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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by pseudonym on August 30, 2003, at 3:09:39
I have recently decided to attack my social anxiety with klonopin, due in part to this board, and have noticed a general improvement in situational anxiety with the opposite sex. My social anxiety is the kind that equals no friends, not dates for 10+ years, no sex ever. Any social situation is painfully undergone but must often be deftly avoided. Oddly enough, I was the valedictorian of my high school, so scholatistic capability was never an issue.
However, despite the klonopin, there is something missing, "something" i would charactertize as negativity and anhedonia. My intention is to try amisulpride at 50mg per day along with Klonopin at 1.25 mg per day for 2 weeks. I'll post to this thread once I receive the amilsulpride and let you know how the trial goes.
The basis for this approach comes from prior posts to this board, most likely by people would have overcome their social anxiety and hence have little reason to visit Psycho-Babble. It would appear that a common component to successful attacking social anxiety is manipulating the dopamine receptor systems. For example, AndrewB is famous for the suggestion of low dose selegiline/amisulpride. Rick for Provigil+Klonopin, and Ame with Klonopin+Mirapex (pre sleep attack).
I understand exercise increases dopaminergic receptor density, while social defeat does the opposite. I need a social win and perhaps klonopin plus amisulpride will do it. If not, we'll work from there.
Posted by Francesco on August 30, 2003, at 7:57:11
In reply to Social anxiety and dopaminergics? Amisulpride..., posted by pseudonym on August 30, 2003, at 3:09:39
why does everybody suggest Klonopin for social anxiety ? aren't all the benzos more or less the same ?
Posted by Janejj on August 30, 2003, at 10:38:29
In reply to why klonopin ? » pseudonym, posted by Francesco on August 30, 2003, at 7:57:11
I believe Klonopin is the longest acting of the lot. Hence why it is used the most for social phobics.
Personally though, if I were to take a benzo, I'm sure i'd fall asleep!
Janejj
Posted by pseudonym on August 30, 2003, at 11:06:52
In reply to why klonopin ? » pseudonym, posted by Francesco on August 30, 2003, at 7:57:11
The reason for choosing Klonopin is that this molecule in studies its been shown to work efffectively for social anxiety without sexual side effects.
All benzos do not work with same.
Klonopin binds at the GABA receptors and "enhance" GABA, an inhibitory neurotransmitter, at the binding site. So do other benzos, you're correct in that.However, there are multiple kinds of GABA receptors, only one subtype of which, when bound, reduces anxiety. Others sedate you. The various benzos have diffential affinity for these different gaba receptors, and correspondingly produce different effects.
I'm speculating here, but it may well be that Klonopin has a higher anxiolytic receptor subtype binding relative to its peers, or failing that, doesn't bind as well to the non-anxiolytic GABA subtypes.
But like you, I need to still handle the anhedonia porition of social anxiety, hence the dopaminergic quest I am on.
Posted by pseudonym on August 30, 2003, at 11:33:22
In reply to Re: why klonopin ? » Francesco , posted by Janejj on August 30, 2003, at 10:38:29
Janejj,
Choosing a benzo for social anxiety depends on more than predicating the decision on the molecule with the longest half life. If duration of action were the primary factor, most would use valium, which has a longer half-life than Klonopin. However, there is no study indicating valium is of equivalent utility to social anxiety as klonopin.
There are however, studies indicating dopaminergic meds do help dysthymics, an-hedonic (pleasure-less) individuals, which often happens to be the same person who is socially anxious. Hence my approach to augment Klonopin at 1.25 mg with amisulpride initially.
Posted by Ame Sans Vie on August 30, 2003, at 14:57:23
In reply to Re: Social anxiety and dopaminergics? Amisulpride., posted by pseudonym on August 30, 2003, at 11:33:22
You're story sounds very much like my own -- same exact symptoms of SP, also at the very top of my class. Have you tried a stimulant concommitantly with the Klonopin? This is the combination that I've finally settled on for my SP (augmented now with Xanax XR as well), and it works marvelously. Dexedrine and Desoxyn are both wonderful; Adderall seemed to slightly decrease sociability for me, and Ritalin was just a nightmare. Taking benzos alone I am able to very easily meet new people, go out with my friends, etc. But with the addition of a pstim, I now find myself actually accepting invitations to parties and such, even when practically everyone there will be a complete stranger.
