![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by k23d on September 19, 2002, at 23:10:07
Posted a while back on my treatment with paxil, disatisfaction with SE and what my thoughts were regarding future treatment. This is a quick follow up for those that are interested.
I've been generally socially anxious since as early age as I can remember and phobic (with panic) for about the past 12 years (27yo now). Realised what it was about 3 years ago.
I've done a group CBT approach for 9 mnths and still continue this on an ongoing basis one on one.
I got my first pdoc about 2 months ago when I wasn't happy with gp prescribed paxil and it's SE. Firstly the pdoc refused to ever consider treatment with BZD. He even didn't want me taking beta blockers for phobic situations given the psychological dependence...
He moved me to remeron 30mg at night and I gotta tell you that for the first month it was a miracle drug. I was socially outgoing, had no panic in phobic situations, had zero procrastination, was motivated and I slept well for the first time in years too.
SE were initially weight gain and high level of aggitation. I snapped at everything. But both of these went away after about 3 weeks.
For the past two weeks it has slowly lost effect on me and now only helps with a general level of sociability (Which is positive). However phobic situations have rebounded with a vengeance as has procrastination.
I've asked my gp to refer me to an anxiety specialist who isn't afraid of benzos. I'm going to give clonazepam twice daily (potentially together with the remeron at night) a try if someone will give it to me.
BTW, paxil worked a treat for me although some situations were still quite high anxiety whise. However the apathy, lack of orgasm, feeling drugged and the appetite of a bull were too much to cope with.
Anyway, there's my story to help anyone else who's on the boat. Comments appreciated re any other methods of success ppl have had.
K23d
Posted by utopizen on September 20, 2002, at 0:02:24
In reply to Paxil - Remeron - Clonazepam Social Anxiety, posted by k23d on September 19, 2002, at 23:10:07
Klonopin is great in treatment-resistant patients... but I'm personally seeing benefits in trying as many drugs as I can before resorting to them. And I've been trying different meds for social anx. for a year now.
It's a *good* thing if you could ever find a med that worked consistently before trying klonopin. I know you're anxious about curing your anxiety, but klonopin isn't a miracle drug because it only lasts for the time you take it- it's not like it re-wires your brain or anything.
Try Neurontin if you can... if you try a high enough dose (I try 1600 sometimes at once) it may really help you find a thing that's non-addictive.
Then your doctor might say, "Okay, if you're willing to work with me that way, I'd be happy to give you take as needed doses of klonopin each month for emergencies." My doctor sometimes gives me 15 .5mg pills, although it seems like that depends on what his mood is that day...
Hang in there! : ) If you're afraid you're not being treated quickly enough, maybe you could also say to your doctor "if I try this pill for a trial, could I take some klonopin while I wait to see if it kicks in?"
I'm sure if you work with your doctor in this way, he'll seem more accomodating. I like to think of Klonopin as an emergency axe, not a cane... but I understand how others can view different philosophies with it... I do understand how it feels to being socially anxious and not get the magical cure the Paxil ad promised before you searched for your doctor.
> Posted a while back on my treatment with paxil, disatisfaction with SE and what my thoughts were regarding future treatment. This is a quick follow up for those that are interested.
>
> I've been generally socially anxious since as early age as I can remember and phobic (with panic) for about the past 12 years (27yo now). Realised what it was about 3 years ago.
>
> I've done a group CBT approach for 9 mnths and still continue this on an ongoing basis one on one.
>
> I got my first pdoc about 2 months ago when I wasn't happy with gp prescribed paxil and it's SE. Firstly the pdoc refused to ever consider treatment with BZD. He even didn't want me taking beta blockers for phobic situations given the psychological dependence...
>
> He moved me to remeron 30mg at night and I gotta tell you that for the first month it was a miracle drug. I was socially outgoing, had no panic in phobic situations, had zero procrastination, was motivated and I slept well for the first time in years too.
>
> SE were initially weight gain and high level of aggitation. I snapped at everything. But both of these went away after about 3 weeks.
>
> For the past two weeks it has slowly lost effect on me and now only helps with a general level of sociability (Which is positive). However phobic situations have rebounded with a vengeance as has procrastination.
>
> I've asked my gp to refer me to an anxiety specialist who isn't afraid of benzos. I'm going to give clonazepam twice daily (potentially together with the remeron at night) a try if someone will give it to me.
>
> BTW, paxil worked a treat for me although some situations were still quite high anxiety whise. However the apathy, lack of orgasm, feeling drugged and the appetite of a bull were too much to cope with.
>
> Anyway, there's my story to help anyone else who's on the boat. Comments appreciated re any other methods of success ppl have had.
>
> K23d
Posted by anxiousgrrrl on September 20, 2002, at 0:28:15
In reply to Paxil - Remeron - Clonazepam Social Anxiety, posted by k23d on September 19, 2002, at 23:10:07
In my experience, klonopin has been great for social anxiety. I was really worried about the dependency issue since I tend to have problems with addiction (nicotine, caffeine). My pdoc swore up and down that if there was a legimate need for the drug I would NOT become addicted. And I haven't. I've gone through spells when I would take it daily, but mostly it's just as-needed, professional conferences at the top of the list.
My pdoc assured me there was no danger of addiction if used properly. And, klonopin has a longer effect and more mellow onset and exit, unlike Xanax and Valium.
Finally, Remeron seems an odd choice... another SSRI would have probably been better for social anxiety.
You sure your pdoc is competent? Didn't do her residency at some podunk school? I've never heard of a pdoc who is afraid of benzos....
