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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 33. This is the beginning of the thread.
Posted by sar on April 19, 2001, at 1:25:36
Have you got one?
If the drug also helped with depression & generalized anxiety, that would be even better.
(and do you happen to know of one that *really* doesn't cause weight gain?)
I'm doing my research but I want to hear it from the people. :)
thanks in advance,
sar
Posted by SalArmy4me on April 19, 2001, at 1:28:02
In reply to favorite drug for social anxiety..., posted by sar on April 19, 2001, at 1:25:36
I thought of Serzone as a possibility.
> Have you got one?
>
> If the drug also helped with depression & generalized anxiety, that would be even better.
>
> (and do you happen to know of one that *really* doesn't cause weight gain?)
>
> I'm doing my research but I want to hear it from the people. :)
>
> thanks in advance,
> sar
Posted by Miss Amy on April 19, 2001, at 1:52:45
In reply to Re: favorite drug for social anxiety..., posted by SalArmy4me on April 19, 2001, at 1:28:02
Serzone has helped my anxiety greatly. Has reduced my depression by lots too. I think the drug helped me get off my ass and follow my passions which also helps me with depression. My all time fave for social anxiety is alcohol of course : )---but that creates a vicious cycle of ups and downs and DOES make you gain weight, so rule that one out! Plus it is nasty poison nastiness. Since I started the serzone I no longer medicate myself with alcohol. I also have gained a few slight pounds (5--no biggie since I feel better!) but I think that's because I AM feeling better and my appetite has increased. That's just me, not the meds. Watching what I eat and exercising has already helped me drop three pounds. Good luck!
Posted by vlvtelvis on April 19, 2001, at 2:35:13
In reply to favorite drug for social anxiety..., posted by sar on April 19, 2001, at 1:25:36
Paxil @ 40 mgs worked pretty well. Right now I'm on 30mgs celexa and that seems to be doing ok for most depression SP and anxiety issues. If i have to give a presentation or speak before a crowd, I'll take .5 mgs klonopin 45mins to an hour ahead of time.
Some people with SP swear by the MAOI's Parnate and Nardil, but it's my natural inclination to like cheese more than people to begin with, so I'd rather give up all human contact than give up cheese as is required with most MAOI's.
Cognitive Behavioral Therapy (CBT) can be very effective if you can find someone well trained in the use of it for SP. I'm usualy a skeptic when it comes to therapy, but this works.
good luck
> Have you got one?
>
> If the drug also helped with depression & generalized anxiety, that would be even better.
>
> (and do you happen to know of one that *really* doesn't cause weight gain?)
>
> I'm doing my research but I want to hear it from the people. :)
>
> thanks in advance,
> sar
Posted by Alan on April 19, 2001, at 8:03:43
In reply to favorite drug for social anxiety..., posted by sar on April 19, 2001, at 1:25:36
> Have you got one?
>
> If the drug also helped with depression & generalized anxiety, that would be even better.
>
> (and do you happen to know of one that *really* doesn't cause weight gain?)
>
> I'm doing my research but I want to hear it from the people. :)
>
> thanks in advance,
> sarAtivan/Neurontin - great combo.
I think the benzos such as Klonopin are most prescribed for SAD and that for a large part of the population, AD's exacerbate the anxiety - especially in more severe cases. I always think benzos are the first line of defense for anything purely anxiety driven.
Just my opinion.
Alan
Posted by jimmygold70 on April 19, 2001, at 9:13:30
In reply to Re: favorite drug for social anxiety..., posted by Alan on April 19, 2001, at 8:03:43
My algorithm - GAD+SP
1. SSRI (Celexa is my favorite) for 2 months
2. Doesn't work - raise the dose to the MAX
3. Didn't work as well, wait for a month
4. Partial response - Add buspirone up to 60mg/day
5. Insufficient response: Swith to Effexor
6. Partial response - raise dose to the MAX
7. Insufficient response - Switch to Klonopin
8. Insufficient response to Klonopin - switch to Nardil, up 90mg/day
9. Too many side effects on Nardil (though full response) - Swith to Manerix / Aurorix
10. Too many side effects Klonopin (though full response) - Swith to Nerontin
11. No or little response to the above - RECONSIDER DIAGNOSIS OF SOCIAL PHOBIANote that there is no perfect treatment for Social Phobia. The more severe condition you are in, the more response you're gonna get. 30% reduction in symptoms is fair.
Also, many other conditions occur with or mimic Social Phobia: Avoidant/Schizoid PD, Borderline PD (!), PTSD to name a few.
