![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Rick on June 10, 2000, at 20:41:24
When I first sent in the post below (now in the June 3 archive), I meant to throw out a question: Is there any other reader with Social Phobia who is using the recently-U.S.-approved med Provigil (modafinil) in combo with other meds...or even alone?? (I know I've seen the related adrafinil -- sold only overseas -- mentioned by JohnL and ohers in a very positive light.)
If you are taking Provigil, has it helped, hurt, or had no effect on your Social Phobia? What else are you taking with it? Did anyone with SP suggest Provigil to their doctor but get a negative response? What reason was given? Just curious.
Thanks in advance,
Rick
=====SOCIAL PHOBIA COCKTAIL -- WOW!!!
Posted by Rick on June 8, 2000, at 0:50:53
Hope it's not too good to last:
Klonopin (1 mg morning, .25 mg afternoon)
Serzone (150 mg morning, 150 mg evening)
Provigil (200 mg morning)(Since these meds plus the Prilosec I'm taking are metabolized largely through the same liver enzymes, bioavailability may be increased for some of them...thus keeping my dosage requirements somewhat lower than usual.)
Klonopin's been great all along, but I've been looking for an even higher level of improvement. Everthing else I've tried, either before or since starting Klonopin, has failed to provide enhancement and/or has caused non-abating bothersome side effects.
The Provigil is incredible, at least for me. I was afraid it would cause counter-productive nervousness, especially when I upped the daily dose from 100 mg to the 200 mg generally recommended for the med's official narcolepsy indication. But instead, the Provigil consistently provides a great "non-wired" wakefulness (although with NO problem sleeping when I WANT to); enhances energy, motivation and cognition; and makes me more assertive and a lot more sociable. I just hope what some have said about a tendency for Provigil to poop out doesn't surface for me.
For the record, I've been taking Klonopin about ten months (but less now than previous
Posted by Rick on June 10, 2000, at 20:48:58
In reply to SOCIAL PHOBIA COCKTAIL -- WOW!!! : Survey Says..., posted by Rick on June 10, 2000, at 20:41:24
(Here's the rest of the old post. I've been having trouble with posts aborting)
For the record, I've been taking Klonopin about ten months (but less now than previously); Serzone for about four weeks (added it to Celexa, then soon dumped the Celexa); and Provigil for about three weeks.
Just wanted to share a success story regarding treatment of my non-depressive Social Anxiety. Who knows if it will last? But so far *every* day for the last two weeks has been just wondeful -- morning to afternnon to night to snooze-land. And as good as everything is now, things seem to be headed nowhere but up.
Rick
Posted by Rick on June 10, 2000, at 20:55:11
In reply to SOCIAL PHOBIA COCKTAIL -- WOW!!! : Survey Says..., posted by Rick on June 10, 2000, at 20:41:24
(Here's the rest of the old post. I've been having trouble with posts aborting)
For the record, I've been taking Klonopin about ten months (but less now than previously); Serzone for about four weeks (added it to Celexa, then soon dumped the Celexa); and Provigil for about three weeks.
Just wanted to share a success story regarding treatment of my non-depressive Social Anxiety. Who knows if it will last? But so far *every* day for the last two weeks has been just wondeful -- morning to afternnon to night to snooze-land. And as good as everything is now, things seem to be headed nowhere but up.
Rick
Posted by Andre Allard on June 11, 2000, at 5:21:40
In reply to SOCIAL PHOBIA COCKTAIL -- WOW!!! : Survey Says..., posted by Rick on June 10, 2000, at 20:41:24
Is Provigil one of those new meds for anxiety? I had social anxiety disorder for a few years. It was very intense at times. In grade 12, I had a biology class that discussed many topics orally. Every single class I would have a panic attack. Sometimes the attacks would be the entire length of the class, which was 75 minutes long. My average HR when around other people was probably around 120 bpm. Talk about anxiety! Effexor seemed to take care of this and more. Now when put in social situations, I am the one who stands out.
I know that most AD's, especially serzone, the ssri's and effexor are effective in treating anxiety disorders. Have you tried buspirone or one of the beta blockers? Good luck!
Posted by Rick on June 11, 2000, at 18:25:40
In reply to Re: SOCIAL PHOBIA COCKTAIL -- WOW!!! : Survey Says..., posted by Andre Allard on June 11, 2000, at 5:21:40
(I'm having a problem where only a part of my post makes it through, so if this one gets cutoff, I'll put the rest in a second post.)
Andre -
Thanks for the reply. Boy, can I relate to your situation. I'm so glad to hear the Effexor has really helped you!!
Before adding Celexa to my Klonopin, and then again later when I ended up swapping the Celexa out for Serzone, I had been searching high and low on the net for personal experiences with Effexor treatment of Social Phobia. That was about four months ago the first time, and two months ago the last time. Effexor was near the top of my try-next list, but there were virtually no testimonials to be found. Where were you??!!!
All's well that ends well, however, as you can tell from my delight with my current cocktail of Klonopin, Serzone, and Provigil. Actually, I've been 60-70% improved since starting Klonopin almost a year ago. It started working very quickly, with negilgible adverse effects at reasonable doses, and it hasn't shown any poop-out at all. It's the absolute mainstay of my treatment (glad there aren't scads of benzo-phobics on this site as I write those words!).
But before hitting on this combo, I was experimenting with many other meds
to try to get to the cusp of 100% improvement (and this included some antidepressant trials BEFORE I started taking Klonopin).As to your question, Provigil is definitely NOT typically viewed as an anti-anxiety drug. It is pretty new in this country, and its official indication is for narcolepsy (basically uncontrollable constant napping during the day). But it is a completely different kind of stimulant than amphetamines/Ritalin, and doesn't tend to cause side effects like anxiety, "crashing", high blood pressure, possible addiction, and other problems that traditional stimulants can cause. And when Provigil does cause side effects, they tend to go away quickly.
Despite its sole official indication for narcolepsy I have read that 40% of its use in the U.S
Posted by Rick on June 11, 2000, at 18:30:02
In reply to Re: SOCIAL PHOBIA COCKTAIL -- WOW!!! : Survey Says..., posted by Rick on June 11, 2000, at 18:25:40
(Here's the rest -- I hope)Despite its sole official indication for narcolepsy I have read that 40% of its use in the U.S. has been for other purposes. (Cepholon is currently testing it for many other disorders, from sleep apnea to attention-deficit disorder to alzheimers. I will soon post a study showing promising results in using Provigil to augment antidepressants.) I added it in a very-successful attempt to counterbalance the moderate fatigue and lack of motivation that the combo of Klonopin and antidepressants often caused. And am I glad I did! As stated previously, I now feel so awake, energetic (but not "wired) and metally sharp! I had tried the more typical route of adding small amounts of stimulating AD's like Wellbutrin to counter the lethargy, but while they woke me up a bit, they also brought back a good deal of my social phobia. To tell the truth, when I originally convinced my pdoc to let me try Provigil, I was betting that it would have the same deleterious effects -- maybe even worse -- than the stimulating AD's. But to my surprise, it didn't increase my anxiety at all! Instead it made me much more talkative and outgoing, which added a wonderful dimension to my calmness-focused social phobia treatment. Calm but "up"! What a combo!
A few more things...While I knew that that Effexor had a reputation (and now an official indication) for treating generalized anxiety, I also knew that many drugs which can help a lot in other anxiety disorders were known to be pretty ineffective for generalized Social Anxiety. That's why, other than finding a few small studies, I was searching in vain to try to find personal Social Anxiety experiences with Effexor.
You mentioned BuSpar and Beta Blockers. Most studies and personal accounts have shown BuSpar to be of little help for Social Phobia (even though it is often very effective in generalized anxiety), but one of my most helpful combos up until now was Klonopin plus low-dose BuSpar and pindolol (a serot
Posted by Rick on June 11, 2000, at 18:35:40
In reply to Re #2: SOC PHOBIA COCKTAIL--WOW!!!:Survey Says..., posted by Rick on June 11, 2000, at 18:30:02
(This has GOT to be the last part!)You mentioned BuSpar and Beta Blockers. Most studies and personal accounts have shown BuSpar to be of little help for Social Phobia (even though it is often very effective in generalized anxiety), but one of my most helpful combos up until now was Klonopin plus low-dose BuSpar and pindolol (a serotonin-friendly beta blocker). The only reason I quit that one was because of some bothersome side effects after my evening doses, as well as endless pill-splitting rituals and the need for carefully-timed multiple doses.
Rick
> Is Provigil one of those new meds for anxiety? I had social anxiety disorder for a few years. It was very intense at times. In grade 12, I had a biology class that discussed many topics orally. Every single class I would have a panic attack. Sometimes the attacks would be the entire length of the class, which was 75 minutes long. My average HR when around other people was probably around 120 bpm. Talk about anxiety! Effexor seemed to take care of this and more. Now when put in social situations, I am the one who stands out.
>
> I know that most AD's, especially serzone, the ssri's and effexor are effective in treating anxiety disorders. Have you tried buspirone or one of the beta blockers? Good luck
Posted by Andre Allard on June 11, 2000, at 19:14:36
In reply to SOCIAL PHOBIA COCKTAIL -- WOW!!! : Survey Says..., posted by Rick on June 10, 2000, at 20:41:24
The reasone why clonazepam (klonopin) has worked for you is probably because you get "buzzed" off of it. I take clonazepam when I have to do a speech. Some times it dulls my mental capacity so much that I become stupid. Give me a couple of clonazepam and I could sit naked in front of an audience and not feel any anxiety. If I were you, I would try to ween myself off of the clonazepam because it is generally not indicated for long term treatment. I think of benzodiazepines as mostly "drugs" and not meds because they make you buzzed or high. Also, with clonazepam, a tolerance is built of quickly. So if you have built up to a high dose of clonazepam, then you will have a hell of a time coming off of the stuff.
In a couple of years there will be a few more meds out for the treatment of anxiety disorders with a benign side effect profile. So be patient. Good luck!
Posted by Rick on June 12, 2000, at 0:06:48
In reply to Re: SOCIAL PHOBIA COCKTAIL -- WOW!!! : Survey Says..., posted by Andre Allard on June 11, 2000, at 19:14:36
(NOTE: given my current mysterious posting difficulties, getting this full message submitted is likely to require multiple postings.)Andre -
I appreciate your thoughts on clonazepam, but most of you warnings are misinformed and have been disproven. My assertion reflects many, many rigorous studies of responsible and proper benzo therapy to treat various medical conditions, supported by a wealth of anecdotal experiences (like mine). Of course, there will always be a minority of cases where chronic usage of benzos will lead to significant (though usually temporary) problems. But so do "safe" AD's. Take Paxil: look at how many people have had complete loss of sexual function and huge weight gain (which is very unhealthy), followed by nightmarish withdrawal symptoms. Benzos have a wealth of unfair stigma attached to them, probably tracing to Vailum abuse soon after it was introduced, as well as today's illicit street combos of benzos and other drugs to provide a quick high.