Posted by k23d on September 20, 2002, at 0:37:00
In reply to Re: Paxil - Remeron - Clonazepam Social Anxiety » k23d, posted by anxiousgrrrl on September 20, 2002, at 0:28:15
> Finally, Remeron seems an odd choice... another SSRI would have probably been better for social anxiety.
>
> You sure your pdoc is competent? Didn't do her residency at some podunk school? I've never heard of a pdoc who is afraid of benzos....
>Thanks for your reply. It's good to hear feedback along the same lines of thought I was having. Gives me strength to press on with it.
As for why remeron - I was given a choice of effexor xr or remeron. I wasn't keen on the effexor due to negative things i'd read about it and that was the only choice I was given.
He certainly seems to know his stuff and he graduated from the top medical school in australia. He did his residency at an anxiety research clinic that did outpatient drug & alcohol services. In his words he spent most of his first few years in medicine weaning people off xanax and valium addictions.
I see his viewpoint and can emapathise with his concerns. I just don't care to work with someone who's not open to all the options.
BTW My gp is very understanding, open about not knowing the story and is seeking other options for me.
K23d
Posted by Roo on September 20, 2002, at 8:55:21
In reply to Paxil - Remeron - Clonazepam Social Anxiety, posted by k23d on September 19, 2002, at 23:10:07
Sorry this isn't an answer to your post....I'm just
curious about the Remeron...how much weight did you
gain? And you say it stopped after awhile? You said Paxil
gave you the appetite of a bull, but didn't Remeron?
Any sexual side effects with Remeron?
Posted by Rick on September 20, 2002, at 10:33:28
In reply to Paxil - Remeron - Clonazepam Social Anxiety, posted by k23d on September 19, 2002, at 23:10:07
My experience mirrors anxiousgrrl's. Except for some possibe memory lapses, Klonopin has been nothing but a BIG success for my social phobia. Overall, I've had at least a 75-80% improvement over my pre-Klonopin days (why didn't I discover it sooner??!!) I have no side effects except good ones. (E.g., the longtime chronic low-level facial pain that I thought might be TMJ unexpectedly disappeared after I started Klonopin. It took me awhile to make the connection. I later found a study verifying this effect.)
Nothing -- not even Nardil, and certainly not Paxil -- has shown higher response rate vs double-blind placebo in social phobia than clonazepam.
If you're not depressed, don't bother with an AD and the side effects + poop-out. I've experimented with adding other agents to Klonopin (instead of the other way around), and some have indeed added a nice dimension (esp. Klonopin + Serzone + low-dose Provigil), but Klonopin is always the key. It MUST be taken regularly for the best benefit. And realize that a lower dose can often work *a lot* better than more. I started at 3 mg/day three+ years ago, and have gradually tapered to 1 mg, all first thing in the morning. (I used to taked divided doses. Don't take it at bedtime. Taking it in the morning will still alleviate evening insomnia without possible morning grogginess, and it will be at highest levels in your bloodstream when you need it most for social interaction.) That's all I've needed for the last eighteen months. My pdoc also said that I won't have trouble should I ever decide to taper off, as long as I stick to 3mg/day or less.
BYTW, there is evidence that Klonopin *can* have some lasting benefits, as detailed in the attached abstract.
Pursue this.
Rick
From: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9790154&dopt=Abstract
J Clin Psychopharmacol 1998 Oct;18(5):373-8
Discontinuation of clonazepam in the treatment of social phobia.Connor KM, Davidson JR, Potts NL, Tupler LA, Miner CM, Malik ML, Book SW, Colket JT, Ferrell F.
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
Patients with social phobia who responded well to 6 months of open-label treatment with clonazepam were assigned to receive either continuation treatment (CT) with clonazepam for another 5 months, or to undergo discontinuation treatment (DT) using a clonazepam taper at the rate of 0.25 mg every 2 weeks, with double-blind placebo substitution. Clinical efficacy was compared between the CT and DT groups using three different social phobia scales. Benzodiazepine withdrawal symptoms were also measured. Relapse rates were 0 and 21.1% in the CT and DT groups, respectively. Subjects in the CT group generally showed a more favorable clinical response at midpoint and/or endpoint, although even in the DT group clinical response remained good. With respect to withdrawal symptoms, the rates were low in both groups (12.5% for CT and 27.7% for DT) with no real evidence suggesting significant withdrawal difficulties. At the end of 11 months of treatment with clonazepam, however, a more rapid withdrawal rate was associated with greater distress. This study offers preliminary evidence to suggest that continuation therapy with clonazepam in the treatment of social phobia is safe and effective, producing a somewhat greater clinical benefit than a slow-taper discontinuation regime. However, even in the DT group, withdrawal symptoms were not found to be a major problem. The study can be taken as supportive of benefit for longterm clonazepam treatment in social phobia, as well as being compatible with a reasonably good outcome after short-term treatment and slow taper.
Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 9790154 [PubMed - indexed for MEDLINE]
Posted by cosis on September 20, 2002, at 11:00:58
In reply to Paxil - Remeron - Clonazepam Social Anxiety, posted by k23d on September 19, 2002, at 23:10:07
Nardil has worked wonderful for my social anxiety, I have tons of energy also... I would considered myself server social anxiety, it took about 4 weeks to kick in....
Posted by k23d on September 21, 2002, at 4:01:37
In reply to Re: Paxil - Remeron - Clonazepam -- k23d, posted by Roo on September 20, 2002, at 8:55:21
> Sorry this isn't an answer to your post....I'm just
> curious about the Remeron...how much weight did you
> gain? And you say it stopped after awhile? You said Paxil
> gave you the appetite of a bull, but didn't Remeron?