My 2 cents.Jimmy
Posted by Miss Amy on April 19, 2001, at 9:57:14
In reply to Re: favorite drug for social anxiety..., posted by Miss Amy on April 19, 2001, at 1:52:45
i saw someone had suggested Paxil in this thread; I hear that it works great for anxiety---both my aunt and a good friend of mine took it and gained 40 pounds and 30 pounds, repectively---plus the side effects of coming off were horrible. Someone else also suggested cognitive therapy--I went that route and within three days of my first session I forced myself to go to a concert 500 miles a way! I had not left the state in two years and i felt a great accomplishment! I learned some coping skills and wanted to test them out--and they worked! If you are dedicated and trusting therapy can really work. Good luck!
Posted by jimmygold70 on April 19, 2001, at 13:32:09
In reply to Re: favorite drug for social anxiety..., posted by Miss Amy on April 19, 2001, at 9:57:14
CBT is effective for many people, but CBT+Drug therapy is even more effective !
> i saw someone had suggested Paxil in this thread; I hear that it works great for anxiety---both my aunt and a good friend of mine took it and gained 40 pounds and 30 pounds, repectively---plus the side effects of coming off were horrible. Someone else also suggested cognitive therapy--I went that route and within three days of my first session I forced myself to go to a concert 500 miles a way! I had not left the state in two years and i felt a great accomplishment! I learned some coping skills and wanted to test them out--and they worked! If you are dedicated and trusting therapy can really work. Good luck!
Posted by mikes on April 19, 2001, at 18:36:32
In reply to Re: favorite drug for social anxiety..., posted by vlvtelvis on April 19, 2001, at 2:35:13
I think CBT would work pretty well. I took St. John's Wort and it made my social phobia and anxiety go away. But even when the St. John's Wort stopped working, the social phobia was still gone. I think I learned that I could be more confident socially.
The anxiety still remained, however.
Posted by Miss Amy on April 19, 2001, at 19:33:25
In reply to Re: favorite drug for social anxiety..., posted by mikes on April 19, 2001, at 18:36:32
Yeah, my anxiety never TOTALLY went away after therapy--but it did become more managable. A lot more. I did the CBT about 3 years ago and finally went on meds in December. Not for panic, but for depression. (But panic is side effect of depression blah blah blah : ) I have not had a full scale panic attack in years now, and I feel I owe that to the CBT---BUT like meds, therapy is different for everybody too. You kind of have to go your own route and see what works best for you. I think we can all agree on that! : )
Posted by kate9999 on April 20, 2001, at 3:18:37
In reply to Social Phobia - Jimmy's Algorithm, posted by jimmygold70 on April 19, 2001, at 9:13:30
I don't know if I'd wait so long to try Nardil - particularly if you're talking severe generalized sp, (or especially with atypical depression).
Also if Nardil side effects are too much, maybe switch first to Parnate - my experience was though I had side effects with both, they were very different side effects, so it would be worth the switch - since I think the RIMAs are maybe less effective.
> My algorithm - GAD+SP
>
> 1. SSRI (Celexa is my favorite) for 2 months
> 2. Doesn't work - raise the dose to the MAX
> 3. Didn't work as well, wait for a month
> 4. Partial response - Add buspirone up to 60mg/day
> 5. Insufficient response: Swith to Effexor
> 6. Partial response - raise dose to the MAX
> 7. Insufficient response - Switch to Klonopin
> 8. Insufficient response to Klonopin - switch to Nardil, up 90mg/day
> 9. Too many side effects on Nardil (though full response) - Swith to Manerix / Aurorix
> 10. Too many side effects Klonopin (though full response) - Swith to Nerontin
> 11. No or little response to the above - RECONSIDER DIAGNOSIS OF SOCIAL PHOBIA
>
> Note that there is no perfect treatment for Social Phobia. The more severe condition you are in, the more response you're gonna get. 30% reduction in symptoms is fair.
>
> Also, many other conditions occur with or mimic Social Phobia: Avoidant/Schizoid PD, Borderline PD (!), PTSD to name a few.
> My 2 cents.
>
> Jimmy
Posted by SalArmy4me on April 20, 2001, at 3:56:18
In reply to Re: Social Phobia - Jimmy's Algorithm, posted by kate9999 on April 20, 2001, at 3:18:37
Posted by KarenB on April 20, 2001, at 14:23:35
In reply to favorite drug for social anxiety..., posted by sar on April 19, 2001, at 1:25:36
sar,
Yes - Sulpiride. It's not available in the US but you can get it mailorder from Europe. Combined with a psychostimulant, it is "the bomb".
It can cause weight gain but with the combination I mention, you'll have enough energy to exercise and keep it off.
