Psycho-Babble Medication Thread 1040349

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New to Posting: Meds Social Anxiety / Atypical Dep

Posted by aster on March 14, 2013, at 18:00:28

Hello everyone. I am new to posting but have been reading here on and off for the past few years. Thanks to all of you for keeping this site fresh and lively. Lots of great info here.

So here is my maiden voyage question: What meds would you suggest for social anxiety and atypical depression? I am waiting until next month until I have insurance again and am leaning towards trying some more SSRIs before I give into an MAOI. I have had fairly severe social anxiety and depression since my early teens and have been on a number of medications with no help yet. So far I have tried (but am on nothing now): Klonopin 3mg/day for 4 years, Paxil (didn't really give it a fair trial because of intense anxiety/agitation + increasing SI), Zoloft (same thing), Prozac (short trial, can't remember why i came off of it), Effexor XR (max dosage for 5 months), lamictal (3 months therapeutic dose), vistaril (3 months, PRN anxiety + paranoia), Celexa (4 months at therapeutic dose), Lexapro, Wellbutrin (short trial due to agitation + anxiety), St Johns Wort (I think this made me hypomanic for a number of months but didn't work other times I've tried it 900 mg/day). I know I didn't really give some of these a fair trial but when you're feeling terrible already its difficult to stick out the intense side effects sometimes. Eventually the Klonopin wasn't doing much for me socially and I was addicted, as well to alcohol. I am since not using any drugs or alcohol and haven't for going on a year in a couple months. For this reason benzos and stimulants are out of the question at this time. I am also aware that my use of alcohol at the time of trialing some of these meds probably didn't help much.

I am willing to try some of these again like Paxil, Wellbutrin, and Prozac. I am thinking I will ask for Prozac and a Beta blocker at my next appointment. Basically I sleep too much, don't get out unless its to work or the grocery store. I work overnights so i don't have to interact with anyone. But really I have avoided so much throughout my life and don't have very high expectations. But the depression, SI, intense anxiety and lethargy/oversleeping is really making things difficult and am ready to trial some meds again. Any thoughts are much appreciated. Thanks


Re: New to Posting: Meds Social Anxiety / Atypical Dep

Posted by Tomatheus on March 14, 2013, at 20:56:00

In reply to New to Posting: Meds Social Anxiety / Atypical Dep, posted by aster on March 14, 2013, at 18:00:28


Hello, and welcome to Psycho-Babble. Unfortunately, I can identify with a lot of the symptoms that you've been experiencing, and even though my medication responses haven't been the same as yours have been, I can identify with having difficulty finding a treatment or combination of treatments that successfully relieves my symptoms -- especially the symptoms associated with my chronic fatigue or vegetative depression. It might not be a bad idea to try an SSRI again, perhaps with a beta blocker, although considering the fact that you haven't been responsive to that type of antidepressant in the past, I don't know how optimistic I'd be about being treated with yet another SSRI. It sounds from your symptoms like you could be a potential MAOI responder, but I can understand wanting to wait until you've tried some more non-MAOI antidepressants before "giving in" to Nardil, Parnate, Marplan, or EMSAM. Other options that you might want to consider would be Remeron and the tricyclic antidepressants, although these antidepressants (from what I understand) tend to promote somnolence and as a result may not be the best choices for someone like you (or me) who suffers from hypersomnia.

I don't have much else to say right now other than to recommend hanging in there and doing everything else that you can to keep your symptoms at bay. Talk therapies, while they may not give you the boost in energy that you need, are oftentimes more helpful in combination with medications for depressive disorders than they are alone. As you probably know, therapy can at least give you the tools to help you cope with your illness and can also help you take the steps that you'll need to take to overcome any functional impairment that you're experiencing once you find a medication that helps you. There are also other strategies that tend to be recommended for people with depressive disorders, such as exercise and meditation. Not everyone necessarily finds such strategies to be effective, but some do, and I think that they're at least worth pursing along with medications.

Well, that sums up everything I have to say now. I wish you luck with your treatment and hope that you get some good suggestions from other members here regarding medications to try.



Re: New to Posting: Meds Social Anxiety / Atypical Dep aster

Posted by Catling on March 14, 2013, at 21:54:49

In reply to New to Posting: Meds Social Anxiety / Atypical Dep, posted by aster on March 14, 2013, at 18:00:28

Hi Aster,

Welcome! Now I'm not the newest member anymore! :D

The two newer medications you may want to look into that come to mind if you're going the ssri/snri route are Viibryd and Cymbalta (a SSNRI). While they didn't work for me, I know that some people have had good luck with those.

In addition to the exercise and meditation that Tomatheus recommended, I would recommend a good multi vitamin. A lot of times it's difficult for those of us who are depressed to get the nutrition that we need because we don't eat right/infrequently/etc. Most multivitamins aren't actually absorbed by the body well, if you can get to a health food store ask for a multivitamin made with real food. Your body will absorb more of the nutrients and you're not putting more chemicals in under the guise of "nutrition". This will also help support whatever medication you and your doctor decide on.

