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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Rocket Jackson on March 7, 2006, at 9:11:52
Hello,
I apologize for the recent onslaught of new threads, but I truly do appreciate all of your feedback thus far. It's always good to hear what's currently "working" out there for those of you who suffer from social anxiety disorder. Having known of my diagnosis for about 5 years but suffered for many more, I've done quite a bit of research on the topic over the past few years. But as most of you know, what is currently approved by the FDA or even showing "promise" in studies doesn't always pan out anecdotally in the real world.
Being a medical school graduate, I took particular interest in anxiety disorders (specifically social anxiety) during my 6 week Psychiatry rotation. It was then that I realized the true void that has existed among the medical field (even Psychiatry) in social anxiety knowledge and treatment. I've seen so many docs quote the same rehashed lines (e.g. SSRIs are the first-line and effective treatment of social phobia) and either don't realize or don't care to realize what really does or doesn't work for patients, not to mention acknowledgement of the nasty side effects. This is quite frustrating to say the least, which is one of the many reasons why forums such as these are so valuable.
With that said, what have you found has been the best treatment so far in your experience? As I've mentioned in other posts, I currently take Klonopin 2mg + Provigil 200mg every 3-5 days prn for events or activities I anticipate will cause more anxiety than the typical baseline level I experience in my everyday living. I'm desperately looking for a daily treatment to add to my regimen to fill in the gaps, and have found Lexapro, Zoloft, Neurontin, Gabitril, Cymbalta, Buspar, and Wellbutrin to be complete busts. I've made a few attempts with daily Klonopin in the past, but it seems to lose its optimal effect when I take it more than 3 days or so. However, this really may be a case of taking an inadequate dose, less-than-optimal times or spacing, or just plain not taking it long enough to achieve good therapeutic levels. I just know how wonderfully it works when I do wait a few days between doses, and I don't want to lose that.
Thanks for all of your support. It's great to see how much feedback exists for all of us who suffer from our various ailments.
Take care,
Rocket
Posted by TylerJ on March 7, 2006, at 10:24:06
In reply to What's your current social anxiety med regimen?, posted by Rocket Jackson on March 7, 2006, at 9:11:52
> Hello,
>
> I apologize for the recent onslaught of new threads, but I truly do appreciate all of your feedback thus far. It's always good to hear what's currently "working" out there for those of you who suffer from social anxiety disorder. Having known of my diagnosis for about 5 years but suffered for many more, I've done quite a bit of research on the topic over the past few years. But as most of you know, what is currently approved by the FDA or even showing "promise" in studies doesn't always pan out anecdotally in the real world.
>
> Being a medical school graduate, I took particular interest in anxiety disorders (specifically social anxiety) during my 6 week Psychiatry rotation. It was then that I realized the true void that has existed among the medical field (even Psychiatry) in social anxiety knowledge and treatment. I've seen so many docs quote the same rehashed lines (e.g. SSRIs are the first-line and effective treatment of social phobia) and either don't realize or don't care to realize what really does or doesn't work for patients, not to mention acknowledgement of the nasty side effects. This is quite frustrating to say the least, which is one of the many reasons why forums such as these are so valuable.
>
> With that said, what have you found has been the best treatment so far in your experience? As I've mentioned in other posts, I currently take Klonopin 2mg + Provigil 200mg every 3-5 days prn for events or activities I anticipate will cause more anxiety than the typical baseline level I experience in my everyday living. I'm desperately looking for a daily treatment to add to my regimen to fill in the gaps, and have found Lexapro, Zoloft, Neurontin, Gabitril, Cymbalta, Buspar, and Wellbutrin to be complete busts. I've made a few attempts with daily Klonopin in the past, but it seems to lose its optimal effect when I take it more than 3 days or so. However, this really may be a case of taking an inadequate dose, less-than-optimal times or spacing, or just plain not taking it long enough to achieve good therapeutic levels. I just know how wonderfully it works when I do wait a few days between doses, and I don't want to lose that.
