Psycho-Babble Medication Thread 616068

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Has Anyone Tried These for Social Anxiety?

Posted by Rocket Jackson on March 4, 2006, at 23:39:38

Hello,

Just curious if anyone out there has tried Topamax, Lyrica, or Keppra for Social Anxiety. I have an appointment with my Psychiatrist next week and am contemplating some different meds to discuss during the visit.

I currently take Clonazepam 2mg/Provigil 200mg prn in anticipation of more stressful social events, but am looking for something to take daily in addition. Unfortunately, it seems the Clonazepam loses its effect after 3-4 days of continuous use. This is quite disappointing in light of the significant benefit I receive from the Clon/Provigil combo (the latter works pretty well with the Clon sedation and may even be somewhat pro-social in my experience). I've tried Lexapro, Zoloft, Cymbalta, and Wellbutrin and have received no noticeable benefit (thought I will admit I'm somewhat biased against the SSRI/SNRIs, etc because of side effects, particularly sexual... as a result, I'm hesitant to try Effexor XR). So I'm looking for something daily to fill in the Klonopin "gaps."

Any experiences you can share would be much appreciated. I know Topamax can be quite "dumbing" at higher doses, but I hear the lower doses (e.g. for migraine prophylaxis) can be effective. And though Lyrica may be Neurontin's new "cousin," I wonder if its different structure and properties may contribute to more beneficial effects. Of course, any additional meds you might be able to recommend would be much appreciated.

Thanks for your advice!

Rocket

 

Re: Has Anyone Tried These for Social Anxiety?

Posted by med_empowered on March 5, 2006, at 1:48:42

In reply to Has Anyone Tried These for Social Anxiety?, posted by Rocket Jackson on March 4, 2006, at 23:39:38

Usually Klonopin "levels off" after a couple days, but you don't lose any anti-anxiety potency for a couple months (perhaps not even then). If you're not experiencing relief..you need more benzo. That said..some docs like Limbitrol, which is an Elavil/Librium combo. To work with Klonopin, I guess you could add something like Cymbalta, maybe also some BuSpar. There was a study in which Keppra turned out pretty well for social phobia; that said, there are also studies showing Seroquel as being good for social phobia, when in all likelihood its only effect is sedation (antipsychotics actually tend to make social phobia worse b/c of D2 inhibition).

My own suggestion would be to try something standard, like: AD+benzo+(maybe Provigil)+(maybe BuSpar)+(maybe mood-stabilizer) before you go totally off-label. That said...of all the pills you mentioned, I'd opt for Keppra first.

 

Re: Has Anyone Tried These for Social Anxiety?

Posted by RobertDavid on March 5, 2006, at 2:39:54

In reply to Re: Has Anyone Tried These for Social Anxiety?, posted by med_empowered on March 5, 2006, at 1:48:42

I tried to switch from klonopin to lyrica. The lyrica did nothing for me. If you try it you probably need to get to higher doses for it to work. I went back to klonopin. Perhaps you never got to a dose high enough for you.

Many go to 4mgs for anxiety. Typically the sedation wears off, but the anti anxiety benifits don't. I've been on it 12 years and am currently at 2mgs, down from 3. Good luck.

 

Re: Has Anyone Tried These for Social Anxiety?

Posted by Tom Twilight on March 5, 2006, at 6:39:27

In reply to Re: Has Anyone Tried These for Social Anxiety?, posted by RobertDavid on March 5, 2006, at 2:39:54

Hi Jackson

Its good to see social anxiety being discussed on the board

I didn't have much luck with Lyrica/Pregabalin for SA, it worked initially but tollerance set in very quickly.

 

Re: Has Anyone Tried These for Social Anxiety?

Posted by Cairo on March 5, 2006, at 12:29:59

In reply to Has Anyone Tried These for Social Anxiety?, posted by Rocket Jackson on March 4, 2006, at 23:39:38

I just started Lyrica for neuropathic pain, but have noticed a modest improvement in mood and less anxiety (some social). Seem to have more energy, too, but it's almost a hyper feeling. May ask to taper dose down a bit, as I'm sensitive to meds.

Regarding improvement in social anxiety, I think my social anxiety is due BOTH to my pain, sleep, and fatigue issues as well as some garden variety social anxiety, but I'm thinking the improvement with Lyrica may be due to the improvement in pain, sleep and fatigue component. Just a guess.

Cairo

 

Re: Has Anyone Tried These for Social Anxiety?

Posted by Rocket Jackson on March 5, 2006, at 20:58:41

In reply to Re: Has Anyone Tried These for Social Anxiety?, posted by RobertDavid on March 5, 2006, at 2:39:54

Thanks for the helpful information. I'd love to try Klonopin daily in light of its benefit, but I'm worried I'll lose the substantial benefit I currently receive when I space my dosing out by 4-5 days. Maybe an increased dose on the days I anticipate more anxiety would do the trick if I indeed go with a daily attempt.

