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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by becksA on August 14, 2003, at 11:11:12
I was thinking about trying lexapro for my SAD, but after doing research wasn't sure, as depression really isn't a problem for me. advice?
Posted by Ame Sans Vie on August 14, 2003, at 14:18:14
In reply to Lexapro for social anxiety??, posted by becksA on August 14, 2003, at 11:11:12
See my response to your post above.
Posted by becksA on August 14, 2003, at 14:24:02
In reply to Re: Lexapro for social anxiety?? » becksA, posted by Ame Sans Vie on August 14, 2003, at 14:18:14
Thanks for all your help!
Posted by Ame Sans Vie on August 14, 2003, at 16:33:47
In reply to Re: Lexapro for social anxiety??, posted by becksA on August 14, 2003, at 14:24:02
No problem -- here's a link to a webpage I just threw together that contains a graphical algorithm that I think would work well for many people with social anxiety:
http://www.geocities.com/lordaadika@sbcglobal.net/socialphobia.html
Posted by zeugma on August 15, 2003, at 8:32:49
In reply to Re: Lexapro for social anxiety??, posted by Ame Sans Vie on August 14, 2003, at 16:33:47
Ama, That's a cool algorithm for Social Anxiety. I haven't done it that way, because social anxiety was not the reason I sought treatment a year ago. The proximate cause was a 'wasting', 'melancholic' depression (couldn't eat, couldn't sleep, somewhat agitated). TCA plus Buspar, after getting to an adequate dose, put this in remission. They are fairly useless for social anxiety, though. Strattera may actually be more useful for social anxiety. I've been at 80mg Strat for about two months, and I have seen some signs that the anxiety in the presence of others may be starting to lighten. Possibly Strattera plus SSRI could be a powerful tool to combat social anxiety?
I would also like to mention the role of CBT in dealing with social anxiety. It's too early for me to tell what the results will be, but apparently it can be quite effective. Drawbacks: time-consuming, takes a lot of work, plus my insurance doesn't cover it (lol). I'll keep everyone posted (at Psychological-Babble) if I make much headway on this route.
Posted by Ame Sans Vie on August 15, 2003, at 17:11:21
In reply to Re: Lexapro for social anxiety??, posted by zeugma on August 15, 2003, at 8:32:49
First off, I'm glad you think the algorithm turned out okay. I'm going to be starting up a *very* detailed site based entirely on the treatment of anxiety disorders (e.g. clinical studies, case reports, personal experiences [that I hope Babblers wouldn't mind submitting], drug monographs, etc. ad nauseam), and becksA's posts just gave me a little incentive to get started. Any suggestions for changes to the algorithm?
I'm sure Strattera + SSRI has the potential to be a great combo for SP, in some people. The effect would after all, in theory, be a lot like Effexor (NE + 5HT reuptake inhibition). That could fall under "Step 5" of my algorithm, I suppose... I plan on adding a lot more detailed information pertaining to "Step 5" in the near-future.
Also, I wholeheartedly agree about CBT being an integral part of any SP treatment-plan that is aimed at eventual remission (esp. CBT + medication). Perhaps you saw my posts on here and on Psychological-Babble concerning Medicaid's upcoming cancellation of therapy coverage -- if you did, you know that I very highly value my therapy (and, perhaps even more so, my therapist in particular) and I'm just infuriated that I won't be able to receive therapy after I turn 21 on Jan. 5.
:-(
Posted by becksA on August 16, 2003, at 13:58:54
In reply to Re: Lexapro for social anxiety?? » zeugma, posted by Ame Sans Vie on August 15, 2003, at 17:11:21
interesting
Posted by reifiedbeans on August 16, 2003, at 14:06:38
In reply to Re: Lexapro for social anxiety??, posted by becksA on August 16, 2003, at 13:58:54
Didn't work as well as Zoloft or Effexor for me. Serzone seems to be pretty worthless for social anxiety.
Posted by zeugma on August 17, 2003, at 18:03:07
In reply to Re: Lexapro for social anxiety?? » zeugma, posted by Ame Sans Vie on August 15, 2003, at 17:11:21
> First off, I'm glad you think the algorithm turned out okay. I'm going to be starting up a *very* detailed site based entirely on the treatment of anxiety disorders (e.g. clinical studies, case reports, personal experiences [that I hope Babblers wouldn't mind submitting], drug monographs, etc. ad nauseam), and becksA's posts just gave me a little incentive to get started. Any suggestions for changes to the algorithm?
>
No, other than to observe that it seems that many pdocs (including mine) are reluctant to prescribe benzodiazepines. Maybe he feels that since I've lasted this long under his care (a year) without 'needing' a benzo, he's not going to run the risk of starting me on one now. I can't say how rational or not this is. I do know that last winter, when struggling with a subtherapeutic dose of nortriptyline, and realizing for the first time (I'm 35, by the way- average age for people to begin treatment for SP is about 30 according to my cognitive therapist- a remarkable delay considering that this disorder usually has onset at 11 or so) that I had SP and knowing that Paxil was FDA-approved for this disorder, asked if I could try it or another SSRI. But Paxil can have a pharmacokinetic reaction with the TCA, and I have a history of not tolerating SSRI's very well. So in desperation I wound up trying Buspar instead. Buspar's an interesting drug- an "interesting, frustrating drug," according to the authors of the impressive new edition of the "Manual of Clinical Psychopharmacology"- and I have kept it around, not for any anxiolytic effects, but because it blocks my REM-induced headaches and makes it a lot easier to fall asleep. Also it has some antidepressant effect. The authors of this tome think it's very underrated- as does, by the way, the author of "Beyond Prozac"- and needs to be prescribed in higher doses to have any effect on SP. I know you didn't find it helpful for this at even 60 mg- I'm curious if any one else had a positive result at that dose. I think there's a better chance of my pdoc letting me try a higher dose of Buspar than a benzo. And I would probably prefer escalating the dose of a drug I know well than to try to start a new one at this point in my treatment.
One other thing- Strattera seems to really help facilitate the cognitive therapy process. It's a great clarity-inducing med, and I find myself noticing all kinds of environmental triggers that set off my SP, and can anticipate the kinds of interaction that are most unsettling, allowing me to make strategies for compensating with the situations as they arise. Prior to starting the Strattera, I just didn't feel alert enough to take careful note of these things- I would simply have emotional reactions that mostly bypassed my awareness levels until it was too late. Of course, this has a lot to do with my severe comorbid inattentive ADHD, and not indicate any special compatibility between CBT and Strattera. But I'm just throwing my experience out there.
>
> Also, I wholeheartedly agree about CBT being an integral part of any SP treatment-plan that is aimed at eventual remission (esp. CBT + medication). Perhaps you saw my posts on here and on Psychological-Babble concerning Medicaid's upcoming cancellation of therapy coverage -- if you did, you know that I very highly value my therapy (and, perhaps even more so, my therapist in particular) and I'm just infuriated that I won't be able to receive therapy after I turn 21 on Jan. 5.
> :-(
I'm glad you're getting your SP treated at a young age. Many years of my life went by where I was unable to develop skills that would help me socially or in the workplace because I was socially phobic. It's a shame that medications can be routinely covered by health plans, but CBT, because it is labor-intensive and time-consuming, is not. Maybe as more studies are done showing its efficacy, and its value in augmenting medication-assisted recovery, this will begin to change. Social anxiety actually costs the state a lot, because people afflicted with severe forms often literally can't work, leading to the loss of tons of tax-derived revenue. So it's in the government's benefit to promote forms of mental health treatment that work.... and in the interest of insurance companies to do so as well, and for the same reason.
This is the end of the thread.
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