CBD hard to get?
- Scott
Posted by herpills on December 6, 2015, at 23:30:08
In reply to Ability and Pristiq for Social Anxiety, posted by Justusphung on December 6, 2015, at 4:16:48
> My doc has prescribed me 2.5mg Abilify and 50mg Pristiq for my social anxiety. I used to take 50mg amisulpride for 4 years which worked quite well for me at the first year of administration, but the effects popped off these few years.
>
> the new combo treatment began 2 weeks ago; however, I still didn't notice any improvement for my anxiety. I'm going to ditch amisulpride and ask for upping the dosage of pristiq.
>
> Do you think it is a wise move?I'm sorry you're not feeling well. The thing with Pristiq, at least in my own experience, this medication takes awhile before it really starts to work, longer than anything else I've ever been on. I'm pretty sure I was on it close to 8 weeks before I really started to feel better. I was having some anxiety at the time, but mainly it was a major depressive episode. It's a good medication, but 2 weeks just isn't long enough yet to assess whether this medication will work for you.
I don't know about the Abilify for anxiety. Do you have depression too? Low dose Abilify (2-5mg) is something commonly added to an antidepressant like Pristiq to treat severe depression.
I think Pristiq+Abilify is a good solid choice for treating severe depression, but if anxiety is your main symptom then I think there are better options that maybe your doctor could talk to you about. I personally like Lyrica for anxiety although if you are being treated in the U.S. then that is an "off label" indication. I've also had success with Remeron (mirtazapine) for depression, anxiety, and insomnia.
Posted by herpills on December 6, 2015, at 23:38:10
In reply to Re: Ability and Pristiq for Social Anxiety » Christ_empowered, posted by SLS on December 6, 2015, at 14:46:12
>
> I wonder how well low dosages of Seroquel would work for social anxiety disorder (SAD). From what I understand, the FDA concluded that it was effective for generalized anxiety disorder (GAD). However, they didn't feel the safety profile justified its use. I would have to disagree with this assessment, especially in light of their approving Seroquel as adjunctive treatment for major depressive disorder (MDD).
>
>
>
> - Scott
Interesting. So the FDA said yup it works, but with the heavy side effects and all we're not approving it? But it's already approved for so many other things...there's certainly many other medications that could be tried first. Well, I'm sure it's prescribed off label for anxiety all the time.Do you have any insight Scott as to why the FDA did not approve Lyrica for anxiety?
Posted by SLS on December 7, 2015, at 7:19:14
In reply to Re: Ability and Pristiq for Social Anxiety » SLS, posted by herpills on December 6, 2015, at 23:38:10
>
> >
> > I wonder how well low dosages of Seroquel would work for social anxiety disorder (SAD). From what I understand, the FDA concluded that it was effective for generalized anxiety disorder (GAD). However, they didn't feel the safety profile justified its use. I would have to disagree with this assessment, especially in light of their approving Seroquel as adjunctive treatment for major depressive disorder (MDD).
> >
> >
> >
> > - Scott
>
>
> Interesting. So the FDA said yup it works, but with the heavy side effects and all we're not approving it? But it's already approved for so many other things...there's certainly many other medications that could be tried first. Well, I'm sure it's prescribed off label for anxiety all the time.
>
> Do you have any insight Scott as to why the FDA did not approve Lyrica for anxiety?I really don't. Perhaps the drug company has elected not to pursue that indication for some reason. It is approved in Europe for GAD. The best response occurs at 450 mg/day.
- Scott
Posted by Lou Pilder on December 8, 2015, at 6:15:51
In reply to Re: Ability and Pristiq for Social Anxiety, posted by SLS on December 6, 2015, at 14:24:50
> > It's parent drug Effexor is used widely for anxiety for some reason, yet i don't understand because it increases noephrinephine, and it increases wakefulness, and attention.
>
> Effexor increases seroronin much more than norepinephrine, although it is conceivable that norepinephrine is important for some people.
>
> It is a good point to recognize that Effexor is proven effective and indicated for anxiety disorders while Pristiq is not. However, Pristiq may be just as good, if not better, for anxiety disorders. Time will tell. Perhaps Justusphung's doctor and his doctor's colleagues have had success with Prisiq.