>
> Thanks for all of your support. It's great to see how much feedback exists for all of us who suffer from our various ailments.
>
> Take care,
>
> RocketI've been battling Social Phobia for years. I've tried every drug you mentioned above and a lot more, to no avail. FOR ME, Parnate (which I'm currently taking) did the trick. For the first time in years, or maybe ever, I have zero S.P. I actually start conversations with strangers and really enjoy social interaction...I used to avoid it most of the time, or at best i was uncomfortable in social situations and sometimes miserable. Parnate has been my miracle drug...no depression, no ocd, no sp, and no anxiety. I take 80 mgs all in the morning and it works great all day long. I've been on it for 1 month.
It took only 1 wk. to start working.
Tyler
Posted by Rocket Jackson on March 7, 2006, at 13:17:34
In reply to Re: What's your current social anxiety med regimen? » Rocket Jackson, posted by TylerJ on March 7, 2006, at 10:24:06
Hi Tyler,
Thanks for the message. I'm glad to hear the Parnate is working so well. I've considered one of the MAOIs, but am concerned about side effects such as sexual dysfunction, weight gain, etc. Have you noticed these or others?
Also, do you find the dietary restrictions to be a major intrusion in your normal lifestyle?
Thanks again,
Rocket
> > Hello,
> >
> > I apologize for the recent onslaught of new threads, but I truly do appreciate all of your feedback thus far. It's always good to hear what's currently "working" out there for those of you who suffer from social anxiety disorder. Having known of my diagnosis for about 5 years but suffered for many more, I've done quite a bit of research on the topic over the past few years. But as most of you know, what is currently approved by the FDA or even showing "promise" in studies doesn't always pan out anecdotally in the real world.
> >
> > Being a medical school graduate, I took particular interest in anxiety disorders (specifically social anxiety) during my 6 week Psychiatry rotation. It was then that I realized the true void that has existed among the medical field (even Psychiatry) in social anxiety knowledge and treatment. I've seen so many docs quote the same rehashed lines (e.g. SSRIs are the first-line and effective treatment of social phobia) and either don't realize or don't care to realize what really does or doesn't work for patients, not to mention acknowledgement of the nasty side effects. This is quite frustrating to say the least, which is one of the many reasons why forums such as these are so valuable.
> >
> > With that said, what have you found has been the best treatment so far in your experience? As I've mentioned in other posts, I currently take Klonopin 2mg + Provigil 200mg every 3-5 days prn for events or activities I anticipate will cause more anxiety than the typical baseline level I experience in my everyday living. I'm desperately looking for a daily treatment to add to my regimen to fill in the gaps, and have found Lexapro, Zoloft, Neurontin, Gabitril, Cymbalta, Buspar, and Wellbutrin to be complete busts. I've made a few attempts with daily Klonopin in the past, but it seems to lose its optimal effect when I take it more than 3 days or so. However, this really may be a case of taking an inadequate dose, less-than-optimal times or spacing, or just plain not taking it long enough to achieve good therapeutic levels. I just know how wonderfully it works when I do wait a few days between doses, and I don't want to lose that.
> >
> > Thanks for all of your support. It's great to see how much feedback exists for all of us who suffer from our various ailments.
> >
> > Take care,
> >
> > Rocket
>
> I've been battling Social Phobia for years. I've tried every drug you mentioned above and a lot more, to no avail. FOR ME, Parnate (which I'm currently taking) did the trick. For the first time in years, or maybe ever, I have zero S.P. I actually start conversations with strangers and really enjoy social interaction...I used to avoid it most of the time, or at best i was uncomfortable in social situations and sometimes miserable. Parnate has been my miracle drug...no depression, no ocd, no sp, and no anxiety. I take 80 mgs all in the morning and it works great all day long. I've been on it for 1 month.
> It took only 1 wk. to start working.