> Any sexual side effects with Remeron?Hi Roo,
I gained about 6kg in 4 months on paxil. Mostly through appetite for sugar(not a problem previously) but also from not excercising through the fatigue it caused (I used to excercise 3-4 times a week). This also caused a lot of my existing weight to convert to fat.I gained another 2-3kg on the remeron but it's stabilised and I'm happily starting to excercise again. Sugar cravings have gone away.
No sexual SE on the remeron. Better than ever...
K23d
Posted by k23d on September 21, 2002, at 4:15:34
In reply to Re: Paxil - Remeron - Clonazepam Social Anxiety, posted by utopizen on September 20, 2002, at 0:02:24
Hi Utopizen,
I Like the name.
I don't know that I necessarily agree that ADs are any less damaging than BZDs. Particuarly given lack of long term studies SSRI. But I am very concerned about bzd dependency so will think through thouroughly. Prior to going on remeron I was already reading through all the research papers...Interesting that epilepsy meds such as neurontin seem to have positive effects on social phobics. Anyone ever experimented with dilantin? Another epilepsy med which is non-bzd anticonvulsant?
Posted by k23d on September 21, 2002, at 4:25:19
In reply to Re: Paxil - Remeron - Clonazepam Social Anxiety » k23d, posted by Rick on September 20, 2002, at 10:33:28
Hi Anxiousgrrrl & Rick,
Thanks for your feedback. I'm curious about the memory loss. How pronounced is it? How does it manifest?
Also, sexually, what effects has it had if any?
In response to one of your comments Rick, I've never thought I was depressed although my dad suffers. I've always been ultra positive about almost everything except anxiety.
My psychologist doesn't think I'm depressed but the new psychiatrist said I had "very mild" depressive symptoms. If anything it was my frustration at not being able deal with the anxiety even with all of the professionals around me.
Thanks for the abstract. I've read the full study as well. Have you got a copy of the "Journal of Pychiatry - Emerging Treatments in Social Phobia 2001" It was a bunch of studies all grouped together and included conclusions drawn across the lot. Really good read. I'll dig out a link if I can find it.
K23d
Posted by chad_3 on September 21, 2002, at 4:56:51
In reply to Re: Paxil - Remeron - Clonazepam Social Anxiety » k23d, posted by Rick on September 20, 2002, at 10:33:28
Rick -
Just wanted to say "Hi". : )
I agree with you on Klonopin being the single most effective anti-SP med purely working on SP.
My stance does differ a bit from you though on the idea that most people will do well on 1-1.5 mg/day taken alone. I think comorbidity in SP is the rule not the exception esepcially dysthymia, mild or mildly recurring depression, low energy, and apparently not uncommon is ADD, panic, depression. Usually I think is something in there limiting Klonopin alone.
I do also think you are a in fact as you say a pretty "pure SP" candidate - just as those in the Davidson studies. I think that Klonopin has a slighty androgenic effect and it tends to be preferred by males as a result - with Xanax anti-androgenic slightly and tending to be prefered by females. Long term use of Klonopin is in real world probably usually accompanied by an antidepressant of other similar agent - when used for SP, I think.
And in your case - I think you are simply a fantastic responder in low dose monotherapy to Klonopin - but are the exception not the norm.
That aside - I agree so much with you on most of your posts that I simply don't contribute. Keep healthy.
And Rick - I understand your career has gone better and better in past years - are you also married I thought you said that once ...
Those are impressive stats for significant generalized SP - and you are a success story. And I do back you 100% on the safety and efficacy of Klonopin - with a few differences and a special regard for Nardil for many who I feel have more symptoms than are treatable by Klonopin alone.
Oh - BTW - I think your SSRI views - especially I noticed now on Paxil - yes I agree. These SSRI's are not particuarly effective for social phobia IMO...
Stay well - stay healthy! I'm going to Vegas!!!
Chad
http://www.socialfear.com/> My experience mirrors anxiousgrrl's. Except for some possibe memory lapses, Klonopin has been nothing but a BIG success for my social phobia. Overall, I've had at least a 75-80% improvement over my pre-Klonopin days (why didn't I discover it sooner??!!) I have no side effects except good ones. (E.g., the longtime chronic low-level facial pain that I thought might be TMJ unexpectedly disappeared after I started Klonopin. It took me awhile to make the connection. I later found a study verifying this effect.)
>
> Nothing -- not even Nardil, and certainly not Paxil -- has shown higher response rate vs double-blind placebo in social phobia than clonazepam.
>
> If you're not depressed, don't bother with an AD and the side effects + poop-out. I've experimented with adding other agents to Klonopin (instead of the other way around), and some have indeed added a nice dimension (esp. Klonopin + Serzone + low-dose Provigil), but Klonopin is always the key. It MUST be taken regularly for the best benefit. And realize that a lower dose can often work *a lot* better than more. I started at 3 mg/day three+ years ago, and have gradually tapered to 1 mg, all first thing in the morning. (I used to taked divided doses. Don't take it at bedtime. Taking it in the morning will still alleviate evening insomnia without possible morning grogginess, and it will be at highest levels in your bloodstream when you need it most for social interaction.) That's all I've needed for the last eighteen months. My pdoc also said that I won't have trouble should I ever decide to taper off, as long as I stick to 3mg/day or less.
>
> BYTW, there is evidence that Klonopin *can* have some lasting benefits, as detailed in the attached abstract.
>
> Pursue this.
>
> Rick
>
> From: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9790154&dopt=Abstract
>
> J Clin Psychopharmacol 1998 Oct;18(5):373-8
>
>
> Discontinuation of clonazepam in the treatment of social phobia.