Best of luck,


Re: New to Posting: Meds Social Anxiety / Atypical Dep

Posted by aster on March 15, 2013, at 9:11:17

In reply to Re: New to Posting: Meds Social Anxiety / Atypical Dep, posted by Tomatheus on March 14, 2013, at 20:56:00

Thank you Tomatheus and Cat. It means a lot to have the nice welcomes and thoughtful replies as a newcomer. Tomatheus, I'm enjoying reading through your blog a little about your experiences with meds. I read that you had quite a strong response to Paxil. Did you have difficulty getting off of it? I hesitate to choose this drug again because of some people's reactions to withdrawal. I hope your abilify is helping you now. And thank you for the ideas on alternatives (both of you). Although I tell myself I don't have the motivation or that it won't help to exercise or meditate or take another multivitamin, I do know that it would help at least a little. I haven't ventured to try either of the SNRIs yet that you mentioned Cat. I will keep them as ideas. Its good to know that someone benefited socially from them.

I know it is highly individual but what meds have you both found to be most effective for atypical depression and social anxiety? Thanks again


Re: New to Posting: Meds Social Anxiety / Atypical Dep aster

Posted by Phillipa on March 15, 2013, at 10:01:36

In reply to Re: New to Posting: Meds Social Anxiety / Atypical Dep, posted by aster on March 15, 2013, at 9:11:17

Don't disregard benzos for short term getting up and out and relieving anxiety as they work extremly well when one takes them been on the over 40 years where now don't actually feel them I know they must be doing something. And through all these years I never took more and at times took none. And another welcome to babble!!! Phillipa


Re: New to Posting: Meds Social Anxiety / Atypical Dep aster

Posted by Tomatheus on March 15, 2013, at 11:06:04

In reply to Re: New to Posting: Meds Social Anxiety / Atypical Dep, posted by aster on March 15, 2013, at 9:11:17


Thank you for responding and for also reading my blog. I actually didn't have any difficulty coming off of Paxil, and I understand that such a response is atypical. I still wonder if maybe my back-and-forth type of response to the medication (where I was experiencing either euthymia or hypomania for a few days, followed by fatigue or depression for a few days, before the cycle repeated itself) might have been why I noticed no withdrawal symptoms after I stopped Paxil. In other words, I'm thinking that maybe because I never felt a certain way for an extended period of time on Paxil and was constantly going back and forth as far as my affective state was concerned, perhaps my biochemistry was also fluctuating on the medication, and my body never became too accustomed to a certain biochemical response, if that makes any kind of sense. Of course, that's just a guess of mine, and I don't really know why I didn't experience withdrawal after I discontinued Paxil, but for me, strangely enough, there was no withdrawal.

I take Abilify now mainly not for its antidepressant properties, but for its antipsychotic properties, because after about seven years of experiencing my symptoms of chronic fatigue, or vegetative depression, I suddenly started experiencing psychotic symptoms along with cognitive problems about six years ago. This was three months into a trial on tranylcypromine (generic Parnate) and SAM-e (a combination that's not recommended to be taken) that I was responding partially to, as far as my chronic fatigue and vegetative depression were concerned. I had previously attributed the onset of my psychosis and cognitive problems to a medication that I tried before these symptoms presented themselves called aminoguanidine, but after recently going through some old e-mails and noticing that I took aminoguanidine a month before the onset of my psychosis and cognitive problems (as opposed to right before these symptoms came on), I reached the conclusion that aminoguanidine most likely did not contribute to the onset of my psychosis and cognitive problems. So, I'm responding reasonably well to Abilify as an antipsychotic, although I don't find its antidepressant/antifatigue properties to be very pronounced.

What I'm taking for my chronic fatigue, or vegetative depression, right now, is vitamin D3. I've only been taking the vitamin for less than a week, but so far, I'm rather pleased by the results. I recently visited an orthomolecular treatment center and had some tests done, and the results that came back indicated that my white blood cells were high (which is a finding that's been coming back for years when I've been hospitalized) and that my vitamin D level was low. So, that's why I'm taking the vitamin D3. I actually think that visiting an orthomolecular doctor, or perhaps a naturopathic doctor if you don't live near an orthomolecular doctor, might be a good idea if you feel like you're stuck, as far as your mental conditions are concerned. I don't know for sure how vitamin D is going to work out in the long run for me, but for me, going to an orthomolecular doctor at least gave me some idea as to what's going on in my body so more informed treatment decisions could be made. You and others on this board might find such an approach to be helpful.

Although I do suffer from hypersomnia and a little bit of leaden paralysis, I would say that my "depression" (if I can call it that -- I tend to prefer to refer to it as a fatigue) is more melancholic than it is atypical. So, what I can tell you about the treatments for atypical depression and social anxiety is based less on my own experiences than it is on what I've read. But as far as my experience with chronic fatigue or vegetative depression is concerned, the only antidepressant that ever significantly relieved my symptoms for more than a few days at a time was Nardil. Although I wouldn't say that I have atypical depression or social anxiety, Nardil did exert significant therapeutic benefits for longer than any other antidepressant than I tried. And it does seem to be stated often that Nardil is considered to be the "gold standard" of treatment for both atypical depression and social anxiety. So, as far as effectiveness is concerned, Nardil seems like it would be the go-to medication for atypical depression and social anxiety, but it's not usually a first choice for these conditions because of the medication's potential for interactions and because individuals taking Nardil must follow a restricted diet. Nardil may also be less effective than it used to be before its formulation was changed in 2003, but some people still seem to respond to the medication, and I think it's certainly something that's worth trying, especially if all else has failed.