I'm happy to see your Klonopin continues to be effective after all these years. This almost seems to be the norm rather than the exception based on feedback from this site and others, which makes me want to give it a full daily effort over at least a few weeks to see if it really might work well for me (I've limited my daily attempts to 4 days in a row max in the past when it seemed the usual benefit had vanished). Do you feel it took days/weeks of consistent use before you found your therapeutic level?

And just curious- what's your current daily dosing regimen? You mentioned you're down to 2mg per day (great job by the way)... are you taking 1mg twice per day? I may try this type of schedule and titrate up slowly depending on effect.

Thanks again for the advice. I'll keep you posted.

> I tried to switch from klonopin to lyrica. The lyrica did nothing for me. If you try it you probably need to get to higher doses for it to work. I went back to klonopin. Perhaps you never got to a dose high enough for you.
>
> Many go to 4mgs for anxiety. Typically the sedation wears off, but the anti anxiety benifits don't. I've been on it 12 years and am currently at 2mgs, down from 3. Good luck.

 

Re: Has Anyone Tried These for Social Anxiety? Rocket Jackson

Posted by RobertDavid on March 6, 2006, at 0:13:17

In reply to Re: Has Anyone Tried These for Social Anxiety?, posted by Rocket Jackson on March 5, 2006, at 20:58:41


> And just curious- what's your current daily dosing regimen? You mentioned you're down to 2mg per day (great job by the way)... are you taking 1mg twice per day? I may try this type of schedule and titrate up slowly depending on effect.

You mentioned you were taking klonopin 4 days a week. Though I do think there are those that only need to take a benzo just here and there as needed for anxiety/panic (and those that take it PRN seem to like xanax or ativan) it's been my experience and impute from others that many truly need to take it daily for it to be effective.

Though the time it takes for relief does vary from person to person you should start to feel relief right away with it improving over a period of a few weeks. And it's my opinion that when taken daily it's best to stay with a benzo with a longer half like such as klonopin. By taking it every day at the same dose you get a maintained drug level in your blood/body which makes it work around the clock, less fluctuations. I would think that by taking it 4 days then stopping for three it would not work at well, blood levels going up and down, rebound anxiety, etc.

Though many do split doses, I have found (and it was my doctors opinion) that I only take it once a day at bedtime (when there is the most sedatioin). It's a high enough dose of a long acting drug to gain benefits around the clock. I think many split doses when they take smaller doses say .5 am and .5 pm. Others I know take the majority at night say 1.5 at night and .5 in the am. And some do equally spit doses. It's just trial and error. And you have to go through trial and error to find the dose that right as well. Again, most seem to fit somewhere between 1 and 4mgs, but I know many that take more, some less. I'd suggest starting low say .5 perhaps 1mg and with your doctors advise slowly go up. You'll know when your where you need to be. For me, I was at 3mgs for a while and which seemed just a little more than I needed so I backed down to 2.5 then settled in with 2mgs (12 years total).

It's just the right amount to takle my social and generalized anxiety, but not so much that I feel loaded. And though the sedative side effects generally lessen or go away, typically the anti anxiety benifits remain on going for most patients. Unless something else comes out and works, I'm fine (and so is my doctor) with taking klonopin the rest of my life. Why would I want to go back to the days of not wanting to leave the house, being so anxious I want to crawl out of my skin?

I think there are doctors and consumers that can be benzo phobic, but many that are not. Klonopin is a gold standard when treating anxiety disorters and in my opinion a great option particularly when other anti depressants have failed. As I recall you have tried other meds without success and I would encourage you to revisit klonopin on a daily basis, give it a few weeks to a month, then see how your doing. Doing a daily journal will help you look back and see how much you've improved (or not).

Lastly, many have this "addiction" fear. I hate that word. I believe that individuals with anxiety disorters do not abuse or become addicted to benzos (again, my doctor shares this belief). That most find the right dose and do not go higher and higher. And like so many other drugs if you want off, you just shouldn't quit all at once. You gradually taper off. It's not a life long sentance. But if you do taper off many should mearly expect their old symptoms to return. Yes, it can be work getting off, but the key to minimize it is a very slow taper.

Sorry to be so detailed and long here, just thought some of this may help you. Whatever you do there is always hope, a new med, therapy, etc. Don't ever give up. Best of luck.

Rob

 

Re: Has Anyone Tried These for Social Anxiety?

Posted by Caedmon on March 11, 2006, at 15:42:04

In reply to Has Anyone Tried These for Social Anxiety?, posted by Rocket Jackson on March 4, 2006, at 23:39:38

Hi,

I've had success treating my SP with 100-125 mg Topamax. Originally rx'ed for said anxiety + binge eating (very off-label). I feel like 25mg topiramate is roughly equivalent to 5mg diazepam, for me, although I realize one can't really compare the two as they work differently.

I have experienced very little cognitive problems - my main complaint is lack of coordination and drowsiness, which have slowly subsided. The Dopamax effect seemed to hit me with dose increases but didn't stick around. I have not lost weight, but at least I no longer binge eat. Slow dose titration really helps. Good luck.



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