SP wasn't the original reason for my usage of a stimulant though. I had ADHD very severely until about the age of 12 (but the high-achieving variety of the disorder) at which time the hyperactivity component began to dissipate and left me with ADD. So the improvement in my SP from amphetamines was actually just a very nice side-effect from taking them for my ADD.
I should mention I also take Ultram for depression and obsessive-compulsive personality D/O. I don't feel it has a huge effect on my SP though, as I can miss a dose of it and, provided I've taken my Dexedrine, Xanax XR and Klonopin, my SP is still absent. The depression and OCPD come right back if I miss more than one or two doses.
Posted by Budgie on August 30, 2003, at 21:44:42
In reply to Re: Social anxiety and dopaminergics? Amisulpride. » pseudonym, posted by Ame Sans Vie on August 30, 2003, at 14:57:23
Hi Ame,
Just out of curiosity (sorry it's a non-med question, Dr. Bob), how did somebody with SP get so close to so many famous people?
I have SA myself, so I'm just wondering- illeagal drugs? I went through a brief but heavy party stage maybe 7-10 years ago where I was suddenly ultra-social. Can't do that anymore, though, and I'm back to my shy self now...
Posted by Viridis on August 30, 2003, at 22:17:21
In reply to why klonopin ? » pseudonym, posted by Francesco on August 30, 2003, at 7:57:11
Effects of different benzos vary a lot. Xanax (alprazolam) is great for short-term anxiety relief and improves mood but wears off fast. Valium (diazepam) makes me feel sleepy and stupid, and I don't like it at all. Klonopin (clonazepam) lasts a pretty long time for me, has no side effects (once I got used to it) and makes me feel pretty normal, without all the anxiety. It seems to affect a lot of people this way, which is why it's the favored benzo. Plus, doctors are more comfortable with prescribing it than, say, Xanax, because the long half-life makes it unlikely that people will take it frequently, supposedly decreasing the chances of dose escalation and abuse.
Posted by Viridis on August 30, 2003, at 22:24:38
In reply to Re: Social anxiety and dopaminergics? Amisulpride. » pseudonym, posted by Ame Sans Vie on August 30, 2003, at 14:57:23
Benzos and pstims can be a good mix -- I take Klonopin and Adderall (and Strattera), plus Xanax as needed. This seems to address anxiety, depression, and ADD simultaneously, with no side effects. I take pretty low doses of each, but the combination is better than any one med alone. I wish that more doctors were willing to experiment with such mixtures, although I understand the reluctance to do so (too complicated/hard to monitor what each med is doing).
Posted by Ame Sans Vie on August 30, 2003, at 22:27:14
In reply to Re: Social anxiety and dopaminergics? Amisulpride. » Ame Sans Vie, posted by Budgie on August 30, 2003, at 21:44:42
That's right, drugs it was. Though my SP wasn't nearly as bad as it is today when I first met them all six years ago, I was still shy around them. Manson offered me any mind-altering substance I wanted, never forcing anything on me though. Started off using cocaine, phenobarbital and absinthe to get past that whole shy thing (I already been using cocaine and alcohol to self-medicate... absinthe was new to me). Then I started using psychedelics and disassociative anesthetics several times a week on my own (LSD, mushrooms, mescaline, MDMA, MDA, MDE, nexus, DMT, AMT, 5-MeO-DMT, 5-MeO-AMT, 5-MeO-MiPT, DiPT, DPT, PCP, ketamine, DXM... you name it). I know my SP would have gotten worse regardless (such is the pattern of mental illness in my family), but I definitely believe that it was my abuse of those drugs in particular that caused it to become so horrible so quickly. This may sound somewhat masochistic, but even though I always had a very paranoid experience on hallucinogens, I couldn't get enough of them. I actually saw bad trips as "enlightening". Go figure. The paranoia was predominantly related to the motives and thoughts of those around me. I was with them all throughout the North American leg of the Mechanical Animals tour in '99, rarely even coming out from backstage to watch the show because I was too far out of it; I'm sure you could see how half a year in a psychedelic haze could exacerbate my problems.