>
> Connor KM, Davidson JR, Potts NL, Tupler LA, Miner CM, Malik ML, Book SW, Colket JT, Ferrell F.
>
> Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
>
> Patients with social phobia who responded well to 6 months of open-label treatment with clonazepam were assigned to receive either continuation treatment (CT) with clonazepam for another 5 months, or to undergo discontinuation treatment (DT) using a clonazepam taper at the rate of 0.25 mg every 2 weeks, with double-blind placebo substitution. Clinical efficacy was compared between the CT and DT groups using three different social phobia scales. Benzodiazepine withdrawal symptoms were also measured. Relapse rates were 0 and 21.1% in the CT and DT groups, respectively. Subjects in the CT group generally showed a more favorable clinical response at midpoint and/or endpoint, although even in the DT group clinical response remained good. With respect to withdrawal symptoms, the rates were low in both groups (12.5% for CT and 27.7% for DT) with no real evidence suggesting significant withdrawal difficulties. At the end of 11 months of treatment with clonazepam, however, a more rapid withdrawal rate was associated with greater distress. This study offers preliminary evidence to suggest that continuation therapy with clonazepam in the treatment of social phobia is safe and effective, producing a somewhat greater clinical benefit than a slow-taper discontinuation regime. However, even in the DT group, withdrawal symptoms were not found to be a major problem. The study can be taken as supportive of benefit for longterm clonazepam treatment in social phobia, as well as being compatible with a reasonably good outcome after short-term treatment and slow taper.
>
> Publication Types:
> Clinical Trial
> Randomized Controlled Trial
>
> PMID: 9790154 [PubMed - indexed for MEDLINE]
>
Posted by chad_3 on September 21, 2002, at 5:20:23
In reply to Re: Paxil - Remeron - Clonazepam Social Anxiety » k23d, posted by Rick on September 20, 2002, at 10:33:28
Rick -
You menioned the TMJ.
This reminded me since I had gotten pulled off my life routine and got sidetracked awhile into the world of abnormal involuntary movements.
I learned that Klonopin is the one drug (well - possibly a 2nd "baclofen") - which is highly recommended for all hyperkinetic movement disorders. This includes some pretty common nocturnal events like myoclonus or "restless legs" and "TMJ" - and all hyperkinetic movement disorders there is about 10 I think.
Also Klonopin common in Parkinsons - for sleep - with dopamine agonists - for lots of sleep stuff.
And partial seizures are treated well by Klonopin with can involve all kinds of weird movmements - usually people with seizure disorders have a "facial blunting" or difficulty being facially expressive.
I read that Klonopin may have indirect help on both SP and Parkinson's because even though it helps prevent excessive involuntary movements - it also "disinihibits" tightening of facial area - relaxing and making more easy for those with SP and Parkinson's and other disorders which often show features of "lack of facial expression" appearing as "emotional blunting" etc etc...
Oh - on my website since I had this free time - I added some abstracts under "dopamine" on pregnenolone - a steroid they find is low in those with gneral SP and general anxiety both.
Chad
http://www.socialfear.com/
Posted by Rick on September 21, 2002, at 19:15:51
In reply to Re: Paxil - Remeron - Clonazepam Social Anxiety » Rick, posted by k23d on September 21, 2002, at 4:25:19
Hi, KD23,
>I'm curious about the memory loss. How pronounced is it? How does it manifest?
First a little disclaimer...My answer to this question is going to be very rambling and maybe hard to follow. I have a hard enough time getting a firm grasp of this issue in my own mind, so trying to give a lucid description here would be too-consuming -- to the extent that I could even succeed if I tried!...
It varies a lot by day. And I don't know how much is due to the clonazepam, vs. typical age-related memory loss vs. inattention/pre-occupation vs. slight residual anxiety vs. some developing memory disorder (I doubt the last one applies -- sure hope not!). But I'm sure it's at least partly the clonazepam, and manifests mainly in sporadic short-term partial-to-full episodic amnesia.
Examples: I participate actively in a meeting, and then the next day -- or even the next hour -- someone says "remember how we talked about doing such-and-such"...and I either have no recollection of it whatsoever, or have to try very hard to remember or find written clues to help bring it back to me.
And one thought instantly knocks another one from my mind, e.g. I tell myself, "Now don't forget to turn out the dome light before you get out of the car," then I notice a book in the car which makes me think of something else and in 5 seconds I forget to turn out the dome light. These things happen over and over and over. And I keep doing really stupid things, e.g., tell myself "now don't forget to set the alarm clock to AM this time instead of PM"...which I diligently do, but then instead forget to press the set-alarm switch! Or at 10 a.m. I leave my boss at work a voice mail question relating to a project I'm spending the whole day on, and at 5 he stops by and says, "you left me a question." And I say, "I did? What about?" ...And this is on a day where I've only spent ten minutes on the phone the whole day, so it's hardly as if I've had a barrage of communications to keep straight. I also just have more trouble remembering events from within the last year, or I may remember bits and pieces but get them all jumbled, or I often remember some inconsequential detail tangential to an event but can't remember the event itself, i.e., "what did that detail relate to?" I.e., I recall tangentials but can't recall the main point. And of course I do the "why did I walk into this room?" and "put the sugar in the freezer" kinds of stuff more than ever. One of the things that bothers me most is forgetting (or having to think REAL hard to recall) the names of people I've been working with very closely as little as two weeks earlier. I forget the names of the stars of a movie I saw just three weeks ago, even though in the past I've always been able to summons up their names instantly when I hadn't seen them in years.