Karen
Posted by sar on April 21, 2001, at 2:55:53
In reply to Re: favorite drug for social anxiety... » sar, posted by KarenB on April 20, 2001, at 14:23:35
Hi everyone,
Thanks for responding. It's good to hear about some people finding some relief from this problem. I've had some CBT but found it fairly beingn in terms of *feeling*--meaning, I no longer jump to catastrophic conclusions about situations and my behavior is better because of that--but the feeling of anxiety remains still.
Karen--how do you go about ordering Sulpiride? On the net? Any idea why it hasn't been approved in the US? What exactly is a psychostimulant?
I know that no one wants to gain weight from meds, but I've had some eating disordered behavior in the past & any weight gain would turn into kind of a mess for me, I just want to avoid one problem agitating another.
thanks again for the input, everyone.
sar
Posted by jimmygold70 on April 21, 2001, at 9:02:25
In reply to Re: Social Phobia - Jimmy's Algorithm, posted by kate9999 on April 20, 2001, at 3:18:37
I would wait longer for Nardil. It should be reserved as a third line therapy. Side effects on Naril are so severe for some people, that they might cease all drug treatments forever. My personal experience was negative, and most physicians would agree that it should be reserved as a third line.
Also, one might yry a nonselective SRI (clomipramine) before Nardil. It is very potent. Also, I believe that some of the positive effects of Nardil are from its anticholinergic activity, which clomipramine has planty of.
Jimmy
> I don't know if I'd wait so long to try Nardil - particularly if you're talking severe generalized sp, (or especially with atypical depression).I haven't thought of that. A good idea. We don't have Parnate sold around here, but it is a sound option. RIMAs are less effective, that's true.
> Also if Nardil side effects are too much, maybe switch first to Parnate - my experience was though I had side effects with both, they were very different side effects, so it would be worth the switch - since I think the RIMAs are maybe less effective.
> > My algorithm - GAD+SP
> >
> > 1. SSRI (Celexa is my favorite) for 2 months
> > 2. Doesn't work - raise the dose to the MAX
> > 3. Didn't work as well, wait for a month
> > 4. Partial response - Add buspirone up to 60mg/day
> > 5. Insufficient response: Swith to Effexor
> > 6. Partial response - raise dose to the MAX
> > 7. Insufficient response - Switch to Klonopin
> > 8. Insufficient response to Klonopin - switch to Nardil, up 90mg/day
> > 9. Too many side effects on Nardil (though full response) - Swith to Manerix / Aurorix
> > 10. Too many side effects Klonopin (though full response) - Swith to Nerontin
> > 11. No or little response to the above - RECONSIDER DIAGNOSIS OF SOCIAL PHOBIA
> >
> > Note that there is no perfect treatment for Social Phobia. The more severe condition you are in, the more response you're gonna get. 30% reduction in symptoms is fair.
> >
> > Also, many other conditions occur with or mimic Social Phobia: Avoidant/Schizoid PD, Borderline PD (!), PTSD to name a few.
> > My 2 cents.
> >
> > Jimmy
Posted by jimmygold70 on April 21, 2001, at 9:10:38
In reply to Did you all see the Harvard Depression Algorithym?, posted by SalArmy4me on April 20, 2001, at 3:56:18
Excellent !
http://www.mhc.com/Algorithms/Depression/index.htm
Posted by KarenB on April 21, 2001, at 11:34:24
In reply to Re: favorite drug for social anxiety..., posted by sar on April 21, 2001, at 2:55:53
> Karen--how do you go about ordering Sulpiride? On the net? Any idea why it hasn't been approved in the US? What exactly is a psychostimulant?
sar,
I think Farmacia Cerati is your best bet - try the name with a .com or do a search. I know AndrewB and SLS know the address if that fails. All I can say is it worked for me. I was in the Philippines with no psychiatric help and was given a list of "things to try." There, it was available over the counter.
You may do best to run off a comprehensive information sheet about it from the Web and give it to your doc and ask that he/she write a script for you, that you can have on hand in case customs gives you a hard time. You can order three months supply at a time, this way but of course you'll want to try it first. It is fast acting, so you don't have to wait three to six weeks to see if it's going to work. I knew the first week.
Most (some?) docs would be willing to sign a script for an overseas drug along with a disclaimer, stating no responsibility if you have a bad reaction. Sulpiride has been in use in Europe for decades and I had no bad side effects whatsoever. There is a bit of weight gain possible, but when on it, with Amineptine, I had more energy than I have ever had in my life and was on a regular exercise program. I was more sane than I ever remember, as well.