IMPORTANT NOTE: I'm kind of passionate about this topic, so PLEASE be sure not take anything I say as a personal attack on your advice!!! Your viewpoint on chronic benzo use is in fact shared by thousands of doctors and millions of citizens.
Again, I respect your right to your own opinions, and thoroughly appreciate your intent, which is provide support and advice.The warnings about chronic benzo use do have some relevance for some people with tendencies towards drug abuse or addiction, substantial alcohol consumption, or frailness...but that's it.
About the "buzz": For me it wasn't very strong -- more like fatigue, actually -- and that effect quickly went away after a week of regular use, leaving only the desired anxiolytic effects. Unless I raise the usual dosage by more than 1 mg, I feel nothing, and I do mean NOTHING, from Klonopin other than continued mental calmness in social and performance situations. And that calmness comes with no "slowdown", lethargy, or decrease in alert
Posted by Rick on June 12, 2000, at 0:19:09
In reply to Re-Andre #1:SOC PHOBIA COCKTAIL--WOW!!: Survey..., posted by Rick on June 12, 2000, at 0:06:48
(part 2 of ?? parts)
About the "buzz": For me it wasn't very strong -- more like fatigue, actually -- and that effect quickly went away after a week of regular use, leaving only the desired anxiolytic effects. Unless I raise the usual dosage by more than 1 mg, I feel nothing, and I do mean NOTHING, from Klonopin other than continued mental calmness in social and performance situations. And that calmness comes with no "slowdown", lethargy, or decrease in alertness...but definitely no high or excessive dis-inhibition. Once in awhile, I feel a very gentle fatigue for five-ten minutes -- usually on a day when I'm already a bit slow from staying up late or getting up early.
This is very different from when I was taking AS-NEEDED Xanax, a shorter-acting benzo that comes on somewhat stronger and presents a slightly greater risk of addiction and withdrawal problems. As-needed (important modifier there!) Xanax really made me feel doped-up, tired and just plain "icky". It made me MORE self-conscious. Although it works well for many (notably panic sufferers), I hated it, except as a sleeping pill. (BTW, since taking 1.5 mg Klonopin in the MORNING, I rarely have trouble getting to sleep, and staying asleep, at night.)
Many studies at some of the most-respected medical centers debunk the rampant benzo myths. In point of fact, the great majority of people who responsibly take low-dose Klonopin on a maintenance basis have no post-dosing "buzz", and can withraw with zero-to-minor difficulty. In fact, Klonopin is often used to ease the withdrawal process for people who find themselves having problems weening off of shorter-acting, less "smooth" benzos. BTW, after taking Klonopin every morning for eight months, I forgot to take it along when I went overseas for two weeks. While I was a little worried about going off cold turkey for that length of time, it turns out I had no problems as a result, except for a few mild headaches, plus some return of my social anxiety.
In a double-blind,
Posted by Rick on June 12, 2000, at 0:25:59
In reply to Re-Andre #1:SOC PHOBIA COCKTAIL--WOW!!: Survey..., posted by Rick on June 12, 2000, at 0:06:48
(part 3 of ?? parts)
In a double-blind, placebo-controlled study by noted Social Phobia researcher J.R. Davidson at Duke University, eight weeks of daily Klonopin produced the highest response rate ever seen in a Social Phobia study. In fact, the response was much higher than in any placebo-controlled *antidepressant* study through today (although the response rate for the AD Nardil was nearly as high). Side effects were minimal, there was no manic behavior, and follow-up studies have demonstrated maintained efficacy without increased dosage, as well as a general lack of withdrawal problems.
As for developing tolerance, we can certainly dismiss that in my case. I started at 2.5 - 3.0 mg per day about a year ago, and even before adding any other meds, I had reduced that to 1.5. Indeed, 1.5-2.0 worked MUCH better for me than 2.5-3.0. At the higher dosages the Klonopin was substantially LESS effective, with the extra mg adding nothing but fatigue and fogginess. This is consistent with study after study that has debunked the ever-increasing-dose myth by showing that people who are taking benzos chronically for *anxiety disorders* tend to require less and less over time for efficacy, rather than more. Frankly, it pains me to repeatedly see or hear references to a widely-referenced Brazilian study on the web that suggests 3.0-6.0 mg/day for Social Phobia! While high doses are necessary in treating epilepsy, Social Phobia should rarely require more than 3.0 mg/day of clonazepam. So many people seem to have this terribly faulted notion that more is always better, especially for something that can offer fairly quick results. (Maybe that's what we're conditioned to expect, living in a Super-Sized, Over-Stuffed, Mega-Gulp society). I am continually dismayed to see that Dr. Bob continues to put a black eye on this other-wise wonderful site by continuing to feature this article as his ONLY article regarding treatment of Social Phobia.
BTW, How much WERE you taking during those prese
Posted by Rick on June 12, 2000, at 0:30:55
In reply to Re-Andre #3:SOC PHOBIA COCKTAIL--WOW!!: Survey..., posted by Rick on June 12, 2000, at 0:25:59
(part 4 of ??)
BTW, How much WERE you taking during those presentations?
Sorry if I'm over-reacting, but when I hear all those myths and stern warning about the dangers of benzos, it really hits my hot button. A recent large-scale survey in Medscape showed that even doctors -- especially General Practitioners -- tended to harbor multiple misconceptions and unsupported fears about this very safe and effective class of medications. Believe me, I'd prefer to need no meds at all, but if I continue to need them I am perfectly happy to stay on Klonopin indefinitely, and my psychiatrist (practicing since 1979) has no problem with it either. He says that as long as I don't exceed 3.0 mg in one day, any withrawal difficulties would be highly unlikely (and my previously-mentioned unintential 2-week cold turkey withdrawal would seem to support that). He admittedly feels AD's are preferable in cases where they provide the patient an equal level of relief. I may someday gradually cut back on the Klonopin just to see what happens, but as I said I have no problem sticking with it as long as it provides consistent, high-level Social Phobia relief.
O.K., I'll get off my soapbox now. In fact, I will have to *force myself* not to respond to further posts specifically regarding benzo safety (even if the poster is agreeing with me), because the notorious benzo debates can go on forever and become way too time-consuming. I've already spent way too much time posting today, especially when I have to post repeatedly to get it all in (what IS this cyber-malady, anyways??) I'll make an exception to my no-more-posts-about-benzo-safety vow if it's something I can respond to in a few sentences.
Sorry for over-babbling on this one Andre, and thanks again for your response.
Rick
--------
The reasone why clonazepam (klonopin) has worked for you is probably
because you get "buzzed" off of it. I take clonazepam when I have to do a speech. Some times it dulls my mental capacity so much that I b
Posted by Lucy Amour on June 12, 2000, at 3:53:04
In reply to Re-Andre #4:SOC PHOBIA COCKTAIL--WOW!!: Survey..., posted by Rick on June 12, 2000, at 0:30:55
Hi Rick
I hope you don't mind me posting a request for your knowledgeable feedback about my meds cocktail. I'm diagnosed with borderline personality disorder, i suffer from intermittent extreme rage, complete lack of motivation, depression, social phobia especially with public speaking which has held me back from achieving so much. I have had to quit Uni because of my phobia. I have been on Paxil 20mg and Imovane(zopiclone hydrochloride) to help me sleep 15mg. My psychiatrist has recently put me on depakote to regulate my moods and anger outbursts but I,m worried it worsens my depression which I think it is but it's hard to tell, it's only been 1 month. I'm on 400mg in the morning and 600mg at night. I feel I need to tackle the phobia and depression more than anything else in order to get ahead in life and I'm interested in the meds you mentioned. I am in Australia, do you know if they are available here? Could you please tell me what you think as I value your opinion after reading your other posts! By the way, I totally agree with your views on Paxil withdrawals- absolutely terrifying! and they told me it was non- addictive, yeah right.
Look forward to your reply
Take care
>
Posted by Rick on June 12, 2000, at 11:54:15
In reply to Re:SOC PHOBIA COCKTAIL--WOW!!: Survey..., posted by Lucy Amour on June 12, 2000, at 3:53:04
Lucy --
Unfortunately, my areas of casual self-study, as well as my self-experience with meds has all been primarily in the area of anxiety. (Although, as you know, many AD's and other meds are useful across different classes of mental disorders.) And while I might call myself "highly informed", I would by no means call myself an "expert", even with respect to anxiety treatment. I personally know almost nothing about Borderline Personality Disorder, although I'm sure there are many Psycho-Babble posters who do.
Klonopin is called Paxam in Australia. I would imagine that generic clonazepam is available to you as well, but this is one drug for which many people swear that the branded version is better -- or at least stronger. I can tell you that, even though I have the generalized form of social phobia, my most dramatic and prompt response to Klonopin was in alleviating what had developed into near-panic when giving presentations. And, as I alluded to before, this relief comes without any sedation, mind-dulling, or "buzz". (Those things may have occurred a bit initially, but quickly went away with daily dosing.)
If your Social Phobia is very strongly tilted towards performance situations, have you tried beta blockers such as propranolol (one of the most common for this purpose) or the serotonin-friendly pindolol? Beta Blockers can be taken on an as-needed basis, and work by directly reducing physical performance-situation symptoms such as a racing heart. For me they weren't anywhere near as effective as daily Klonopin, although they do provide a very calming effect to some people.
I had been taking pindolol every day with the Klonopin, and found it added a very nice dimension. However, I had to stop taking it, because once I successfully shed 60 pounds the beta blocker made my blood pressure too low. Also, they can cause some fatigue, especially when taken on an as-needed basis.Of course, you must talk to your doctor, and make sure any combo you take isn't likely to cause unsafe interactions. That said, I'm shocked at how many doctors (at least in this country) both fail to identify potentially dangerous interactions AND claim that some drugs shouldn't be combined when the combination can be perfectly safe and beneficial. I've successfully challenged doctors on such matters several times, armed with info from the net (official monographs,
articles or Medline abstracts from respected medical journals, drug-interaction dictionaries, and posts from patients).Good luck to you, and let us know how things work out. If you don't get any further responses form this thread, why not try starting a new thread? There may be some people who never make it to this thread, but who are successfully
dealing with a combo of challenges which are very similar to your own. In fact, I wish Dr. Bob allowed the subject headings to be longer (read: more detailed) to catch the eye of more readers who have the most relevant advice or experiences to share!!Say "Hi" to my Aussie uncle for me! Hint: He used to host a popular TV news-magazine there, although if you're young you might not remember it. Oh, and he has an American accent.