>
> > You could add nuerontin or lyrica those are well known non addictive anxiety meds
>
> That's a good suggestion. Lyrica in particular has been found to be effective for social anxiety disorder, particularly at higher dosages. I would even consider using it as an adjunct to other treatments.
>
>
> - ScottFriends,
Be not deceived. For Scott has posted that another poster has suggested to take Lyrica and that Lyrica is non-addicting, and Scott writes,[...That's a good suggestion...].
Lyrica is a schedule V addictive drug. And this misinformation posted here that it is non-addicting is more deceit that comes out of this site that could lead you or your child that you are drugging with this drug to their deaths or a lifetime of sorrows and addiction. This is all to be seen here as being supportive by a psychiatrist chairing this site that says that being supportive takes precedence. Addiction to a harmful substance that could cause you to kill yourself or your child is supportive?
Now you mothers, headed for the dance of psychiatry, being led to believe that this drug is safe by reading Scott's suggestion, could find addiction and death, for the deceived mind is the Devil's playground. Ya got trouble. Lot's and lot's of trouble. I'm talking about the children being deceived here, backpacked young ones, peeking through the portals of this website after school, looking at bottles, and tablets and pills that could mark the difference between them being a live person or a corpse, and led to think that they will cover their tell-tale anxiety with Lyrica.
Well friends, I should say. How could any addictive drug be good for you or your child? First, psychiatric drugs from a doctor, then could be addiction and an early death.
Now I know that you are all the right kind of people and I want to be perfectly frank. You got Scott promoting to take an addictive drug that by what he wrote you could think that it is not, think that these drugs are safer than they really are that could be the first step to a life time of misery. The material facts that could balance the promotion of this drug are left out which could cause a distortion and misleading of the facts that could lead you to your death. And worse, a psychiatrist allows this promotion to be seen as being supportive here. Never mind that he does not step in and correct Scott, or follow the rules of the FDA for promoting drugs, for Mr. Hsiung is doing in his thinking what will be good for his community as a whole. And he wants you to trust him at that because he says that he is incorporating the Golden Rule and fairness here while denying me equal protection of his rules and allowing Scott to promote misinformation. That is an insult to Judaism.
Lou
Posted by Zyprexa on December 8, 2015, at 21:01:52
In reply to Re: Ability and Pristiq for Social Anxiety » Zyprexa, posted by SLS on December 6, 2015, at 22:28:06
No the CBD was easy to get. I just ordered it off the internet, no prescription.
Posted by rjlockhart37 on December 8, 2015, at 21:49:18
In reply to Lou's urgent warning-truzme » SLS, posted by Lou Pilder on December 8, 2015, at 6:15:51
Lou, how many chucks did wood chuck chuck???
Posted by Lamdage22 on December 11, 2015, at 11:11:48
In reply to Re: Ability and Pristiq for Social Anxiety » SLS, posted by Zyprexa on December 8, 2015, at 21:01:52
> No the CBD was easy to get. I just ordered it off the internet, no prescription.
Unfortunately there is no "no prescription" CBD in Germany. I think i could get it illicitly though.
My appointment is not until April with the Cannabinoid Doc.
I like what i hear about what the substance does to you psychologically.
Posted by SLS on December 11, 2015, at 12:51:04
In reply to Re: Ability and Pristiq for Social Anxiety, posted by Lamdage22 on December 11, 2015, at 11:11:48
> > No the CBD was easy to get. I just ordered it off the internet, no prescription.
>
> Unfortunately there is no "no prescription" CBD in Germany. I think i could get it illicitly though.
>
> My appointment is not until April with the Cannabinoid Doc.
>
> I like what i hear about what the substance does to you psychologically.
>It is interesting how CBD and THC have opposing effects when it comes to psychosis. I hope you are able to get the CBD.
- Scott
Posted by Lamdage22 on December 11, 2015, at 13:02:24
In reply to Re: Ability and Pristiq for Social Anxiety » Lamdage22, posted by SLS on December 11, 2015, at 12:51:04
> It is interesting how CBD and THC have opposing effects when it comes to psychosis. I hope you are able to get the CBD.
>
>
> - ScottVery much so. Pure THC is POISON for mental disorders. However, with enough CBD....