Amineptine (a psychostimulant) sadly, after being in use for years in Europe, was discontinued for "possibility of abuse." I never took more than the recommended dose and had no desire to do so, so I don't know what they are talking about. I was getting it, along with the Sulpiride, shipped to me from the Philippines with a script from my doctor there. I have found nothing like that combo since.
A possible addition with the Sulpiride, since Amineptine is not available, is Adderall or Ritalin (I don't like Ritalin but it works well for some). Or, I am thinking, Lamictal, because of it's reputation as an activating mood stabilizer, with some antidepressant action. An activating mood stabilizer, along with Sulpiride, which is an anti-anxiety, neuroleptic (anti psychotic when used in high doses) may be just the ticket BUT I am not a doctor. Ask your doctor first. If they are offended by your desire to get involved with your recovery, FIND SOMEONE ELSE. It's hard to start over, but I recently did and my new doc is a Godsend. Great docs are as hard to find as great teachers. How many truly gifted teachers do YOU remember from school?
I was diagnosed here in the States, by a specialist, with Bipolar Disorder. You may, after unsuccessful trials, want to see someone like that. I don't know where you are but if you are anywhere near Denver, CO, Dr. Steven Dubovsky of the University of Colorado, is very good.
Hope you find something that works for you, soon. Very soon.
Karen
Posted by Leighwit on April 21, 2001, at 12:32:24
In reply to Did you all see the Harvard Depression Algorithym?, posted by SalArmy4me on April 20, 2001, at 3:56:18
Thanks very much for posting the link. Very useful on a number of levels!
LBW
> http://www.mhc.com/Algorithms/Depression/index.htm
Posted by JahL on April 22, 2001, at 0:20:15
In reply to Re: favorite drug for social anxiety..., posted by Alan on April 19, 2001, at 8:03:43
> Ativan/Neurontin - great combo.Hi Alan.
Can you tell me what dose of Neurontin you take? Thanx.~
Sar,
Karen's recommendation of Sulpiride is a good one; it has consistently controlled (tho' not cured) my s.p. for over a year now. None of the other suggestions (except Paxil/Prozac briefly) have worked for me (tho' are all valid in their own right). It's pretty fast-acting & you shld determine its effectiveness within days. Low dose=few side-effects. Farmaciacerati are excellent.You might also want to consider Amisulpride, a sister compound which a few on this board have had good success with.
I've said it b4; I don't believe any therapy will *cure* (as in achieve complete remission) severe s.p., tho' it will support you in dealing (whatever that means) with the various issues & symptoms.
Come 2 a decision yet?
J.
Posted by mikes on April 22, 2001, at 19:18:26
In reply to favorite drug for social anxiety..., posted by sar on April 19, 2001, at 1:25:36
sodium oxybate ;)
> Have you got one?
>
Posted by sar on April 23, 2001, at 0:17:59
In reply to Re: favorite drug for social anxiety..., posted by mikes on April 22, 2001, at 19:18:26
I just checked xxx but couldn't find a meds section...but half the site is currently under construction. I'll check back tomorrow.
Karen...thanks for the specialist recommendation, that may be what I need. I hope yall will forgive my incessant questions, but I'm new to the meds/pdoc game and I'm not well educated about drugs, finding good specialists, etc. I've put it off for a long time, largely because of my fear and distrust in psychiatry.
my social anxiety has not been diagnosed as severe, I would guess that it's moderate...just wanted to clarify that because some of the posts mentioned "severe sp." But who knows? Anyway, it's become a primary concern with me because sp and depression seem to feed off one another quite hungrily, and sp seems more easily treatable (maybe).
Jah...thanks. I'm going to discuss Neurontin, Nardil, gabapentin, lamictal, Sulpiride, and klonopin as soon as I can see a doctor...which will hopefully be tuesday. I read one of your threads on another post and hope that you're feeling better and taking care of yourself.
mikes... :) where do you obtain your ghb and how does it feel? do you find it addictive?
lemme toss another question out...how do these drugs make you feel physically? What symptoms do you find Sulpiride (or whichever other sp drug) most successfully relieves?
thanks again,
sar
Posted by Alan on April 23, 2001, at 8:15:08
In reply to Re: social anxiety...SAR. » Alan, posted by JahL on April 22, 2001, at 0:20:15
>
> > Ativan/Neurontin - great combo.
>
> Hi Alan.
> Can you tell me what dose of Neurontin you take? Thanx.
> J.Yes J.
It waxes and wanes (over several weeks, not days) between 300MG and 600MG. Why you ask?
I use it to moderate the effect of Ativan fluctuating in my system with which I self medicate according to situational anxiety (performance anxiety).