I've always been absent-minded, it's just gotten much worse. Totally forgetting very recent discussions can be a real handicap in many ways, and even sometimes result in arguments where I claim, "I never said that!", but then later, after trying real hard to recall, realize, "Oops, maybe I DID!".
(TOLD YOU that answer would be a rambler! BTW that reminds me of another e.g.: I'll tell myself over and over, "don't send off this post without putting in something about X," but then either completely forget about it 1 minute later OR recall that I was supposed to write something but rack my brains unsuccessfully trying to remember what it could have been.)
> Also, sexually, what effects has it had if any?Klonopin increased my libido some. I get the impression that's uncommon, although not rare. I *may* also have slightly less "stamina" then before, but generally no problem. And I'm one of those guys who has total sexual wipeout on a small dose of an SSRI or Nardil (although I understand from Chad that the Nardil SD tends to resolve after awhile -- I wasn't on it long enough to find out.)
> In response to one of your comments Rick, I've never thought I was depressed although my dad suffers. I've always been ultra positive about almost everything except anxiety.
That's great! While I've always been generally happy and moderately optimistic, I've long been a "worrier" and can't say I'm "ultra positive." I don't think I've ever been even close to depression except once when a loved one died from a rather shocking illness, although even then I doubt it would have been considered clinical Major Depression.
> My psychologist doesn't think I'm depressed but the new psychiatrist said I had "very mild" depressive symptoms.
Some psychs think that, by definition, someone with social phobia is, at the least, dysthmic.
>If anything it was my frustration at not being able deal with the anxiety even with all of the professionals around me.
That's understandable.
> Thanks for the abstract. I've read the full study as well. Have you got a copy of the "Journal of Pychiatry - Emerging Treatments in Social Phobia 2001" It was a bunch of studies all grouped together and included conclusions drawn across the lot. Really good read. I'll dig out a link if I can find it.I do indeed have that useful document, but if you can find the link without too much searching I'm sure others would find it useful, too.
Rick
Posted by Rick on September 21, 2002, at 19:49:21
In reply to Re: Paxil - Remeron - Clonazepam Social Anxiety, posted by chad_3 on September 21, 2002, at 4:56:51
Chad -
> Just wanted to say "Hi". : )
"Hi" back!
> I agree with you on Klonopin being the single most effective anti-SP med purely working on SP.
>
> My stance does differ a bit from you though on the idea that most people will do well on 1-1.5 mg/day taken alone. I think comorbidity in SP is the rule not the exception esepcially dysthymia, mild or mildly recurring depression, low energy, and apparently not uncommon is ADD, panic, depression. Usually I think is something in there limiting Klonopin alone.I agree that most people with SP have some comorbidity, although the amount who don't is far from insignificant. Also, to the extent the comorbidity is another anxiety disorder (except OCD), Klonopin montherapy could be quite effective. E.g., the manufacturer's monograph recommends a Klonopin dose of just 1 mg/day for most people with panic disorder, citing studies that failed to find additional benefit from doses higher than 1 mg.
>
>
> And in your case - I think you are simply a fantastic responder in low dose monotherapy to Klonopin - but are the exception not the norm.Can't agree with you here, at least as far as those with "pure" SP go. There are plenty of people who do extremely well on 1 mg/day. The Davidson vs.-placebo Klonopin monotherapy SP study showed a mean ending dose of 2.4, with doses ranging from .5 mg/day to 3. And that's with a 78% response rate. Also see the below link from an earlier Davidson study that showed that Klonopin SP patients generally lowered their dose as time passed, to an average of about 1 mg/day -- exactly what I'm taking.
> That aside - I agree so much with you on most of your posts that I simply don't contribute. Keep healthy.
Thanks. I agree with most of what you post, too, and always find it insightful, thought-provoking and useful.
>
> And Rick - I understand your career has gone better and better in past years - are you also married I thought you said that once ...I'm in a long-term relationship. Without this support and a few key lucky breaks in life, it is more likely my SP would have led to comorbidity (I *do* suffer from some compulsive tendencies, although it doesn't meet a clinical diagnosis.)
> Those are impressive stats for significant generalized SP - and you are a success story. And I do back you 100% on the safety and efficacy of Klonopin - with a few differences and a special regard for Nardil for many who I feel have more symptoms than are treatable by Klonopin alone.
I hope I've made it clear that I know Nardil can be a lifesaver for many Social Phobics with comorbities -- AND, many without. But I still personally feel that there's no need for an AD in someone who's not depressed or dysthmic, and that physically, benzos are about the safest psychotropics out there.
> Stay well - stay healthy! I'm going to Vegas!!!
I love Vegas! Enjoy, and win big!
Rick
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1757453&dopt=Abstract
Posted by Rick on September 21, 2002, at 20:18:27
In reply to Re: Klonopin - Social Anxiety pure form, posted by chad_3 on September 21, 2002, at 5:20:23
> I read that Klonopin may have indirect help on both SP and Parkinson's because even though it helps prevent excessive involuntary movements - it also "disinihibits" tightening of facial area - relaxing and making more easy for those with SP and Parkinson's and other disorders which often show features of "lack of facial expression" appearing as "emotional blunting" etc etc...
Interesting you say that, because one of my first somatic social phobia symptoms started in high school. When I'd be walking toward someone, esp. down a long hallway, my face would tighten and my head would shake. Ironically, the head shaking disappered a few years later, but was replaced by vocal tremor when anxious. That's still my biggest outward symptom, although Klonopin has eliminated most of it (probably mostly through the treatment of the anxiety, but maybe also through direct anti-tremor efects).