>
>
> Tyler
Posted by luca1975 on March 7, 2006, at 13:36:36
In reply to Re: What's your current social anxiety med regimen? ? TylerJ, posted by Rocket Jackson on March 7, 2006, at 13:17:34
How about the NK1 antagonists?
I know of a study under way at the moment in my city, most likely in yours as well.
Posted by TylerJ on March 7, 2006, at 16:07:48
In reply to Re: What's your current social anxiety med regimen? » TylerJ, posted by Rocket Jackson on March 7, 2006, at 13:17:34
Rocket,
No weight gain, actually have a reduced appetite-still healthy but reduced. Only sexual side-effects are major increase in Libido, takes a little longer to orgasm but definitely no anorgasmia, and my erections are still very full and firm...my wife likes my sexual "side effects" :)Tyler
Posted by Rocket Jackson on March 7, 2006, at 17:59:40
In reply to Re: What's your current social anxiety med regimen? » Rocket Jackson, posted by TylerJ on March 7, 2006, at 16:07:48
Man, Tyler you sure are selling me on Parnate. I know milage may vary by individual, but it sure is great to see someone getting such great benefit from a medication. I see my Psychiatrist tomorrow and may very well suggest the Parnate option. Can't hurt to try!
Take care, and thanks again for your input!
> Rocket,
> No weight gain, actually have a reduced appetite-still healthy but reduced. Only sexual side-effects are major increase in Libido, takes a little longer to orgasm but definitely no anorgasmia, and my erections are still very full and firm...my wife likes my sexual "side effects" :)
>
> Tyler
Posted by TylerJ on March 7, 2006, at 19:03:05
In reply to Re: What's your current social anxiety med regimen? » TylerJ, posted by Rocket Jackson on March 7, 2006, at 17:59:40
> Man, Tyler you sure are selling me on Parnate. I know milage may vary by individual, but it sure is great to see someone getting such great benefit from a medication. I see my Psychiatrist tomorrow and may very well suggest the Parnate option. Can't hurt to try!
>
> Take care, and thanks again for your input!
>
> > Rocket,
> > No weight gain, actually have a reduced appetite-still healthy but reduced. Only sexual side-effects are major increase in Libido, takes a little longer to orgasm but definitely no anorgasmia, and my erections are still very full and firm...my wife likes my sexual "side effects" :)
> >
> > Tyler
>
>Good for you. It's definitely the best I've ever been on..and although everbody's different, it may very well work for you. It's definitely worth a try! I wish you the very best, and please don't hesitate to contact me any time.
Tyler :)
also, Parnate can cause insomnia. So if you do try it make sure He gives you something for that. I take Trazodone.
Posted by jedi on March 8, 2006, at 1:04:52
In reply to What's your current social anxiety med regimen?, posted by Rocket Jackson on March 7, 2006, at 9:11:52
Hey Rocket,
For me the best treatment for social anxiety was Nardil combined with clonazepam. I am diagnosed with treatment resistant, major atypical depression (currently in remission) with social and generalized anxiety disorder. I am not currently taking Nardil, but it is the only medication that brought me out of at least three major depressions over the past ten years. It is also the gold standard for treatment of social anxiety. If not for the side effect of weight gain (severe carbohydrate cravings), I would probably be happy taking Nardil the rest of my life. But, because of this side effect, I try to quit the medication every few years. I wish that Parnate would have worked for me, but no such luck.I still take 1mg of clonazepam daily for the social anxiety. It helps, but is not as potent as the combination of Nardil with clonazepam. Currently I take 2400mg of EPA and 2000mg of DHA along with the clonazepam. I believe these fatty acids act as a mood stabilizer and enabled me to wean off the Nardil over a six week period. Because I am a long term daily user of clonazepam, I don't feel the "sigh" of relief that people get when using benzos prn. But I know it is still working on the social and generalized anxiety.
Good luck & take care,
Jedi...