Rick
------
> Hi Rick
> I hope you don't mind me posting a request for your knowledgeable feedback about my meds cocktail. I'm diagnosed with borderline personality disorder, i suffer from intermittent extreme rage, complete lack of motivation, depression, social phobia especially with public speaking which has held me back from achieving so much. I have had to quit Uni because of my phobia. I have been on Paxil 20mg and Imovane(zopiclone hydrochloride) to help me sleep 15mg. My psychiatrist has recently put me on depakote to regulate my moods and anger outbursts but I,m worried it worsens my depression which I think it is but it's hard to tell, it's only been 1 month. I'm on 400mg in the morning and 600mg at night. I feel I need to tackle the phobia and depression more than anything else in order to get ahead in life and I'm interested in the meds you mentioned. I am in Australia, do you know if they are available here? Could you please tell me what you think as I value your opinion after reading your other posts! By the way, I totally agree with your views on Paxil withdrawals- absolutely terrifying! and they told me it was non- addictive, yeah right.
> Look forward to your reply
> Take care
> >
Posted by AMenz on June 1, 2001, at 11:03:14
In reply to Re:SOC PHOBIA COCKTAIL--WOW!!: Survey..., posted by Rick on June 12, 2000, at 11:54:15
Rick I have social anxiety and BPII. Zoloft did wonders for social anxiety but created mixed mania which was unabearable.
Two questions: does Provigil promote cycling?
Also looked in following site:http://www.nursespdr.com/members/database/ndrhtml/modafinil.htmlAs a possible side effect of provigil they mention
oro-facial dyskenesia. This sounds dangerously close to tardive dyskenesia although I have not looked it up.Please your thoughts if any on above.
AMenz
> Lucy --
>
> Unfortunately, my areas of casual self-study, as well as my self-experience with meds has all been primarily in the area of anxiety. (Although, as you know, many AD's and other meds are useful across different classes of mental disorders.) And while I might call myself "highly informed", I would by no means call myself an "expert", even with respect to anxiety treatment. I personally know almost nothing about Borderline Personality Disorder, although I'm sure there are many Psycho-Babble posters who do.
>
> Klonopin is called Paxam in Australia. I would imagine that generic clonazepam is available to you as well, but this is one drug for which many people swear that the branded version is better -- or at least stronger. I can tell you that, even though I have the generalized form of social phobia, my most dramatic and prompt response to Klonopin was in alleviating what had developed into near-panic when giving presentations. And, as I alluded to before, this relief comes without any sedation, mind-dulling, or "buzz". (Those things may have occurred a bit initially, but quickly went away with daily dosing.)
>
> If your Social Phobia is very strongly tilted towards performance situations, have you tried beta blockers such as propranolol (one of the most common for this purpose) or the serotonin-friendly pindolol? Beta Blockers can be taken on an as-needed basis, and work by directly reducing physical performance-situation symptoms such as a racing heart. For me they weren't anywhere near as effective as daily Klonopin, although they do provide a very calming effect to some people.
> I had been taking pindolol every day with the Klonopin, and found it added a very nice dimension. However, I had to stop taking it, because once I successfully shed 60 pounds the beta blocker made my blood pressure too low. Also, they can cause some fatigue, especially when taken on an as-needed basis.
>
> Of course, you must talk to your doctor, and make sure any combo you take isn't likely to cause unsafe interactions. That said, I'm shocked at how many doctors (at least in this country) both fail to identify potentially dangerous interactions AND claim that some drugs shouldn't be combined when the combination can be perfectly safe and beneficial. I've successfully challenged doctors on such matters several times, armed with info from the net (official monographs,
> articles or Medline abstracts from respected medical journals, drug-interaction dictionaries, and posts from patients).
>
> Good luck to you, and let us know how things work out. If you don't get any further responses form this thread, why not try starting a new thread? There may be some people who never make it to this thread, but who are successfully
> dealing with a combo of challenges which are very similar to your own. In fact, I wish Dr. Bob allowed the subject headings to be longer (read: more detailed) to catch the eye of more readers who have the most relevant advice or experiences to share!!
>
> Say "Hi" to my Aussie uncle for me! Hint: He used to host a popular TV news-magazine there, although if you're young you might not remember it. Oh, and he has an American accent.
>
> Rick
>
> ------
> > Hi Rick
> > I hope you don't mind me posting a request for your knowledgeable feedback about my meds cocktail. I'm diagnosed with borderline personality disorder, i suffer from intermittent extreme rage, complete lack of motivation, depression, social phobia especially with public speaking which has held me back from achieving so much. I have had to quit Uni because of my phobia. I have been on Paxil 20mg and Imovane(zopiclone hydrochloride) to help me sleep 15mg. My psychiatrist has recently put me on depakote to regulate my moods and anger outbursts but I,m worried it worsens my depression which I think it is but it's hard to tell, it's only been 1 month. I'm on 400mg in the morning and 600mg at night. I feel I need to tackle the phobia and depression more than anything else in order to get ahead in life and I'm interested in the meds you mentioned. I am in Australia, do you know if they are available here? Could you please tell me what you think as I value your opinion after reading your other posts! By the way, I totally agree with your views on Paxil withdrawals- absolutely terrifying! and they told me it was non- addictive, yeah right.
> > Look forward to your reply
> > Take care
> > >
Posted by Rick on June 2, 2001, at 2:32:58
In reply to Re:SOC PHOBIA COCKTAIL--WOW!!: Survey..., posted by AMenz on June 1, 2001, at 11:03:14
AMenz -
I'm not really qualified to answer your questions. But after sifting through lots of posts on the neton the net, I've only seen one or two cases where someone was concerned about rapid cycling on Provigil, and even then it was conjecture.
As with just about any med, some bipolar II users praised modafinil, and others found it ineffective or bothersome. Actually, Provigil seems to disagree with fewer bipolar users than unipolar.
Medline shows no study abstracts associating modafinil with crapid cycling, even though I could see how one would wonder. To the contrary, in the small Medline-reported study where Provigil worked extremely well in quickly kick-starting AD's (and alleviating med-induced fatigue as a bonus), almost half of the responders were bipolar patients who had not repsonded prior to augmentation with provigil.
Beyond the monographs, I can't find anything relating to movement disorders induced by modafinil, which is not to say it never happens. I'm personally very prone to these kinds of side effects, and haven't had a problem at 100 mg. most days and 200 mg about 25% of the time. Actually the 2% incidence of dyskenesias reported for Provigil is a lot lower than for many meds commonly used in bipolar depression and schizophrenia. I've never seen anyone report a problem. But again the disclaimer: these aren't areas where I feel particularly qualified to comment.
BTW, regarding Zoloft treatment of your Social Phobia, how much did you take? How long did it take to start "working wonders"? What else were you taking at the same time? What, if any, were your your primary persistent side effects?
Thanks,
Rick
> Rick I have social anxiety and BPII. Zoloft did wonders for social anxiety but created mixed mania which was unabearable.
>
> Two questions: does Provigil promote cycling?
> Also looked in following site:http://www.nursespdr.com/members/database/ndrhtml/modafinil.html
>
> As a possible side effect of provigil they mention
> oro-facial dyskenesia. This sounds dangerously close to tardive dyskenesia although I have not looked it up.
>
> Please your thoughts if any on above.
>
> AMenz
>
> > Lucy --
> >
> > Unfortunately, my areas of casual self-study, as well as my self-experience with meds has all been primarily in the area of anxiety. (Although, as you know, many AD's and other meds are useful across different classes of mental disorders.) And while I might call myself "highly informed", I would by no means call myself an "expert", even with respect to anxiety treatment. I personally know almost nothing about Borderline Personality Disorder, although I'm sure there are many Psycho-Babble posters who do.
> >
> > Klonopin is called Paxam in Australia. I would imagine that generic clonazepam is available to you as well, but this is one drug for which many people swear that the branded version is better -- or at least stronger. I can tell you that, even though I have the generalized form of social phobia, my most dramatic and prompt response to Klonopin was in alleviating what had developed into near-panic when giving presentations. And, as I alluded to before, this relief comes without any sedation, mind-dulling, or "buzz". (Those things may have occurred a bit initially, but quickly went away with daily dosing.)
> >
> > If your Social Phobia is very strongly tilted towards performance situations, have you tried beta blockers such as propranolol (one of the most common for this purpose) or the serotonin-friendly pindolol? Beta Blockers can be taken on an as-needed basis, and work by directly reducing physical performance-situation symptoms such as a racing heart. For me they weren't anywhere near as effective as daily Klonopin, although they do provide a very calming effect to some people.
> > I had been taking pindolol every day with the Klonopin, and found it added a very nice dimension. However, I had to stop taking it, because once I successfully shed 60 pounds the beta blocker made my blood pressure too low. Also, they can cause some fatigue, especially when taken on an as-needed basis.
> >
> > Of course, you must talk to your doctor, and make sure any combo you take isn't likely to cause unsafe interactions. That said, I'm shocked at how many doctors (at least in this country) both fail to identify potentially dangerous interactions AND claim that some drugs shouldn't be combined when the combination can be perfectly safe and beneficial. I've successfully challenged doctors on such matters several times, armed with info from the net (official monographs,
> > articles or Medline abstracts from respected medical journals, drug-interaction dictionaries, and posts from patients).
> >
> > Good luck to you, and let us know how things work out. If you don't get any further responses form this thread, why not try starting a new thread? There may be some people who never make it to this thread, but who are successfully
> > dealing with a combo of challenges which are very similar to your own. In fact, I wish Dr. Bob allowed the subject headings to be longer (read: more detailed) to catch the eye of more readers who have the most relevant advice or experiences to share!!
> >
> > Say "Hi" to my Aussie uncle for me! Hint: He used to host a popular TV news-magazine there, although if you're young you might not remember it. Oh, and he has an American accent.
> >
> > Rick
> >
> > ------
> > > Hi Rick
> > > I hope you don't mind me posting a request for your knowledgeable feedback about my meds cocktail. I'm diagnosed with borderline personality disorder, i suffer from intermittent extreme rage, complete lack of motivation, depression, social phobia especially with public speaking which has held me back from achieving so much. I have had to quit Uni because of my phobia. I have been on Paxil 20mg and Imovane(zopiclone hydrochloride) to help me sleep 15mg. My psychiatrist has recently put me on depakote to regulate my moods and anger outbursts but I,m worried it worsens my depression which I think it is but it's hard to tell, it's only been 1 month. I'm on 400mg in the morning and 600mg at night. I feel I need to tackle the phobia and depression more than anything else in order to get ahead in life and I'm interested in the meds you mentioned. I am in Australia, do you know if they are available here? Could you please tell me what you think as I value your opinion after reading your other posts! By the way, I totally agree with your views on Paxil withdrawals- absolutely terrifying! and they told me it was non- addictive, yeah right.
> > > Look forward to your reply
> > > Take care
> > > >
Posted by AMenz on June 2, 2001, at 11:08:20
In reply to Re:SOC PHOBIA COCKTAIL--WOW!!: Survey... » AMenz, posted by Rick on June 2, 2001, at 2:32:58
Thankx for your response.
First let me answer your quesetions re Zoloft.