Well, I'm sorry for making this post as long as I did, but I hope that you find the information that I've provided here to be of some use. As I did in my last post, I'd like to wish you luck with your treatment. Hopefully you'll find a treatment of combination of treatments that will serve you well, and hopefully that will be sooner rather than later.



Re: New to Posting: Meds Social Anxiety / Atypical Dep aster

Posted by Catling on March 15, 2013, at 13:41:35

In reply to Re: New to Posting: Meds Social Anxiety / Atypical Dep, posted by aster on March 15, 2013, at 9:11:17

Hi again, Aster. :)

I would have to say that brand name Wellbutrin has worked the best on depression out of anything I've ever tried. I have more anxiety when I'm on it because the depression isn't masking any of my anxiety and that can feel sometimes even worse than the depression - which at least I'm used to. As Phillipa mentioned, don't be afraid to try benzos if you need them for anxiety. There is so much social stigma around them and I had a really hard time taking them at first because my friends were all saying, "Oh my god, you're gonna get hooked on those!" Which, in retrospect, has made me very careful with them and makes me really evaluate whether I need them at any given moment or not so I suppose that's not a bad thing.

Aside from Wellbutrin, I would say that I am responding "best" to Parnate. I say best because even though I have some response it is not enough. I am not motivated to do even things I want to do, let alone the things I need to do. I cannot maintain a daily routine. I find even simple tasks like personal care sometimes are beyond me. But I do make it out of bed every day, I can hold conversations with people close to me and while I don't feel "strong" enough to leave the house (other than my weekly scheduled visits with my BFF) more than a couple times a month at best, I am more functional than if I wasn't on it. Most troublesome to me though is that I cannot write, and as someone who is a poet, even though unpublished, not being able to think "in poetry" is still disheartening. Those are the things I am hoping to get back by adding an antipsychotic to the mix.

I've always had to treat my anxiety separately from my depression. It is very strong just on a general everyday basis and that much worse when in crowds. Luckily I've had doctors who have taken that seriously, because in some ways it can be more debilitating than the depression for me in terms of quality of life. Back before treating my anxiety, a trip to the grocery store would lay me up in bed for a couple days.

Gabapentin and then lyrica have worked the best for me on anxiety. I haven't found that any of the antidepressants have helped significantly with my anxiety. I can't tolerate anything that makes me groggy and a lot of what they want to prescribe for anxiety can do that to me. I've tried trazadone, serzone (which a lot of doctors are afraid of prescribing because of the liver thing, but the doctor who prescribed it for me felt the risk was truly minimal and that it gets a lot of bad hype), vistaril, etc and found them to be sedating without touching my actual anxiety, if that makes sense. I don't want to be less aware, I just want to not feel anxiety and there's a really distinct difference for me between the two. I used to use xanax for panic attacks and ativan for social anxiety/breakthrough anxiety (when my meds aren't keeping my general anxiety sufficiently in check). Thank goodness that as my depression has gotten worse the panic attacks have mostly stopped because they were awful. I still use ativan as needed but my anxiety is pretty well controlled with the lyrica and I don't use it often, maybe 3 times a month. But also it's fair to mention that since I don't go out I'm not in as many triggering situations.

I hope you get a really good doctor and that you can find one medication that will work for both issues for you. That is really the ideal, I think. I really try to stick with as few medications and at as low a dose is effective because I hate taking medicine and even after a decade of using psych meds, I'm still a bit unresigned to needing them. ;)

Sorry for the rambly.

Best of luck.


Re: New to Posting: Meds Social Anxiety / Atypical Dep

Posted by joe schmoe on March 15, 2013, at 17:40:36

In reply to Re: New to Posting: Meds Social Anxiety / Atypical Dep aster, posted by Catling on March 15, 2013, at 13:41:35

Personally, I found a combination of Celexa and Klonopin to be very helpful for atypical depression and social anxiety.

Wellbutrin made me very anxious and also angry, and caused chest pain.


Re: New to Posting: Meds Social Anxiety / Atypical Dep

Posted by aster on March 16, 2013, at 11:37:55

In reply to Re: New to Posting: Meds Social Anxiety / Atypical Dep, posted by joe schmoe on March 15, 2013, at 17:40:36

Thanks everyone for sharing your experiences. I sometimes read horror stories about side effects with Nardil and Paxil. Weight gain for both and sleep/anxiety issues. Any ideas as to whether Paxil is really that more effective than any other SSRIs for social anxiety? I don't know if its worth bearing the agitation issues getting through the trial or whether I should just go for something like Prozac that doesn't seem to have the agitation and weight gain issues. Thanks again everyone, and hope all are doing well

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