Even after the "head shakes" stopped, my face would still tense up around others, particularly in certain situations. I learned that people sometimes thought I was giving them a "mean" expresion on purpose, that I didn't like them. Sometimes they'd make fun off me or mock my intense expression (not-so-nicely in high school; usually good-naturedly since...BTW, I hated high school, and this was one reason).
Even today, my face will sometimes tense up a little, but I no longer freak out about having to walk towards someone or look them straight in the face.
> Oh - on my website since I had this free time - I added some abstracts under "dopamine" on pregnenolone - a steroid they find is low in those with gneral SP and general anxiety both.Funny you should mention that, too. About six years ago, before I had ever heard of social phobia, I read about Pregnenolone's supposed "fountain of youth" properties. I started taking it daily, without doing any safety or effectiveness research as I would today. I stopped after about a year when I saw no benefits. And in retrospect I realize my "Pregnenolone days" were about the time my social phobia became its worse (e.g., doing presentations, which used to make me merely a little nervous, started inducing near-panic). So, I'm definitely not going to be one of the first to jump on the Pregnenolone-for-SP bandwagon!
Before that, I took DHEA for at least a year, again with no research and no beneficial effects I could detect. Isn't Pregnenolone a precursor to DHEA and other hormones? I sometimes wonder if the DHEA and or Pregnenolone contributed to my impaired glucose tolerance (DHEA can decrease insulin sensitivity). The carcinogenity potential of DHEA also concerns me, especially given my family history. Hormone supplementation in general is something I would tread lightly with for these reasons and others.
Rick
Posted by chad_3 on September 22, 2002, at 2:16:05
In reply to Re: Klonopin - Social Anxiety pure form » chad_3, posted by Rick on September 21, 2002, at 20:18:27
Rick -
>>>>>>
Interesting you say that, because one of my first somatic social phobia symptoms started in high school. When I'd be walking toward someone, esp. down a long hallway, my face would tighten and my head would shake.
Ironically, the head shaking disappered a few years later, but was replaced by vocal tremor when anxious. That's still my biggest outward symptom, although Klonopin has eliminated most of it (probably mostly through the treatment of the anxiety, but maybe also through direct anti-tremor efects).
-------------
The reacionts I got intially to da blocker in jan and may 2002 were significant in facial and neck areas ... and with a tremulousness component. Although Klonopin resolves things as they stood recently, I have had diurnal variations and later on nocturnal awakening and sleep-wake transion stuff including neck movements. The facial and neck area seems to be the main trouble area in most tardive dystonias and many other hyperkinetics - and interesitngly people with autism and parkinson's are among the most likely people to develop dystonias - the latter from l-dopa 'rebound' effects.Misdiagnosis, delayed diagnosis, lack of diagnosis - seems to be the norm in drug induced movement disorders. If you didn't see the webpage of the young woman I posted a couple weeks ago on reglan induced tardive dystonia / chorea - it is very informative and she tells it like it is. I wrote to her a couple times she is very sweet and strong both - she is married and has what looks like a positive future for herself but her experience with the neuro's - my case was not so severe but I could definitely relate. (sorry I digressed a bit there from your post ...)
>>>>>>>
> Even today, my face will sometimes tense up a little, but I no longer freak out about having to walk towards someone or look them straight in the face.
>>>>
I have found Klonopin great for increasing greatly ease and desire of eye contact. Terms I read in both the movements and anxiety area like "startle response" and "fear" - the klonopin seems to correct these traits of mine extremely well. With good treatment I will actually often tend to be seeking out eye contact as opposed to avoiding it. I had a "blood phobia" - difficulty urinating when others watching - all disappear totally with Klonopin. Worrying overly ... et al..
>>>>
> Funny you should mention that, too. About six years ago, before I had ever heard of social phobia, I read about Pregnenolone's supposed "fountain of youth" properties. I started taking it daily, without doing any safety or effectiveness research as I would today. I stopped after about a year when I saw no benefits. And in retrospect I realize my "Pregnenolone days" were about the time my social phobia became its worse (e.g., doing presentations, which used to make me merely a little nervous, started inducing near-panic). So, I'm definitely not going to be one of the first to jump on the Pregnenolone-for-SP bandwagon!
<<<<<>
You don't like caffeine much either do you? I noticed that caffeine enhances progesterone levels quite a bit - and in my Dr notes I hand out I point out I have a 200-1000 mg / day habit going back 8 years! I love caffeine! I have absolutely no tendency towards panic attacks - and have done well with even tiny doses of stimulants. I like smoking too but gave it up - I found that high caffiene - and provigil - both reduce my desire to smoke - I actually finally quit my few Carlton's a day habit when on Provigil for 1 year until the amisulpride fiasco pulled me off everything awhile....An aside, my brother probably has G.A.D. with seconadary SP - he does really good with Effexor - I can't handle Effexor but it does seem so far for males to be good for primary GAD +/- dysthymia/depression.
>>>>
> Before that, I took DHEA for at least a year, again with no research and no beneficial effects I could detect. Isn't Pregnenolone a precursor to DHEA and other hormones? I sometimes wonder if the DHEA and or Pregnenolone contributed to my impaired glucose tolerance (DHEA can decrease insulin sensitivity). The carcinogenity potential of DHEA also concerns me, especially given my family history. Hormone supplementation in general is something I would tread lightly with for these reasons and others.
>>>>
I tried DHEA in past. It knocked out my finasteride effect. I later quit finasteride and got similar effect. More in last year have concerns on finasteride, and reduced from 1.25 to 0.8. I read last week it reduces pregnenolone signifificantly. I know in my case quitting from 1.25 to 0 finasteride was boost to my mood and yes sex drive noticed effect. The provigil tended to counteract the finasteride much like DHEA - but I definitely preferred provigil. DHEA actually made me get a bit too aggressive sometimes with people - and a bit axiogenic but disinhibiting. And the hair loss returning.I don't know at 0.8 if finasteride causes me side effects - I may discontinue a week and find out for sure.