Posted by rjlockhart37 on December 11, 2015, at 19:07:43
In reply to Re: Ability and Pristiq for Social Anxiety, posted by Lamdage22 on December 11, 2015, at 13:02:24
i have CBD oil but it does not have a major effect on me, originally i got it an thought it was similar to weed, but i smoked hydro weed at a party, and it made feel detached from reality, it's like everything stopped making sense, and i could see a new way of thinking........
CBD oil makes me feel calm, but not high at all......
Posted by Justusphung on December 12, 2015, at 3:20:13
In reply to Re: Ability and Pristiq for Social Anxiety, posted by rjlockhart37 on December 11, 2015, at 19:07:43
Anyone tries Deanxit?
Posted by Christ_empowered on December 13, 2015, at 11:13:59
In reply to Deanxit, posted by Justusphung on December 12, 2015, at 3:20:13
I don't know much about deanxit. Its apparently a combo of an AD w/ a low dose of flupenthixol. Low dose flupenthixol is sometimes used in depression, sort of a low cost, old school Abilify, I suppose.
Its apparently designed for short term use. Maybe try it while you and your doc work out a long term treatment plan? Of course, its apparently used long term anyway, so I guess its up to your pdoc.
Good luck.
Posted by Justusphung on December 13, 2015, at 20:54:51
In reply to Re: Deanxit, posted by Christ_empowered on December 13, 2015, at 11:13:59
Strangely, when I was taking pristiq and abilify, I felt more depressed and slept all day long, reluctant to do anything. Then, my pdoc prescribed lyrica 25mg, deanxit once daily, and propanolol 10mg three times a day as to augment the original mediation. I found the deanxit motivating, allowing me to leave my bed. This effect is similar to the one given by amisulpride.
Now, I have stopped taking pristiq, only taking amisulpride 50mg and deanxit twice daily. According to my situation, which other drugs are suitable to help me motivate and calm down?
Posted by Zyprexa on December 13, 2015, at 21:11:44
In reply to Re: Ability and Pristiq for Social Anxiety, posted by rjlockhart37 on December 11, 2015, at 19:07:43
You have to take the CBD for a while till it has an effect. About 2 months. The calm, sedated effect is instant. But the AP effect takes a while then I reduced zyprexa.
Posted by SLS on December 14, 2015, at 14:10:31
In reply to Re: Deanxit, posted by Justusphung on December 13, 2015, at 20:54:51
> Strangely, when I was taking pristiq and abilify, I felt more depressed and slept all day long, reluctant to do anything. Then, my pdoc prescribed lyrica 25mg, deanxit once daily, and propanolol 10mg three times a day as to augment the original mediation. I found the deanxit motivating, allowing me to leave my bed. This effect is similar to the one given by amisulpride.
>
> Now, I have stopped taking pristiq, only taking amisulpride 50mg and deanxit twice daily. According to my situation, which other drugs are suitable to help me motivate and calm down?I had never heard of Deanxit (flupentixol/melitracen).
Which type of depression do you have - melancholic depression or atypical depression? Can you describe your symptoms? Do you feel worst in the morning?
How do you react to SSRIs in general?
If you react badly to all serotonin reuptake inhibitors, you may need to look at desipramine, a tricyclic antidepressant (TCA) that is selective for norepinephrine. It will often reduce anxiety when the anxiety is a component of depression - which it often is with melancholic depression. It will not work for GAD. Since melitracen is also a TCA, you might need to discontinue the Deanxit or else try adding a small amount desipramine to see how you react to it.
Since the flupentixol isn't calming you down enough, you might not need it if desipramine works. Besides, I have never been a fan of combination pills. You might need way more melitracen than what you are getting with the Deanxit. However, if you were to take a dosage of Deanxit that would bring your melitracen intake high enough to be effective, the flupentixol would be way too high. It is much better, in my opinion, to dose each drug separately.
Have you ever tried Abilify? If not, it would be interesting to see how you respond to it. If it doesn't cause akathisia, it can actually act like an augmenter of antidepressants and anxiolytic (anxiety-reducing). For me, I felt some restlessness during the first week or so. It was uncomfortable, but disappeared entirely. I would say that the number of people who experience true akathisia represent a minority.
Wellbutrin might be too anxiogenic (anxiety-producing) or agitating for you. I'm not sure.
- Scott
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