Zoloft was titrated up to 100mg (25, 50, 100). At each stage after a couple of weeks it had the desired effect of eliminating completely social anxiety (I don't know if concomitant use of 1mg of Lorezapam daily created a synergistic effect).
After becoming accustomed to the level the social anxiety (milder though) returned and the level was upped the next notch. I assumed that upwards of 100 (don't know 150, 200, whatever the effect might be permanent.
What it did was to take away all fear in social interactions, it became very easy to be nice and supportive to people, to listen to their conversation, to appreciate their jokes, etc. All the things that make people like you and in turn be willing to extend the same to you. (That has been my experience with people) I also became extraordinarily calm. Other people seemed to me overexited, prone to take offense, etc. What a trip!!!
Calm seems to have a great effect on others. I became popular. That was a new experience for me believe me.
Of course the issue with all these medication induced personality changes, is one of identity. Is this me, or am I taking former symptoms as my personality. Who is she, the lady or the tiger? Know what I mean.
I find it interesting that other people on the board have not discussed ( or I have not seen) the issue of identity and medication.
Maybe I've told you more than you wanted to hear.
BTW did you plug provigil in a particular search engine and come up with monographs, or are there sites you can recommend.
> AMenz -
>
> I'm not really qualified to answer your questions. But after sifting through lots of posts on the neton the net, I've only seen one or two cases where someone was concerned about rapid cycling on Provigil, and even then it was conjecture.
>
> As with just about any med, some bipolar II users praised modafinil, and others found it ineffective or bothersome. Actually, Provigil seems to disagree with fewer bipolar users than unipolar.
>
> Medline shows no study abstracts associating modafinil with crapid cycling, even though I could see how one would wonder. To the contrary, in the small Medline-reported study where Provigil worked extremely well in quickly kick-starting AD's (and alleviating med-induced fatigue as a bonus), almost half of the responders were bipolar patients who had not repsonded prior to augmentation with provigil.
>
> Beyond the monographs, I can't find anything relating to movement disorders induced by modafinil, which is not to say it never happens. I'm personally very prone to these kinds of side effects, and haven't had a problem at 100 mg. most days and 200 mg about 25% of the time. Actually the 2% incidence of dyskenesias reported for Provigil is a lot lower than for many meds commonly used in bipolar depression and schizophrenia. I've never seen anyone report a problem. But again the disclaimer: these aren't areas where I feel particularly qualified to comment.
>
> BTW, regarding Zoloft treatment of your Social Phobia, how much did you take? How long did it take to start "working wonders"? What else were you taking at the same time? What, if any, were your your primary persistent side effects?
>
>
> Thanks,
> Rick
>
>
> > Rick I have social anxiety and BPII. Zoloft did wonders for social anxiety but created mixed mania which was unabearable.
> >
> > Two questions: does Provigil promote cycling?
> > Also looked in following site:http://www.nursespdr.com/members/database/ndrhtml/modafinil.html
> >
> > As a possible side effect of provigil they mention
> > oro-facial dyskenesia. This sounds dangerously close to tardive dyskenesia although I have not looked it up.
> >
> > Please your thoughts if any on above.
> >
> > AMenz
> >
> > > Lucy --
> > >
> > > Unfortunately, my areas of casual self-study, as well as my self-experience with meds has all been primarily in the area of anxiety. (Although, as you know, many AD's and other meds are useful across different classes of mental disorders.) And while I might call myself "highly informed", I would by no means call myself an "expert", even with respect to anxiety treatment. I personally know almost nothing about Borderline Personality Disorder, although I'm sure there are many Psycho-Babble posters who do.
> > >
> > > Klonopin is called Paxam in Australia. I would imagine that generic clonazepam is available to you as well, but this is one drug for which many people swear that the branded version is better -- or at least stronger. I can tell you that, even though I have the generalized form of social phobia, my most dramatic and prompt response to Klonopin was in alleviating what had developed into near-panic when giving presentations. And, as I alluded to before, this relief comes without any sedation, mind-dulling, or "buzz". (Those things may have occurred a bit initially, but quickly went away with daily dosing.)
> > >
> > > If your Social Phobia is very strongly tilted towards performance situations, have you tried beta blockers such as propranolol (one of the most common for this purpose) or the serotonin-friendly pindolol? Beta Blockers can be taken on an as-needed basis, and work by directly reducing physical performance-situation symptoms such as a racing heart. For me they weren't anywhere near as effective as daily Klonopin, although they do provide a very calming effect to some people.
> > > I had been taking pindolol every day with the Klonopin, and found it added a very nice dimension. However, I had to stop taking it, because once I successfully shed 60 pounds the beta blocker made my blood pressure too low. Also, they can cause some fatigue, especially when taken on an as-needed basis.
> > >
> > > Of course, you must talk to your doctor, and make sure any combo you take isn't likely to cause unsafe interactions. That said, I'm shocked at how many doctors (at least in this country) both fail to identify potentially dangerous interactions AND claim that some drugs shouldn't be combined when the combination can be perfectly safe and beneficial. I've successfully challenged doctors on such matters several times, armed with info from the net (official monographs,
> > > articles or Medline abstracts from respected medical journals, drug-interaction dictionaries, and posts from patients).
> > >
> > > Good luck to you, and let us know how things work out. If you don't get any further responses form this thread, why not try starting a new thread? There may be some people who never make it to this thread, but who are successfully
> > > dealing with a combo of challenges which are very similar to your own. In fact, I wish Dr. Bob allowed the subject headings to be longer (read: more detailed) to catch the eye of more readers who have the most relevant advice or experiences to share!!
> > >
> > > Say "Hi" to my Aussie uncle for me! Hint: He used to host a popular TV news-magazine there, although if you're young you might not remember it. Oh, and he has an American accent.
> > >
> > > Rick
> > >
> > > ------
> > > > Hi Rick
> > > > I hope you don't mind me posting a request for your knowledgeable feedback about my meds cocktail. I'm diagnosed with borderline personality disorder, i suffer from intermittent extreme rage, complete lack of motivation, depression, social phobia especially with public speaking which has held me back from achieving so much. I have had to quit Uni because of my phobia. I have been on Paxil 20mg and Imovane(zopiclone hydrochloride) to help me sleep 15mg. My psychiatrist has recently put me on depakote to regulate my moods and anger outbursts but I,m worried it worsens my depression which I think it is but it's hard to tell, it's only been 1 month. I'm on 400mg in the morning and 600mg at night. I feel I need to tackle the phobia and depression more than anything else in order to get ahead in life and I'm interested in the meds you mentioned. I am in Australia, do you know if they are available here? Could you please tell me what you think as I value your opinion after reading your other posts! By the way, I totally agree with your views on Paxil withdrawals- absolutely terrifying! and they told me it was non- addictive, yeah right.
> > > > Look forward to your reply
> > > > Take care
> > > > >
Posted by Rick on June 3, 2001, at 4:02:19
In reply to Re:SOC PHOBIA COCKTAIL--WOW!!: Survey..., posted by AMenz on June 2, 2001, at 11:08:20
AMenz -
(Quick preview: Of the links I provide here, I think the last one is especially interesting.)
No, you definitely didn't post more than I "wanted to hear"! Thanks for the detailed Zoloft info.
You may have already done this search, but I found almost 40 posts in the Psycho-Babble archives that reference personality changes.(Click "search with options" at the bottom of this page and enter "personality changes" in quotes). These are mostly, but not entirely concerning med-induced changes.
Also try the following Deja-Google link as well, being sure to click "view thread" at the end of each result so that you'll see all the posts:
I think I can appreciate what your saying, re the personality change, although my perception of my own Social Phobia treatment is quite different. I see it more as allowing my "real" personality to come through, instead of letting a
chemical imbalance in my brain dictate that I'm going to be too anxious and too pathologically self-conscious to be myself. With this burden mostly lifted, I can now act with others more like I act around the handful of people I've long been pretty comfortable with. Put another way, I'm more open, assertive, enthusiastic, and interested in OTHERS. Obviously, this is well received by people who I see regularly, and yes, once in awhile they may react with surprise. But I'm basically still a low-key guy, certainly no party animal. Funny, you and I were saying very much the same thing, but you seemed to view it in a negative light. Nothing about the change feels at all unnatural to me. Nicely surprising, but not unnatural or fake, either mentally or physically.But perhaps for your situation, factors such as depression (and bipolar depression in particular); your own life's experiences and behaviors; and/or ingrained feeling of "weakness" from using meds, lead you to perceive a reduction of deep-seated social phobia as "unnatural". (Sorry for the long, unwieldy sentence!) At the risk of sounding like a broken record (if anyone knows what those are anymore), I'm probably not all that qualified to comment on your situation.
Most of what I posted re Provigil and bipolarity was from what I read on the net, both previously and after seeing your original post. Here's a link to post results from a Usenet search, mainly from alt.depression.medication and alt.depression.manic:
http://groups.google.com/groups?q=Provigil+bipolar&hl=en&lr=&safe=off&site=groups
Also, go to www.google.com, enter the terms Provigil and bipolar in the search box, and you'll find many relevant web pages that support the comments in my last post. Many of these are from "ask the doctor" sections of sites dedicated on bipolarity. I have no idea how credible they are, but again there was very little mention of possible problems with Provigil in bipolarity. There were many mentions of benefit plus quite a few mentioning lack of benefit.
I find the page below especially interesting, because it provides more detail -- on a patient-by-patient basis, of the participants and meds regimens in the Provigil AD-augmentation study. It specifically cites the lack of cycling problems among the bipolar participants, although we ARE talking about only three individuals here.
Rick
Detail on study of Provigil-as-augmenting agent:
http://alertpubs.com/august2000psych.htm#Stimulant Augmentation in Depression
> Thankx for your response.
>
> First let me answer your quesetions re Zoloft.
>
> Zoloft was titrated up to 100mg (25, 50, 100). At each stage after a couple of weeks it had the desired effect of eliminating completely social anxiety (I don't know if concomitant use of 1mg of Lorezapam daily created a synergistic effect).
>
> After becoming accustomed to the level the social anxiety (milder though) returned and the level was upped the next notch. I assumed that upwards of 100 (don't know 150, 200, whatever the effect might be permanent.
>
> What it did was to take away all fear in social interactions, it became very easy to be nice and supportive to people, to listen to their conversation, to appreciate their jokes, etc. All the things that make people like you and in turn be willing to extend the same to you. (That has been my experience with people) I also became extraordinarily calm. Other people seemed to me overexited, prone to take offense, etc. What a trip!!!
>
> Calm seems to have a great effect on others. I became popular. That was a new experience for me believe me.
>
> Of course the issue with all these medication induced personality changes, is one of identity. Is this me, or am I taking former symptoms as my personality. Who is she, the lady or the tiger? Know what I mean.
>
> I find it interesting that other people on the board have not discussed ( or I have not seen) the issue of identity and medication.
>
> Maybe I've told you more than you wanted to hear.