I spoke to them all quite often during the agoraphobia over the past few years and even managed to go to Houston to stay with them for a weekend at a hotel every now and then (with the help of some very good friends of mine -- Klonopin and Xanax). It was my mom who introduced me to them in the first place, and he's offered to send us VIP passes for each one of the shows on their next North American tour, once all the dates are confirmed. Whether or not we'll be attending is entirely dependent on our financial situation, though.
Either way, this time -- no drugs. :-)
Posted by Budgie on August 30, 2003, at 22:51:51
In reply to Re: Social anxiety and dopaminergics? Amisulpride. » Budgie, posted by Ame Sans Vie on August 30, 2003, at 22:27:14
Wow, that's incredible, you're record I mean. I thought I was bad! I can totally relate about your pattern of use. I have no idea why I continued to do drugs long after I knew they were causing me serious psychological harm- marijuana with its paranoia, especially. I guess I was convinced that experiencing different states of consciousness (no matter how insane) was "enlightening" in itself, too. I had been depressed before, but the drugs *definitely* triggered my major illnesses, viz. SA.
I really hope you get to go see your friends. By the way, have you found that any of them, or Jerry Cantrell (who you said was releasing an anti-drug benefit album?) have significantly altered their use as they age an see bad things happen to their friends? I sincerely apologize if I'm being nosy at all!
Posted by Ame Sans Vie on August 30, 2003, at 23:12:40
In reply to Re: Social anxiety and dopaminergics? Amisulpride. » Ame Sans Vie, posted by Viridis on August 30, 2003, at 22:24:38
I absolutely agree -- I've gotten very hyped up in the past about medications only to be very let down a few weeks later (and several examples of this can be found on PB -- Mirapex, Provigil, Lexapro, Tranquili-G). But this quasi-narcotic/SNRI + benzo + amphetamine thing just blows everything else out of the water. And like you said -- no side effects! I mean, I'd be happy to have my symptoms improved only 20% if no side effects were involved, but to have achieved 100% relief with no problems whatsoever?! It's a dream come true. I've decided I'm definitely at a point now where I need no further medication additions or tweaking, as much as the idea of using certain medications for "cosmetic psychopharmacology" appeals to me (i.e. a dopamine agonist to increase motivation). Being on the Atkins diet and weightlifting daily have provided me with all the drive I need -- and rid me of 25 lbs. in the past month. :-)
I'm confident that down the pipeline in the not-so-distant future are reliably effective drugs which mimic pstims, benzos, and opioids without many of the properties that render many doctors so averse to prescribing them (esp. long-term or in combination). In fact, there are several such benzodiazepines undergoing tests currently... I can't remember the names or manufacturers, but when I find out I'll post it.
Posted by Ame Sans Vie on August 30, 2003, at 23:21:25
In reply to Re: Ame Sans Vie, posted by Budgie on August 30, 2003, at 22:51:51
Jerry is pretty much completely clean and sober (social drinker, that's it). Manson's currently very much enamoured with absinthe and has always loved pot, but only rarely uses other drugs. The other guys in the band are pretty much the same way... though Pogo does medicate his severe ADHD with Adderall, and Ginger takes Percodan for back pain -- but that's all completely legitimate. I'm so glad they all got off that path...... I really think Layne's death was an eye-opener to all of us.
You're not being nosey at all -- I'm sure the guys don't mind me telling you that they've finally wisened up a bit. :-)
Posted by pseudonym on September 17, 2003, at 0:37:45
In reply to Social anxiety and dopaminergics? Amisulpride..., posted by pseudonym on August 30, 2003, at 3:09:39
Well, I mentioned that I would update pBabble as to the efficacy of the amisulpride. Here's the update. Having used 50mg amisulpride (aka Deniban) for 5 days, I have noticed a postive effect. In general, while it does not entirely eliminate social anxiety, I simply feel happier, euthymic. I enjoyed going to work, I enjoyed a double date I went out on this weekend, a long time in coming for me, and my social interaction has changed from fearful to amiable. I would describe the resultant change in a word as "positivity".
This is at least some positive evidence of a dopaminergic aspect to my social anxiety. One aspect of SA is fear, which amisulpride does not entirely address, the other aspect is anhedonia, which amisulpride seems to markedly reduce, if not eliminate. I'll post again in a week or so to see what effect I note - placebo, transient, or otherwise.
This is the end of the thread.
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