On side bar - I am resuming work part time - taking classes part time one semester only - and am considering part time teaching and part time profesionnal working. I am for 2 weeks now back to 60 nardil + 4.5 klonopin, an older regimen I used 2 years before lowering klonopin to 2.5-3.0 and adding 65-75 provigil. ; )Goodnight all!
Chad
http://www.socialfear.com/
Posted by chad_3 on September 22, 2002, at 2:23:51
In reply to Social Anxiety, stimulants, hormones, benzos..., posted by chad_3 on September 22, 2002, at 2:16:05
Sorry I though re-read before posting ...
I meant to say caffiene significantly boosts "pregnenolone" not "progesterone"...
chad
ps: My brother - he has probably G.A.D. - does great with low effexor alone - and is diabetic also - he too seems to consume caffiene like a fish.
I had a girlfriend - she had SP! and some panic and she HATED caffiene even a little - our situations all unique ...!
Posted by Rick on September 22, 2002, at 11:26:05
In reply to Social Anxiety, stimulants, hormones, benzos..., posted by chad_3 on September 22, 2002, at 2:16:05
Chad -
> Misdiagnosis, delayed diagnosis, lack of diagnosis - seems to be the norm in drug induced movement disorders.
I've done some studying on tremor and its various causes, but in general I'm not very knowledgeable about movement disorders. Back when my pdoc was trying selegiline monotherapy for my social phobia (after a probably-too-short Nardil trial rife wih side effects and what I thought was poop-out), he had me add lithium as a potentiator. That was my weirdest experience ever on psychotropics. The very first night, I laid in bed and my arms and legs would just whip out randomly in exaggerated spastic motions every few minutes. I must have looked like I was doing some kind of supine 70's dance all night long. It really freaked me out, and that was the end of the lithium experiment. Within two days everything was back to normal. My pdoc never ventured a guess as to what that could have been, and told me, "strange, I've never heard of that reaction in 25 years of practice." I wonder what it was?
> I had a "blood phobia" - difficulty urinating when others watching - all disappear totally with Klonopin. Worrying overly ... et al..
Nardil was the only drug that gave me urinary hesitancy, although that was in private and obviously not related to social phobia. That felt very strange and was frustrating and a little scary...to have a bladder begging for emptying and have to stand there five minutes before I could even *begin* the release. Seemed to be much worse at night. While on Nardil, the only problem I recall in public restrooms was falling down from the severe hypotension it caused (that was my first psychotropic, and I think I escalated the dose too-quickly).
>>So, I'm definitely not going to be one of the first to jump on the Pregnenolone-for-SP bandwagon!
> You don't like caffeine much either do you?
Other than water, my favorite beverages are all caffeinated. It's not so much because of the caffeine (although I enjoy the lift I get from Java), but rather because I think caffeinated coffee and Coke taste SOOO much better than their decaffeinated counterparts. Nonetheless, it does work against my treatment somewhat (as well as possibly raising my heart rate). Even the small amount of jitteriness can make me more prone to some breakthrough vocal tremor in some situations. So during the work week I drink lots of decaf stuff. But I definitely "make up" for it on the weekends, when I make no effort to restrict caffeine intake.
> An aside, my brother probably has G.A.D. with seconadary SP - he does really good with Effexor - I can't handle Effexor but it does seem so far for males to be good for primary GAD +/- dysthymia/depression.
I have a friend who switched to Effexor for depression after years on Prozac. Not only is he delighted with how much better it's working for his depression, but I notice he no longer seems nervous around others and is much more outgoing.
He claims to have zero sexual dysfunction from it.> I tried DHEA in past. It knocked out my finasteride effect. I later quit finasteride and got similar effect. More in last year have concerns on finasteride, and reduced from 1.25 to 0.8. I read last week it reduces pregnenolone signifificantly. I know in my case quitting from 1.25 to 0 finasteride was boost to my mood and yes sex drive noticed effect. The provigil tended to counteract the finasteride much like DHEA - but I definitely preferred provigil. DHEA actually made me get a bit too aggressive sometimes with people - and a bit axiogenic but disinhibiting. And the hair loss returning.
I actually started finasteride/Propecia a month after starting Klonopin, when I was concerned that the Klonopin might be causing some hair loss.
I haven't personally noticed any side effects from the Propecia, but it seems to have done the trick for the hair thinning (regardless of whether it was really due to the Klonopin or not).> I don't know at 0.8 if finasteride causes me side effects - I may discontinue a week and find out for sure.
>
>
> On side bar - I am resuming work part time - taking classes part time one semester only - and am considering part time teaching.I don't know how much of this is remaining SP vs. other kinds of insecurities vs. personal preference, but the thought of teaching (in the traditional academic sense) continues to scare me.
I kind of envy those who enjoy it.Rick
Posted by Rick on September 22, 2002, at 11:33:37
In reply to caffieine boost pregnenolone not progesterone, posted by chad_3 on September 22, 2002, at 2:23:51
> ps: My brother - he has probably G.A.D. - does great with low effexor alone - and is diabetic alsoThe friend I mentioned in the last reply, who is doing so well on Effexor, is also diabetic. And I remember someone who used to post here who was also diabetic and really depended on Effexor. (She once said her glucose control really went out of whack when her HMO made her switch to another AD). I wonder if, for some reason, diabetics have a particularly good reaction to Effexor? In one sense it might seem as if Effexor would NOT be a good choice, since most Type II diabetics are hypertensive, and Effexor can sometimes raise blood pressure.