>
> BTW did you plug provigil in a particular search engine and come up with monographs, or are there sites you can recommend.
> > AMenz -
> >
> > I'm not really qualified to answer your questions. But after sifting through lots of posts on the neton the net, I've only seen one or two cases where someone was concerned about rapid cycling on Provigil, and even then it was conjecture.
> >
> > As with just about any med, some bipolar II users praised modafinil, and others found it ineffective or bothersome. Actually, Provigil seems to disagree with fewer bipolar users than unipolar.
> >
> > Medline shows no study abstracts associating modafinil with crapid cycling, even though I could see how one would wonder. To the contrary, in the small Medline-reported study where Provigil worked extremely well in quickly kick-starting AD's (and alleviating med-induced fatigue as a bonus), almost half of the responders were bipolar patients who had not repsonded prior to augmentation with provigil.
> >
> > Beyond the monographs, I can't find anything relating to movement disorders induced by modafinil, which is not to say it never happens. I'm personally very prone to these kinds of side effects, and haven't had a problem at 100 mg. most days and 200 mg about 25% of the time. Actually the 2% incidence of dyskenesias reported for Provigil is a lot lower than for many meds commonly used in bipolar depression and schizophrenia. I've never seen anyone report a problem. But again the disclaimer: these aren't areas where I feel particularly qualified to comment.
> >
> > BTW, regarding Zoloft treatment of your Social Phobia, how much did you take? How long did it take to start "working wonders"? What else were you taking at the same time? What, if any, were your your primary persistent side effects?
> >
> >
> > Thanks,
> > Rick
> >
> >
> > > Rick I have social anxiety and BPII. Zoloft did wonders for social anxiety but created mixed mania which was unabearable.
> > >
> > > Two questions: does Provigil promote cycling?
> > > Also looked in following site:http://www.nursespdr.com/members/database/ndrhtml/modafinil.html
> > >
> > > As a possible side effect of provigil they mention
> > > oro-facial dyskenesia. This sounds dangerously close to tardive dyskenesia although I have not looked it up.
> > >
> > > Please your thoughts if any on above.
> > >
> > > AMenz
> > >
> > > > Lucy --
> > > >
> > > > Unfortunately, my areas of casual self-study, as well as my self-experience with meds has all been primarily in the area of anxiety. (Although, as you know, many AD's and other meds are useful across different classes of mental disorders.) And while I might call myself "highly informed", I would by no means call myself an "expert", even with respect to anxiety treatment. I personally know almost nothing about Borderline Personality Disorder, although I'm sure there are many Psycho-Babble posters who do.
> > > >
> > > > Klonopin is called Paxam in Australia. I would imagine that generic clonazepam is available to you as well, but this is one drug for which many people swear that the branded version is better -- or at least stronger. I can tell you that, even though I have the generalized form of social phobia, my most dramatic and prompt response to Klonopin was in alleviating what had developed into near-panic when giving presentations. And, as I alluded to before, this relief comes without any sedation, mind-dulling, or "buzz". (Those things may have occurred a bit initially, but quickly went away with daily dosing.)
> > > >
> > > > If your Social Phobia is very strongly tilted towards performance situations, have you tried beta blockers such as propranolol (one of the most common for this purpose) or the serotonin-friendly pindolol? Beta Blockers can be taken on an as-needed basis, and work by directly reducing physical performance-situation symptoms such as a racing heart. For me they weren't anywhere near as effective as daily Klonopin, although they do provide a very calming effect to some people.
> > > > I had been taking pindolol every day with the Klonopin, and found it added a very nice dimension. However, I had to stop taking it, because once I successfully shed 60 pounds the beta blocker made my blood pressure too low. Also, they can cause some fatigue, especially when taken on an as-needed basis.
> > > >
> > > > Of course, you must talk to your doctor, and make sure any combo you take isn't likely to cause unsafe interactions. That said, I'm shocked at how many doctors (at least in this country) both fail to identify potentially dangerous interactions AND claim that some drugs shouldn't be combined when the combination can be perfectly safe and beneficial. I've successfully challenged doctors on such matters several times, armed with info from the net (official monographs,
> > > > articles or Medline abstracts from respected medical journals, drug-interaction dictionaries, and posts from patients).
> > > >
> > > > Good luck to you, and let us know how things work out. If you don't get any further responses form this thread, why not try starting a new thread? There may be some people who never make it to this thread, but who are successfully
> > > > dealing with a combo of challenges which are very similar to your own. In fact, I wish Dr. Bob allowed the subject headings to be longer (read: more detailed) to catch the eye of more readers who have the most relevant advice or experiences to share!!
> > > >
> > > > Say "Hi" to my Aussie uncle for me! Hint: He used to host a popular TV news-magazine there, although if you're young you might not remember it. Oh, and he has an American accent.
> > > >
> > > > Rick
> > > >
> > > > ------
> > > > > Hi Rick
> > > > > I hope you don't mind me posting a request for your knowledgeable feedback about my meds cocktail. I'm diagnosed with borderline personality disorder, i suffer from intermittent extreme rage, complete lack of motivation, depression, social phobia especially with public speaking which has held me back from achieving so much. I have had to quit Uni because of my phobia. I have been on Paxil 20mg and Imovane(zopiclone hydrochloride) to help me sleep 15mg. My psychiatrist has recently put me on depakote to regulate my moods and anger outbursts but I,m worried it worsens my depression which I think it is but it's hard to tell, it's only been 1 month. I'm on 400mg in the morning and 600mg at night. I feel I need to tackle the phobia and depression more than anything else in order to get ahead in life and I'm interested in the meds you mentioned. I am in Australia, do you know if they are available here? Could you please tell me what you think as I value your opinion after reading your other posts! By the way, I totally agree with your views on Paxil withdrawals- absolutely terrifying! and they told me it was non- addictive, yeah right.
> > > > > Look forward to your reply
> > > > > Take care
> > > > > >
Posted by Rick on June 3, 2001, at 4:08:18
In reply to Re:SOC PHOBIA COCKTAIL--WOW!!: Survey... » AMenz, posted by Rick on June 3, 2001, at 4:02:19
P.S.:
In the last link ( http://alertpubs.com/august2000psych.htm ), scroll down to the second article, "Stimulant Augmentation in Depression").
Rick
> AMenz -
>
> (Quick preview: Of the links I provide here, I think the last one is especially interesting.)
>
> No, you definitely didn't post more than I "wanted to hear"! Thanks for the detailed Zoloft info.
>
> You may have already done this search, but I found almost 40 posts in the Psycho-Babble archives that reference personality changes.(Click "search with options" at the bottom of this page and enter "personality changes" in quotes). These are mostly, but not entirely concerning med-induced changes.
>
> Also try the following Deja-Google link as well, being sure to click "view thread" at the end of each result so that you'll see all the posts:
>
> http://groups.google.com/groups?q=%22personality+changes%22&hl=en&lr=&safe=off&btnG=Google+Search&meta=site%3Dgroups%26group%3Dalt.support.depression.medication
>
>
> I think I can appreciate what your saying, re the personality change, although my perception of my own Social Phobia treatment is quite different. I see it more as allowing my "real" personality to come through, instead of letting a
> chemical imbalance in my brain dictate that I'm going to be too anxious and too pathologically self-conscious to be myself. With this burden mostly lifted, I can now act with others more like I act around the handful of people I've long been pretty comfortable with. Put another way, I'm more open, assertive, enthusiastic, and interested in OTHERS. Obviously, this is well received by people who I see regularly, and yes, once in awhile they may react with surprise. But I'm basically still a low-key guy, certainly no party animal. Funny, you and I were saying very much the same thing, but you seemed to view it in a negative light. Nothing about the change feels at all unnatural to me. Nicely surprising, but not unnatural or fake, either mentally or physically.
>
> But perhaps for your situation, factors such as depression (and bipolar depression in particular); your own life's experiences and behaviors; and/or ingrained feeling of "weakness" from using meds, lead you to perceive a reduction of deep-seated social phobia as "unnatural". (Sorry for the long, unwieldy sentence!) At the risk of sounding like a broken record (if anyone knows what those are anymore), I'm probably not all that qualified to comment on your situation.
>
> Most of what I posted re Provigil and bipolarity was from what I read on the net, both previously and after seeing your original post. Here's a link to post results from a Usenet search, mainly from alt.depression.medication and alt.depression.manic:
>
> http://groups.google.com/groups?q=Provigil+bipolar&hl=en&lr=&safe=off&site=groups
>
> Also, go to www.google.com, enter the terms Provigil and bipolar in the search box, and you'll find many relevant web pages that support the comments in my last post. Many of these are from "ask the doctor" sections of sites dedicated on bipolarity. I have no idea how credible they are, but again there was very little mention of possible problems with Provigil in bipolarity. There were many mentions of benefit plus quite a few mentioning lack of benefit.
>
> I find the page below especially interesting, because it provides more detail -- on a patient-by-patient basis, of the participants and meds regimens in the Provigil AD-augmentation study. It specifically cites the lack of cycling problems among the bipolar participants, although we ARE talking about only three individuals here.
>
> Rick
>
> Detail on study of Provigil-as-augmenting agent:
>
> http://alertpubs.com/august2000psych.htm#Stimulant Augmentation in Depression
>
>
>
>
>
>
> > Thankx for your response.
> >
> > First let me answer your quesetions re Zoloft.
> >
> > Zoloft was titrated up to 100mg (25, 50, 100). At each stage after a couple of weeks it had the desired effect of eliminating completely social anxiety (I don't know if concomitant use of 1mg of Lorezapam daily created a synergistic effect).
> >
> > After becoming accustomed to the level the social anxiety (milder though) returned and the level was upped the next notch. I assumed that upwards of 100 (don't know 150, 200, whatever the effect might be permanent.
> >
> > What it did was to take away all fear in social interactions, it became very easy to be nice and supportive to people, to listen to their conversation, to appreciate their jokes, etc. All the things that make people like you and in turn be willing to extend the same to you. (That has been my experience with people) I also became extraordinarily calm. Other people seemed to me overexited, prone to take offense, etc. What a trip!!!
> >
> > Calm seems to have a great effect on others. I became popular. That was a new experience for me believe me.
> >
> > Of course the issue with all these medication induced personality changes, is one of identity. Is this me, or am I taking former symptoms as my personality. Who is she, the lady or the tiger? Know what I mean.
> >
> > I find it interesting that other people on the board have not discussed ( or I have not seen) the issue of identity and medication.
> >
> > Maybe I've told you more than you wanted to hear.
> >
> > BTW did you plug provigil in a particular search engine and come up with monographs, or are there sites you can recommend.
> > > AMenz -
> > >
> > > I'm not really qualified to answer your questions. But after sifting through lots of posts on the neton the net, I've only seen one or two cases where someone was concerned about rapid cycling on Provigil, and even then it was conjecture.