> With that said, what have you found has been the best treatment so far in your experience? As I've mentioned in other posts, I currently take Klonopin 2mg + Provigil 200mg every 3-5 days prn for events or activities I anticipate will cause more anxiety than the typical baseline level I experience in my everyday living. I'm desperately looking for a daily treatment to add to my regimen to fill in the gaps, and have found Lexapro, Zoloft, Neurontin, Gabitril, Cymbalta, Buspar, and Wellbutrin to be complete busts. I've made a few attempts with daily Klonopin in the past, but it seems to lose its optimal effect when I take it more than 3 days or so. However, this really may be a case of taking an inadequate dose, less-than-optimal times or spacing, or just plain not taking it long enough to achieve good therapeutic levels. I just know how wonderfully it works when I do wait a few days between doses, and I don't want to lose that.
>
> Thanks for all of your support. It's great to see how much feedback exists for all of us who suffer from our various ailments.
>
> Take care,
>
> Rocket
Posted by Phillipa on March 8, 2006, at 17:44:48
In reply to Re: What's your current social anxiety med regimen? » Rocket Jackson, posted by jedi on March 8, 2006, at 1:04:52
Are they really teaching you about the MAOI's in medical school? Fondly, Phillipa
Posted by Rocket Jackson on March 8, 2006, at 22:09:23
In reply to Re: What's your current social anxiety med regimen?, posted by Phillipa on March 8, 2006, at 17:44:48
> Are they really teaching you about the MAOI's in medical school? Fondly, Phillipa
They covered the MAOIs in my second-year Pharmacology course in med school and a little on the boards (mostly the classic food restriction questions and how to treat the hypertensive crises), but that was pretty much it. Occasionally a patient would be on an MAOI when admitted as an inpatient for some other medical problem, and this had to be considered when deciding what treatment to start in the hospital. I really wish I would've had more exposure in my Psychiatry rotation, but it took place at a state facility where we mostly rotated in forensics. Overall, very little exposure unfortunately.
Take care,
Rocket
Posted by tizza on March 10, 2006, at 18:59:02
In reply to Re: What's your current social anxiety med regimen? » Phillipa, posted by Rocket Jackson on March 8, 2006, at 22:09:23
They only thing that seems to help me is Valium, I just pop 5 or 10mg before an event and out the door I go, Xanax worked too well (addictive) and clonazepam was OK. I have found that over the last 10 to 12 years that benzo's are the only thing that work for me. No SSRI, SNRI, Tri Cyclic or RIMA has done anything for me in that reguard but I have never tried a MAOI and I'm not willing to becase my diet basically revolves around everything you can't eat and I'd probably forget or go insane about the restrictions. Smoked salmon, salami, aged meets, cheeses, red wine, etc, FORGET IT. Paul.
Posted by Caedmon on March 11, 2006, at 15:55:37
In reply to What's your current social anxiety med regimen?, posted by Rocket Jackson on March 7, 2006, at 9:11:52
I may as well include my full Rx regimen:
Wellbutrin SR 300mg
Topamax 125mg
Risperdal 1mg
Fish oil 3 g EPA/DHA
Diazepam 5-15mg (prn)I recently d/c Effexor. Gave me tinnitus. I'm in the midst of d/c'ing whatever meds I can, since I feel I'm on too many.
You are absolutely right about no one knowing how to treat social phobia. Add to that, the general benzophobia prevalent in the medical community (when benzodiazepines are generally well-tolerated and effective), and... getting good Tx pretty well stinks.
I should mention that my Sx are more along a depressed-avoidant axis than an anxious one. Chronic low self-esteem and all that. So far one of the best drugs I've taken for SP has been modafinil, but it's way too expensive. I'm eagerly anticipating a price drop when it goes to pharmacy shelves for ADHD this year, or the patent expires in June, whichever happens quicker. I hope Cephalon doesn't manage to keep the patent.
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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