>I had a girlfriend - she had SP! and some panic and she HATED caffiene even a little - our situations all unique ...!
Ain't that the truth!
Rick
Posted by chad_3 on September 25, 2002, at 0:50:22
In reply to Re: Social Anxiety, stimulants, hormones, benzos... » chad_3, posted by Rick on September 22, 2002, at 11:26:05
Howdy Rick -
... Back when my pdoc was trying selegiline monotherapy for my social phobia (after a probably-too-short Nardil trial rife wih side effects and what I thought was poop-out), he had me add lithium as a potentiator. That was my weirdest experience ever on psychotropics. The very first night, I laid in bed and my arms and legs would just whip out randomly in exaggerated spastic motions every few minutes. I must have looked like I was doing some kind of supine 70's dance all night long. It really freaked me out, and that was the end of the lithium experiment. Within two days everything was back to normal. >>>>>
That *does* sound scary. I though maybe of looking it up but with movements - is very difficult so many things very similar - the wild flinging sounds like could maybe be myoclonus though, or something similar. Myoclonus I read a bit and found it was best treated with pure 5ht-2 antagnoists. Lithium I think is pro-serotoinin and could lower high d2 dopamine at same time - perhaps that was the deal? Who knows but sounds like could have been a sudden shift from high d2 dopamine and opposite effect on serotonin s2 - to the opposite - quick change and myoclonus.
>
> Nardil was the only drug that gave me urinary hesitancy, although that was in private and obviously not related to social phobia. That felt very strange and was frustrating and a little scary...to have a bladder begging for emptying and have to stand there five minutes before I could even *begin* the release. Seemed to be much worse at night.
<<<<
Yep - I had that too noticed it soon after starting. was annoying for me so I went "in private". In my case like about everything that totally went away in a couple months.
>>>>>
While on Nardil, the only problem I recall in public restrooms was falling down from the severe hypotension it caused (that was my first psychotropic, and I think I escalated the dose too-quickly).
>>>>>
I also had some of the hypotension - sometimes would jump out of bed in morning with all the energy ready to go and woops! lay back down. Running up staris - might end up dizzy at top - or getting out of chair and have to sit down again. Again in my case that completely went away took a few months for complete remission of that, was kinda gradual improfvment I think.
>>>>
> >>So, I'm definitely not going to be one of the first to jump on the Pregnenolone-for-SP bandwagon!
>>>>
Sometime I want to look and see if taking it straight is the same as having blood levels rise due to something else - as in the caffeine study I saw - because when I looked up pregnenolone straight - on pubmed - I don't recall it being used that way (maybe it is but don't know) - and I typed in on google expecting to see something and did see bunch of salespeople selling it as herb - was about everything I saw top 40 or so hits.... I'll probably want to look that up sometimes so far I only saw caffeine and some steroidal stuff as non-pregneolone drugs affecting blood levels of that- oh i recall ketoconazole raised pregnenolone and dropped testosterone though. finasteride raises terstorone at expense of dht - i noticed my testosterone was actually above range 10% or so of normal range - but is not whole story - dht is more potent - which finasetirde does lower...also lower pregnenolone...
>>>>
Java), but rather because I think caffeinated coffee and Coke taste SOOO much better than their decaffeinated counterparts. Nonetheless, it does work against my treatment somewhat (as well as possibly raising my heart rate). Even the small amount of jitteriness can make me more prone to some breakthrough vocal tremor in some situations. So during the work week I drink lots of decaf stuff. But I definitely "make up" for it on the weekends, when I make no effort to restrict caffeine intake.
>>>>>
I am pretty sure in part I tolerate higher caffiene due to both serotonergics and/or klonopin ...
>>>>
> I have a friend who switched to Effexor for depression after years on Prozac. Not only is he delighted with how much better it's working for his depression, but I notice he no longer seems nervous around others and is much more outgoing.
> He claims to have zero sexual dysfunction from it.
>>>>
My brother also tried Prozac first, and later Paxil. He says Effexor the best by far. And diabetic as I said like your friend. Good for his anxiety, dythymia, and more social. He also claims no sex side efffects as your friend does. Well I wish I could make such a claim for Effexor but I'm afriad it gives me enough at the very low dose aka ssri's! Seems unfair given the anxiety I feel on it!!!! ; )
>>>>
>
> I actually started finasteride/Propecia a month after starting Klonopin, when I was concerned that the Klonopin might be causing some hair loss.
> I haven't personally noticed any side effects from the Propecia, but it seems to have done the trick for the hair thinning (regardless of whether it was really due to the Klonopin or not).
>>>>
Propecia does seem to work really well for most people I understnad - my brother takes it it works for him too ..
>>>>
> I don't know how much of this is remaining SP vs. other kinds of insecurities vs. personal preference, but the thought of teaching (in the traditional academic sense) continues to scare me.
> I kind of envy those who enjoy it.
>>>>>>
Thanks, I appreciate the nice words. I'm not sure yet how I would do but if I try it out I'll be sure to post expereiences. I have tried toastmatsters - but I will say also that I think personal relationships are a *way* more important for our health that the ability to talk in front of a group with ease. I'm sure you've heard about some of the famous stars like Johnny Carson who report being extremely shy "in private" or "at parties" because they aren't in control. It does feel good I think to be able to speak up there and is good - but to me - the real deal is in the interpersonal area - in my case the small groups of interpersonal groups - all contributing in a friendly way - that is my most difficult area in the world of SP I think - moreso that one on one interactions...Chad..
http://www.socialfear.com/
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