> > >
> > > As with just about any med, some bipolar II users praised modafinil, and others found it ineffective or bothersome. Actually, Provigil seems to disagree with fewer bipolar users than unipolar.
> > >
> > > Medline shows no study abstracts associating modafinil with crapid cycling, even though I could see how one would wonder. To the contrary, in the small Medline-reported study where Provigil worked extremely well in quickly kick-starting AD's (and alleviating med-induced fatigue as a bonus), almost half of the responders were bipolar patients who had not repsonded prior to augmentation with provigil.
> > >
> > > Beyond the monographs, I can't find anything relating to movement disorders induced by modafinil, which is not to say it never happens. I'm personally very prone to these kinds of side effects, and haven't had a problem at 100 mg. most days and 200 mg about 25% of the time. Actually the 2% incidence of dyskenesias reported for Provigil is a lot lower than for many meds commonly used in bipolar depression and schizophrenia. I've never seen anyone report a problem. But again the disclaimer: these aren't areas where I feel particularly qualified to comment.
> > >
> > > BTW, regarding Zoloft treatment of your Social Phobia, how much did you take? How long did it take to start "working wonders"? What else were you taking at the same time? What, if any, were your your primary persistent side effects?
> > >
> > >
> > > Thanks,
> > > Rick
> > >
> > >
> > > > Rick I have social anxiety and BPII. Zoloft did wonders for social anxiety but created mixed mania which was unabearable.
> > > >
> > > > Two questions: does Provigil promote cycling?
> > > > Also looked in following site:http://www.nursespdr.com/members/database/ndrhtml/modafinil.html
> > > >
> > > > As a possible side effect of provigil they mention
> > > > oro-facial dyskenesia. This sounds dangerously close to tardive dyskenesia although I have not looked it up.
> > > >
> > > > Please your thoughts if any on above.
> > > >
> > > > AMenz
> > > >
> > > > > Lucy --
> > > > >
> > > > > Unfortunately, my areas of casual self-study, as well as my self-experience with meds has all been primarily in the area of anxiety. (Although, as you know, many AD's and other meds are useful across different classes of mental disorders.) And while I might call myself "highly informed", I would by no means call myself an "expert", even with respect to anxiety treatment. I personally know almost nothing about Borderline Personality Disorder, although I'm sure there are many Psycho-Babble posters who do.
> > > > >
> > > > > Klonopin is called Paxam in Australia. I would imagine that generic clonazepam is available to you as well, but this is one drug for which many people swear that the branded version is better -- or at least stronger. I can tell you that, even though I have the generalized form of social phobia, my most dramatic and prompt response to Klonopin was in alleviating what had developed into near-panic when giving presentations. And, as I alluded to before, this relief comes without any sedation, mind-dulling, or "buzz". (Those things may have occurred a bit initially, but quickly went away with daily dosing.)
> > > > >
> > > > > If your Social Phobia is very strongly tilted towards performance situations, have you tried beta blockers such as propranolol (one of the most common for this purpose) or the serotonin-friendly pindolol? Beta Blockers can be taken on an as-needed basis, and work by directly reducing physical performance-situation symptoms such as a racing heart. For me they weren't anywhere near as effective as daily Klonopin, although they do provide a very calming effect to some people.
> > > > > I had been taking pindolol every day with the Klonopin, and found it added a very nice dimension. However, I had to stop taking it, because once I successfully shed 60 pounds the beta blocker made my blood pressure too low. Also, they can cause some fatigue, especially when taken on an as-needed basis.
> > > > >
> > > > > Of course, you must talk to your doctor, and make sure any combo you take isn't likely to cause unsafe interactions. That said, I'm shocked at how many doctors (at least in this country) both fail to identify potentially dangerous interactions AND claim that some drugs shouldn't be combined when the combination can be perfectly safe and beneficial. I've successfully challenged doctors on such matters several times, armed with info from the net (official monographs,
> > > > > articles or Medline abstracts from respected medical journals, drug-interaction dictionaries, and posts from patients).
> > > > >
> > > > > Good luck to you, and let us know how things work out. If you don't get any further responses form this thread, why not try starting a new thread? There may be some people who never make it to this thread, but who are successfully
> > > > > dealing with a combo of challenges which are very similar to your own. In fact, I wish Dr. Bob allowed the subject headings to be longer (read: more detailed) to catch the eye of more readers who have the most relevant advice or experiences to share!!
> > > > >
> > > > > Say "Hi" to my Aussie uncle for me! Hint: He used to host a popular TV news-magazine there, although if you're young you might not remember it. Oh, and he has an American accent.
> > > > >
> > > > > Rick
> > > > >
> > > > > ------
> > > > > > Hi Rick
> > > > > > I hope you don't mind me posting a request for your knowledgeable feedback about my meds cocktail. I'm diagnosed with borderline personality disorder, i suffer from intermittent extreme rage, complete lack of motivation, depression, social phobia especially with public speaking which has held me back from achieving so much. I have had to quit Uni because of my phobia. I have been on Paxil 20mg and Imovane(zopiclone hydrochloride) to help me sleep 15mg. My psychiatrist has recently put me on depakote to regulate my moods and anger outbursts but I,m worried it worsens my depression which I think it is but it's hard to tell, it's only been 1 month. I'm on 400mg in the morning and 600mg at night. I feel I need to tackle the phobia and depression more than anything else in order to get ahead in life and I'm interested in the meds you mentioned. I am in Australia, do you know if they are available here? Could you please tell me what you think as I value your opinion after reading your other posts! By the way, I totally agree with your views on Paxil withdrawals- absolutely terrifying! and they told me it was non- addictive, yeah right.
> > > > > > Look forward to your reply
> > > > > > Take care
> > > > > > >
Posted by AMenz on June 3, 2001, at 13:30:48
In reply to Re:SOC PHOBIA COCKTAIL--WOW!!: Survey... » AMenz, posted by Rick on June 3, 2001, at 4:08:18
Thank you for the links and comments. I assume you are still on your initial cocktail. I am considering adding provigil. It does seem bening.
> P.S.:
>
> In the last link ( http://alertpubs.com/august2000psych.htm ), scroll down to the second article, "Stimulant Augmentation in Depression").
>
> Rick
>
>
> > AMenz -
> >
> > (Quick preview: Of the links I provide here, I think the last one is especially interesting.)
> >
> > No, you definitely didn't post more than I "wanted to hear"! Thanks for the detailed Zoloft info.
> >
> > You may have already done this search, but I found almost 40 posts in the Psycho-Babble archives that reference personality changes.(Click "search with options" at the bottom of this page and enter "personality changes" in quotes). These are mostly, but not entirely concerning med-induced changes.
> >
> > Also try the following Deja-Google link as well, being sure to click "view thread" at the end of each result so that you'll see all the posts:
> >
> > http://groups.google.com/groups?q=%22personality+changes%22&hl=en&lr=&safe=off&btnG=Google+Search&meta=site%3Dgroups%26group%3Dalt.support.depression.medication
> >
> >
> > I think I can appreciate what your saying, re the personality change, although my perception of my own Social Phobia treatment is quite different. I see it more as allowing my "real" personality to come through, instead of letting a
> > chemical imbalance in my brain dictate that I'm going to be too anxious and too pathologically self-conscious to be myself. With this burden mostly lifted, I can now act with others more like I act around the handful of people I've long been pretty comfortable with. Put another way, I'm more open, assertive, enthusiastic, and interested in OTHERS. Obviously, this is well received by people who I see regularly, and yes, once in awhile they may react with surprise. But I'm basically still a low-key guy, certainly no party animal. Funny, you and I were saying very much the same thing, but you seemed to view it in a negative light. Nothing about the change feels at all unnatural to me. Nicely surprising, but not unnatural or fake, either mentally or physically.
> >
> > But perhaps for your situation, factors such as depression (and bipolar depression in particular); your own life's experiences and behaviors; and/or ingrained feeling of "weakness" from using meds, lead you to perceive a reduction of deep-seated social phobia as "unnatural". (Sorry for the long, unwieldy sentence!) At the risk of sounding like a broken record (if anyone knows what those are anymore), I'm probably not all that qualified to comment on your situation.
> >
> > Most of what I posted re Provigil and bipolarity was from what I read on the net, both previously and after seeing your original post. Here's a link to post results from a Usenet search, mainly from alt.depression.medication and alt.depression.manic:
> >
> > http://groups.google.com/groups?q=Provigil+bipolar&hl=en&lr=&safe=off&site=groups
> >
> > Also, go to www.google.com, enter the terms Provigil and bipolar in the search box, and you'll find many relevant web pages that support the comments in my last post. Many of these are from "ask the doctor" sections of sites dedicated on bipolarity. I have no idea how credible they are, but again there was very little mention of possible problems with Provigil in bipolarity. There were many mentions of benefit plus quite a few mentioning lack of benefit.
> >
> > I find the page below especially interesting, because it provides more detail -- on a patient-by-patient basis, of the participants and meds regimens in the Provigil AD-augmentation study. It specifically cites the lack of cycling problems among the bipolar participants, although we ARE talking about only three individuals here.
> >
> > Rick
> >
> > Detail on study of Provigil-as-augmenting agent:
> >
> > http://alertpubs.com/august2000psych.htm#Stimulant Augmentation in Depression
> >
> >
> >
> >
> >
> >
> > > Thankx for your response.
> > >
> > > First let me answer your quesetions re Zoloft.
> > >
> > > Zoloft was titrated up to 100mg (25, 50, 100). At each stage after a couple of weeks it had the desired effect of eliminating completely social anxiety (I don't know if concomitant use of 1mg of Lorezapam daily created a synergistic effect).
> > >
> > > After becoming accustomed to the level the social anxiety (milder though) returned and the level was upped the next notch. I assumed that upwards of 100 (don't know 150, 200, whatever the effect might be permanent.
> > >
> > > What it did was to take away all fear in social interactions, it became very easy to be nice and supportive to people, to listen to their conversation, to appreciate their jokes, etc. All the things that make people like you and in turn be willing to extend the same to you. (That has been my experience with people) I also became extraordinarily calm. Other people seemed to me overexited, prone to take offense, etc. What a trip!!!
> > >
> > > Calm seems to have a great effect on others. I became popular. That was a new experience for me believe me.
> > >
> > > Of course the issue with all these medication induced personality changes, is one of identity. Is this me, or am I taking former symptoms as my personality. Who is she, the lady or the tiger? Know what I mean.
> > >
> > > I find it interesting that other people on the board have not discussed ( or I have not seen) the issue of identity and medication.
> > >
> > > Maybe I've told you more than you wanted to hear.
> > >
> > > BTW did you plug provigil in a particular search engine and come up with monographs, or are there sites you can recommend.
> > > > AMenz -
> > > >
> > > > I'm not really qualified to answer your questions. But after sifting through lots of posts on the neton the net, I've only seen one or two cases where someone was concerned about rapid cycling on Provigil, and even then it was conjecture.