The ativan fluctuates anywhere from 3 to 6 MG depending on the performance situation on a weekly basis. To enhance mood stability I came up with the idea of balancing it with neurontin, using it in tandem with the ativan flux. Decrease Ativan = increase neurontin, etc.
My psychopharmocologist thought it was a great idea especially since it worked! I had been through 10 years of refining, experimenting, etc and after trying everything but MAOI's I decided that this combo provided me with the most liveable in side effects compared to anything else....and I mean everything else....
The only drawback with the ativan is some short term memory loss - but it's not too bad. REM sleep brainwave disruption for me at 5-6 MG ativan so increasing neurontin especially at night helps me sleep better.
Any suggestions, comments?
Alan
Posted by JahL on April 23, 2001, at 11:38:25
In reply to Re: favorite drug for social anxiety..., posted by sar on April 23, 2001, at 0:17:59
> > I just checked xxx but couldn't find a meds section...but half the site is currently under construction. I'll check back tomorrow.
Try this:
xxx
> > Jah...thanks. I'm going to discuss Neurontin, Nardil, gabapentin, lamictal, Sulpiride, and klonopin as soon as I can see a doctor...which will hopefully be tuesday. I read one of your threads on another post and hope that you're feeling better and taking care of yourself.Thanks. Just riding out the storm;-)
> > lemme toss another question out...how do these drugs make you feel physically? What symptoms do you find Sulpiride (or whichever other sp drug) most successfully relieves?Sar, the Sulpiride helps with all the s.p. symptoms equally (tho' not completely). Paranoid convictions (that you're the object of other's attn) & inner panic are mitigated, as are physical symptoms such as palpitations & adrenaline rushes. I feel calmer & more @ ease with people.
I think people mention 'severe' s.p. because it's more likely to be TR & so sufferers are attracted to this brd. The fact that yours is 'only' moderate, I think, increases the odds of successful resolution with meds. However I'm not so sure s.p. is more easily treatable (than depr.). For one thing there's a paucity of rsch concerning it compared to depression.
Let us know how it goes on Tuesday (&, if he hasn't already, don't be surprised if yr doc pushes an SSRI-std treatment-on you!)
J.
Posted by KarenB on April 23, 2001, at 11:54:12
In reply to Re: favorite drug for social anxiety..., posted by sar on April 23, 2001, at 0:17:59
> lemme toss another question out...how do these drugs make you feel physically? What symptoms do you find Sulpiride (or whichever other sp drug) most successfully relieves?
sar,
I get this feeling of bodily "heaviness," when I am depressed. Like I can't move, as if every muscle in my body is fatigued and, well, heavy. I really think Sulpiride helped with that. But, it was taken with a stimulant (which did not work well for me on it's own) so I think the two had a synergistic effect.
Karen
Posted by JahL on April 23, 2001, at 12:15:44
In reply to Re: social anxiety...SAR. to JahL, posted by Alan on April 23, 2001, at 8:15:08
> > > Ativan/Neurontin - great combo.> > Can you tell me what dose of Neurontin you take?
> It waxes and wanes (over several weeks, not days) between 300MG and 600MG. Why you ask?
Similar reason to below. I'm about to add Neurontin to my ineffective Lamictal, primarily to combat social phobia/generalised anxiety. I'm interested in what doses are working for s.p.; most of the available info concerns itself with dosing for epilepsy.
*Theoretically* the Neurontin cld also help with my depression/ADD/depersonalisation.
> The ativan fluctuates anywhere from 3 to 6 MG depending on the performance situation on a weekly basis. To enhance mood stability I came up with the idea of balancing it with neurontin
> My psychopharmocologist thought it was a great idea especially since it worked! I had been through 10 years of refining, experimenting, etc and after trying everything but MAOI's I decided that this combo provided me with the most liveable in side effects compared to anything else....and I mean everything else....
Nice to see some of us come out the other side!
> The only drawback with the ativan is some short term memory loss - but it's not too bad. REM sleep brainwave disruption for me at 5-6 MG ativan so increasing neurontin especially at night helps me sleep better.
> Any suggestions, comments?I'm a little new to the AED side of things. AlI I can tell you is that the rec'd Neurontin dose for depression/anxiety seems to be 900-2000mg (& in some cases up to 4800mg!). I wonder if slightly increasing the Neurontin wld allow a further Ativan reduction. I take Klonopin for Lamictal-induced, & endogenous, insomnia, & can relate to the (ST) memory problems you rpt.
A couple of studys have shown Neurontin not to impair cognitive ability (unlike say, Topiramate).
Thanks,
J.
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