> > > >
> > > > As with just about any med, some bipolar II users praised modafinil, and others found it ineffective or bothersome. Actually, Provigil seems to disagree with fewer bipolar users than unipolar.
> > > >
> > > > Medline shows no study abstracts associating modafinil with crapid cycling, even though I could see how one would wonder. To the contrary, in the small Medline-reported study where Provigil worked extremely well in quickly kick-starting AD's (and alleviating med-induced fatigue as a bonus), almost half of the responders were bipolar patients who had not repsonded prior to augmentation with provigil.
> > > >
> > > > Beyond the monographs, I can't find anything relating to movement disorders induced by modafinil, which is not to say it never happens. I'm personally very prone to these kinds of side effects, and haven't had a problem at 100 mg. most days and 200 mg about 25% of the time. Actually the 2% incidence of dyskenesias reported for Provigil is a lot lower than for many meds commonly used in bipolar depression and schizophrenia. I've never seen anyone report a problem. But again the disclaimer: these aren't areas where I feel particularly qualified to comment.
> > > >
> > > > BTW, regarding Zoloft treatment of your Social Phobia, how much did you take? How long did it take to start "working wonders"? What else were you taking at the same time? What, if any, were your your primary persistent side effects?
> > > >
> > > >
> > > > Thanks,
> > > > Rick
> > > >
> > > >
> > > > > Rick I have social anxiety and BPII. Zoloft did wonders for social anxiety but created mixed mania which was unabearable.
> > > > >
> > > > > Two questions: does Provigil promote cycling?
> > > > > Also looked in following site:http://www.nursespdr.com/members/database/ndrhtml/modafinil.html
> > > > >
> > > > > As a possible side effect of provigil they mention
> > > > > oro-facial dyskenesia. This sounds dangerously close to tardive dyskenesia although I have not looked it up.
> > > > >
> > > > > Please your thoughts if any on above.
> > > > >
> > > > > AMenz
> > > > >
> > > > > > Lucy --
> > > > > >
> > > > > > Unfortunately, my areas of casual self-study, as well as my self-experience with meds has all been primarily in the area of anxiety. (Although, as you know, many AD's and other meds are useful across different classes of mental disorders.) And while I might call myself "highly informed", I would by no means call myself an "expert", even with respect to anxiety treatment. I personally know almost nothing about Borderline Personality Disorder, although I'm sure there are many Psycho-Babble posters who do.
> > > > > >
> > > > > > Klonopin is called Paxam in Australia. I would imagine that generic clonazepam is available to you as well, but this is one drug for which many people swear that the branded version is better -- or at least stronger. I can tell you that, even though I have the generalized form of social phobia, my most dramatic and prompt response to Klonopin was in alleviating what had developed into near-panic when giving presentations. And, as I alluded to before, this relief comes without any sedation, mind-dulling, or "buzz". (Those things may have occurred a bit initially, but quickly went away with daily dosing.)
> > > > > >
> > > > > > If your Social Phobia is very strongly tilted towards performance situations, have you tried beta blockers such as propranolol (one of the most common for this purpose) or the serotonin-friendly pindolol? Beta Blockers can be taken on an as-needed basis, and work by directly reducing physical performance-situation symptoms such as a racing heart. For me they weren't anywhere near as effective as daily Klonopin, although they do provide a very calming effect to some people.
> > > > > > I had been taking pindolol every day with the Klonopin, and found it added a very nice dimension. However, I had to stop taking it, because once I successfully shed 60 pounds the beta blocker made my blood pressure too low. Also, they can cause some fatigue, especially when taken on an as-needed basis.
> > > > > >
> > > > > > Of course, you must talk to your doctor, and make sure any combo you take isn't likely to cause unsafe interactions. That said, I'm shocked at how many doctors (at least in this country) both fail to identify potentially dangerous interactions AND claim that some drugs shouldn't be combined when the combination can be perfectly safe and beneficial. I've successfully challenged doctors on such matters several times, armed with info from the net (official monographs,
> > > > > > articles or Medline abstracts from respected medical journals, drug-interaction dictionaries, and posts from patients).
> > > > > >
> > > > > > Good luck to you, and let us know how things work out. If you don't get any further responses form this thread, why not try starting a new thread? There may be some people who never make it to this thread, but who are successfully
> > > > > > dealing with a combo of challenges which are very similar to your own. In fact, I wish Dr. Bob allowed the subject headings to be longer (read: more detailed) to catch the eye of more readers who have the most relevant advice or experiences to share!!
> > > > > >
> > > > > > Say "Hi" to my Aussie uncle for me! Hint: He used to host a popular TV news-magazine there, although if you're young you might not remember it. Oh, and he has an American accent.
> > > > > >
> > > > > > Rick
> > > > > >
> > > > > > ------
> > > > > > > Hi Rick
> > > > > > > I hope you don't mind me posting a request for your knowledgeable feedback about my meds cocktail. I'm diagnosed with borderline personality disorder, i suffer from intermittent extreme rage, complete lack of motivation, depression, social phobia especially with public speaking which has held me back from achieving so much. I have had to quit Uni because of my phobia. I have been on Paxil 20mg and Imovane(zopiclone hydrochloride) to help me sleep 15mg. My psychiatrist has recently put me on depakote to regulate my moods and anger outbursts but I,m worried it worsens my depression which I think it is but it's hard to tell, it's only been 1 month. I'm on 400mg in the morning and 600mg at night. I feel I need to tackle the phobia and depression more than anything else in order to get ahead in life and I'm interested in the meds you mentioned. I am in Australia, do you know if they are available here? Could you please tell me what you think as I value your opinion after reading your other posts! By the way, I totally agree with your views on Paxil withdrawals- absolutely terrifying! and they told me it was non- addictive, yeah right.
> > > > > > > Look forward to your reply
> > > > > > > Take care
> > > > > > > >
Posted by Rick on June 3, 2001, at 14:39:38
In reply to Re:SOC PHOBIA COCKTAIL--WOW!!: Survey..., posted by AMenz on June 3, 2001, at 13:30:48
Yes, I'm still on the same cocktail, but with somewhat more Serzone, and only 100 mg Provigil on most days. It's still extremely effective for my non-depressive Social Phobia. (Sure doesn't do anything for my non-SP-related obsessions and compulsions, though!) My only complaints are some dry mouth and some memory problems -- which personal experimentation seems to show is Serzone-driven despite Klonopin's reputation for amnesic effects.
> Thank you for the links and comments. I assume you are still on your initial cocktail. I am considering adding provigil. It does seem bening.
>
>
>
> > P.S.:
> >
> > In the last link ( http://alertpubs.com/august2000psych.htm ), scroll down to the second article, "Stimulant Augmentation in Depression").
> >
> > Rick
> >
> >
> > > AMenz -
> > >
> > > (Quick preview: Of the links I provide here, I think the last one is especially interesting.)
> > >
> > > No, you definitely didn't post more than I "wanted to hear"! Thanks for the detailed Zoloft info.
> > >
> > > You may have already done this search, but I found almost 40 posts in the Psycho-Babble archives that reference personality changes.(Click "search with options" at the bottom of this page and enter "personality changes" in quotes). These are mostly, but not entirely concerning med-induced changes.
> > >
> > > Also try the following Deja-Google link as well, being sure to click "view thread" at the end of each result so that you'll see all the posts:
> > >
> > > http://groups.google.com/groups?q=%22personality+changes%22&hl=en&lr=&safe=off&btnG=Google+Search&meta=site%3Dgroups%26group%3Dalt.support.depression.medication
> > >
> > >
> > > I think I can appreciate what your saying, re the personality change, although my perception of my own Social Phobia treatment is quite different. I see it more as allowing my "real" personality to come through, instead of letting a
> > > chemical imbalance in my brain dictate that I'm going to be too anxious and too pathologically self-conscious to be myself. With this burden mostly lifted, I can now act with others more like I act around the handful of people I've long been pretty comfortable with. Put another way, I'm more open, assertive, enthusiastic, and interested in OTHERS. Obviously, this is well received by people who I see regularly, and yes, once in awhile they may react with surprise. But I'm basically still a low-key guy, certainly no party animal. Funny, you and I were saying very much the same thing, but you seemed to view it in a negative light. Nothing about the change feels at all unnatural to me. Nicely surprising, but not unnatural or fake, either mentally or physically.
> > >
> > > But perhaps for your situation, factors such as depression (and bipolar depression in particular); your own life's experiences and behaviors; and/or ingrained feeling of "weakness" from using meds, lead you to perceive a reduction of deep-seated social phobia as "unnatural". (Sorry for the long, unwieldy sentence!) At the risk of sounding like a broken record (if anyone knows what those are anymore), I'm probably not all that qualified to comment on your situation.
> > >
> > > Most of what I posted re Provigil and bipolarity was from what I read on the net, both previously and after seeing your original post. Here's a link to post results from a Usenet search, mainly from alt.depression.medication and alt.depression.manic:
> > >
> > > http://groups.google.com/groups?q=Provigil+bipolar&hl=en&lr=&safe=off&site=groups
> > >
> > > Also, go to www.google.com, enter the terms Provigil and bipolar in the search box, and you'll find many relevant web pages that support the comments in my last post. Many of these are from "ask the doctor" sections of sites dedicated on bipolarity. I have no idea how credible they are, but again there was very little mention of possible problems with Provigil in bipolarity. There were many mentions of benefit plus quite a few mentioning lack of benefit.
> > >
> > > I find the page below especially interesting, because it provides more detail -- on a patient-by-patient basis, of the participants and meds regimens in the Provigil AD-augmentation study. It specifically cites the lack of cycling problems among the bipolar participants, although we ARE talking about only three individuals here.
> > >
> > > Rick
> > >
> > > Detail on study of Provigil-as-augmenting agent:
> > >
> > > http://alertpubs.com/august2000psych.htm#Stimulant Augmentation in Depression
> > >
> > >
> > >
> > >
> > >
> > >
> > > > Thankx for your response.
> > > >
> > > > First let me answer your quesetions re Zoloft.
> > > >
> > > > Zoloft was titrated up to 100mg (25, 50, 100). At each stage after a couple of weeks it had the desired effect of eliminating completely social anxiety (I don't know if concomitant use of 1mg of Lorezapam daily created a synergistic effect).
> > > >
> > > > After becoming accustomed to the level the social anxiety (milder though) returned and the level was upped the next notch. I assumed that upwards of 100 (don't know 150, 200, whatever the effect might be permanent.
> > > >
> > > > What it did was to take away all fear in social interactions, it became very easy to be nice and supportive to people, to listen to their conversation, to appreciate their jokes, etc. All the things that make people like you and in turn be willing to extend the same to you. (That has been my experience with people) I also became extraordinarily calm. Other people seemed to me overexited, prone to take offense, etc. What a trip!!!
> > > >
> > > > Calm seems to have a great effect on others. I became popular. That was a new experience for me believe me.
> > > >
> > > > Of course the issue with all these medication induced personality changes, is one of identity. Is this me, or am I taking former symptoms as my personality. Who is she, the lady or the tiger? Know what I mean.
> > > >
> > > > I find it interesting that other people on the board have not discussed ( or I have not seen) the issue of identity and medication.
> > > >
> > > > Maybe I've told you more than you wanted to hear.
> > > >
> > > > BTW did you plug provigil in a particular search engine and come up with monographs, or are there sites you can recommend.
> > > > > AMenz -
> > > > >
> > > > > I'm not really qualified to answer your questions. But after sifting through lots of posts on the neton the net, I've only seen one or two cases where someone was concerned about rapid cycling on Provigil, and even then it was conjecture.
> > > > >
> > > > > As with just about any med, some bipolar II users praised modafinil, and others found it ineffective or bothersome. Actually, Provigil seems to disagree with fewer bipolar users than unipolar.
> > > > >
> > > > > Medline shows no study abstracts associating modafinil with crapid cycling, even though I could see how one would wonder. To the contrary, in the small Medline-reported study where Provigil worked extremely well in quickly kick-starting AD's (and alleviating med-induced fatigue as a bonus), almost half of the responders were bipolar patients who had not repsonded prior to augmentation with provigil.
> > > > >
> > > > > Beyond the monographs, I can't find anything relating to movement disorders induced by modafinil, which is not to say it never happens. I'm personally very prone to these kinds of side effects, and haven't had a problem at 100 mg. most days and 200 mg about 25% of the time. Actually the 2% incidence of dyskenesias reported for Provigil is a lot lower than for many meds commonly used in bipolar depression and schizophrenia. I've never seen anyone report a problem. But again the disclaimer: these aren't areas where I feel particularly qualified to comment.
> > > > >
> > > > > BTW, regarding Zoloft treatment of your Social Phobia, how much did you take? How long did it take to start "working wonders"? What else were you taking at the same time? What, if any, were your your primary persistent side effects?
> > > > >
> > > > >
> > > > > Thanks,
> > > > > Rick
> > > > >
> > > > >
> > > > > > Rick I have social anxiety and BPII. Zoloft did wonders for social anxiety but created mixed mania which was unabearable.
> > > > > >
> > > > > > Two questions: does Provigil promote cycling?
> > > > > > Also looked in following site:http://www.nursespdr.com/members/database/ndrhtml/modafinil.html
> > > > > >
> > > > > > As a possible side effect of provigil they mention
> > > > > > oro-facial dyskenesia. This sounds dangerously close to tardive dyskenesia although I have not looked it up.
> > > > > >
> > > > > > Please your thoughts if any on above.
> > > > > >
> > > > > > AMenz
> > > > > >
> > > > > > > Lucy --
> > > > > > >
> > > > > > > Unfortunately, my areas of casual self-study, as well as my self-experience with meds has all been primarily in the area of anxiety. (Although, as you know, many AD's and other meds are useful across different classes of mental disorders.) And while I might call myself "highly informed", I would by no means call myself an "expert", even with respect to anxiety treatment. I personally know almost nothing about Borderline Personality Disorder, although I'm sure there are many Psycho-Babble posters who do.
> > > > > > >
> > > > > > > Klonopin is called Paxam in Australia. I would imagine that generic clonazepam is available to you as well, but this is one drug for which many people swear that the branded version is better -- or at least stronger. I can tell you that, even though I have the generalized form of social phobia, my most dramatic and prompt response to Klonopin was in alleviating what had developed into near-panic when giving presentations. And, as I alluded to before, this relief comes without any sedation, mind-dulling, or "buzz". (Those things may have occurred a bit initially, but quickly went away with daily dosing.)
> > > > > > >
> > > > > > > If your Social Phobia is very strongly tilted towards performance situations, have you tried beta blockers such as propranolol (one of the most common for this purpose) or the serotonin-friendly pindolol? Beta Blockers can be taken on an as-needed basis, and work by directly reducing physical performance-situation symptoms such as a racing heart. For me they weren't anywhere near as effective as daily Klonopin, although they do provide a very calming effect to some people.
> > > > > > > I had been taking pindolol every day with the Klonopin, and found it added a very nice dimension. However, I had to stop taking it, because once I successfully shed 60 pounds the beta blocker made my blood pressure too low. Also, they can cause some fatigue, especially when taken on an as-needed basis.
> > > > > > >
> > > > > > > Of course, you must talk to your doctor, and make sure any combo you take isn't likely to cause unsafe interactions. That said, I'm shocked at how many doctors (at least in this country) both fail to identify potentially dangerous interactions AND claim that some drugs shouldn't be combined when the combination can be perfectly safe and beneficial. I've successfully challenged doctors on such matters several times, armed with info from the net (official monographs,
> > > > > > > articles or Medline abstracts from respected medical journals, drug-interaction dictionaries, and posts from patients).
> > > > > > >
> > > > > > > Good luck to you, and let us know how things work out. If you don't get any further responses form this thread, why not try starting a new thread? There may be some people who never make it to this thread, but who are successfully
> > > > > > > dealing with a combo of challenges which are very similar to your own. In fact, I wish Dr. Bob allowed the subject headings to be longer (read: more detailed) to catch the eye of more readers who have the most relevant advice or experiences to share!!
> > > > > > >
> > > > > > > Say "Hi" to my Aussie uncle for me! Hint: He used to host a popular TV news-magazine there, although if you're young you might not remember it. Oh, and he has an American accent.
> > > > > > >
> > > > > > > Rick
> > > > > > >
> > > > > > > ------
> > > > > > > > Hi Rick
> > > > > > > > I hope you don't mind me posting a request for your knowledgeable feedback about my meds cocktail. I'm diagnosed with borderline personality disorder, i suffer from intermittent extreme rage, complete lack of motivation, depression, social phobia especially with public speaking which has held me back from achieving so much. I have had to quit Uni because of my phobia. I have been on Paxil 20mg and Imovane(zopiclone hydrochloride) to help me sleep 15mg. My psychiatrist has recently put me on depakote to regulate my moods and anger outbursts but I,m worried it worsens my depression which I think it is but it's hard to tell, it's only been 1 month. I'm on 400mg in the morning and 600mg at night. I feel I need to tackle the phobia and depression more than anything else in order to get ahead in life and I'm interested in the meds you mentioned. I am in Australia, do you know if they are available here? Could you please tell me what you think as I value your opinion after reading your other posts! By the way, I totally agree with your views on Paxil withdrawals- absolutely terrifying! and they told me it was non- addictive, yeah right.
> > > > > > > > Look forward to your reply
> > > > > > > > Take care
> > > > > > > > >
Posted by rick_number1001@yahoo.com on August 18, 2001, at 21:53:34
In reply to Re-Andre #4:SOC PHOBIA COCKTAIL--WOW!!: Survey..., posted by Rick on June 12, 2000, at 0:30:55
I just wanted to add to this that I have
found Klonopin to be the single most effective
medication I have taken for my 'very severe'
(if untreated) case of SP.I have taken Klonopin regularly for over 4 years.
The first 3 years I tried with a number of
different antidepressants but it worked best
with Nardil (45-60mg) and K at 4.5mg, and also
with Zoloft 50mg + Serzone 300mg + K 4.5mg.The Nardil Klonopin combo is one I stayed on at
the above doses for 2 years. However I noticed
that my technical learning skills seemed lesser
than they were. Had I had a different kind of
jt would not have mattered but I needed very good
mental sharpness. Motivation also slipped for me
some over time.After 3 years at 4.5mg Klonopin, I had little
trouble reducing it down to 0mg (for 2 days). I
tapered at a rate of 1.0mg per week until I was
at 2mg/day. This was easy, only part of the time
I added 100-200mg Serzone during taper. 2mg to
1mg caused some anxiety (still a very fast taper
at 1mg/week). I added gabapentin and serzone and
got by fine, continuing to work as my professional
job and so on.
The last week I tried 1.0 to 0.0. As I suspected
this was harder and I really needed more than a
week to do it right. After 2 days I went back up
to 1.0. I then decided that 2.0 was working pretty
well and my congination and energy were up.
Eventually I went to 2.5 plus 100-200 Serzone
with Nardil, sometimes 100mg Wellbutrin (caused
hair loss so I stopped but worked nice).
I tried Provigil and loved it.
For 4 months I took Nardil 60 + Klonopin 2.5
+ Provigil 100 + Serzone 100-200.
It worked pretty well with little side effects.Looking over drug diary I noted that my initial
weeks WITHOUT Serzone I was more upbeat. I dropped
Serzone and for 2-3 months have been with:Nardil 60mg + Klonopin 2.5-2.75 + Prov 75-100.
I like it! On this combo I get good treatment of
symtoms with good cognitive function, good energy,
and little side effects; primarily I notice I average
only 5 to 5.5 hours sleep a night. A little low,
but in the last 8 years I probably averaged 6 - 6.5
so it is not far off.BTW, I decided to put up a website and it is at
www.socialfear.com
I would welcome any feedback or comments on
the website or this post.Thanks much - great posts here on some novel
agents that few have tried.Now if the doctors can only get some things
traight!... :) (just kidding docs).Craig
Then
> (part 4 of ??)
>
> BTW, How much WERE you taking during those presentations?
>
> Sorry if I'm over-reacting, but when I hear all those myths and stern warning about the dangers of benzos, it really hits my hot button. A recent large-scale survey in Medscape showed that even doctors -- especially General Practitioners -- tended to harbor multiple misconceptions and unsupported fears about this very safe and effective class of medications. Believe me, I'd prefer to need no meds at all, but if I continue to need them I am perfectly happy to stay on Klonopin indefinitely, and my psychiatrist (practicing since 1979) has no problem with it either. He says that as long as I don't exceed 3.0 mg in one day, any withrawal difficulties would be highly unlikely (and my previously-mentioned unintential 2-week cold turkey withdrawal would seem to support that). He admittedly feels AD's are preferable in cases where they provide the patient an equal level of relief. I may someday gradually cut back on the Klonopin just to see what happens, but as I said I have no problem sticking with it as long as it provides consistent, high-level Social Phobia relief.
>
> O.K., I'll get off my soapbox now. In fact, I will have to *force myself* not to respond to further posts specifically regarding benzo safety (even if the poster is agreeing with me), because the notorious benzo debates can go on forever and become way too time-consuming. I've already spent way too much time posting today, especially when I have to post repeatedly to get it all in (what IS this cyber-malady, anyways??) I'll make an exception to my no-more-posts-about-benzo-safety vow if it's something I can respond to in a few sentences.
>
> Sorry for over-babbling on this one Andre, and thanks again for your response.
>
> Rick
>
> --------
> The reasone why clonazepam (klonopin) has worked for you is probably
> because you get "buzzed" off of it. I take clonazepam when I have to do a speech. Some times it dulls my mental capacity so much that I b
This is the end of the thread.
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