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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by TubalCain on April 9, 2014, at 20:28:40
Since adolescence I have suffered from facial blushing. It is not just a reddening of the cheeks but a deep red flush of the entire face. At other times my face, neck, and chest will have red splotches on them. This causes social anxiety.
When I was 17 I was prescribed Paxil. For a number of years this completely eradicated the blushing and my social anxiety went away.
Over the years the efficacy of Paxil diminished. After about 10 years I decided to try some other medications but the results were not good:
Buspar - no help
Effexor - minimal help
Inderal - may have helped but had bad side effects (heart rate too low?)
Metoprolol - minimal help
Clonidine - minimal help
Xanax - minimal helpI'm now 33 and have gone back on 50mg of Paxil. I tried Remeron along with the Paxil for awhile but noticed little difference in the blushing.
I have a few questions I was hoping someone here might be able to answer:
First, why would the Paxil become less efficacious over time? Are there additional medications I could try that might restart Paxil's potency?
Second, would trying a different SSRI be a good idea? Or have I probably built up a tolerance to all of them?
Third, are there any other medications you think might help with this condition?
Thanks for any advice. Feel free to ask me questions.
Posted by Christ_empowered on April 9, 2014, at 22:10:30
In reply to Supplement to Paxil for facial blushing?, posted by TubalCain on April 9, 2014, at 20:28:40
"Poop out" is when an AD (often an sri) stops working. The brain adapts to drug-induced changes, and that might explain it.Maybe...Cymbalta? Effexor xr? Klonopin (the go-to benzo for social phobia) plus whatever AD(s) you select?
I do Orthomolecular. Its high dose vitamins w/ your meds. I know, sounds like hippy BS. It works for some people.
The core of OM is high dose C (I use time release, 2x daily), high dose B complex (I use a time release B-100), and high dose niacin or niacinamide (I use niacinamide). Niacinamide functions kinda sorta like a benzo, like Xanax, would, but it does more over time....
...anyway, there's lots of stuff to augment ADs with. I wouldn't try another sri, personally; I'd add something in. Tapering off a high dose of Paxil can be a pain, and that's the last thing you'd need right now (my personal take on it..clearly, I'm not an MD).
You could add: an old school TCA (maybe Surmontil?), Neurontin, lyrica, switch to Effexor and add remeron...
...there's options!
Posted by Phillipa on April 9, 2014, at 22:20:02
In reply to Re: Supplement to Paxil for facial blushing?, posted by Christ_empowered on April 9, 2014, at 22:10:30
Were you depressed at age 17? If not why paxil an ad? Phillipa
Posted by ed_uk2010 on April 10, 2014, at 15:20:02
In reply to Supplement to Paxil for facial blushing?, posted by TubalCain on April 9, 2014, at 20:28:40
>Second, would trying a different SSRI be a good idea? Or have I probably built up a tolerance to all of them?
You could certainly try one. I'd suggest sertraline (Zoloft), citalopram (Celexa) or escitalopram (Lexapro).
Posted by TubalCain on April 10, 2014, at 18:54:39
In reply to Re: Supplement to Paxil for facial blushing?, posted by Christ_empowered on April 9, 2014, at 22:10:30
> The core of OM is high dose C (I use time release, 2x daily), high dose B complex (I use a time release B-100), and high dose niacin or niacinamide (I use niacinamide).
If you don't mind, what constitutes a "high dose" of each vitamin? Even better, what specific brands, if any, do you order?
> You could add: an old school TCA (maybe Surmontil?), Neurontin, lyrica, switch to Effexor and add remeron...
I will look into these. I have tried Remeron alongside the Paxil but I don't think it helped.
Posted by TubalCain on April 10, 2014, at 18:55:37
In reply to Re: Supplement to Paxil for facial blushing?, posted by Phillipa on April 9, 2014, at 22:20:02
> Were you depressed at age 17? If not why paxil an ad? Phillipa
I was not depressed at 17. I was diagnosed with social anxiety disorder and I believe SSRIs are commonly prescribed for that condition.
Posted by Phillipa on April 10, 2014, at 19:48:31
In reply to Supplement to Paxil for facial blushing?, posted by TubalCain on April 10, 2014, at 18:55:37
Personally I have not had them help with anxiety. Panic or social. Any other meds you tried? Phillipa
Posted by jono_in_adelaide on April 11, 2014, at 0:49:22
In reply to Re: Supplement to Paxil for facial blushing? » TubalCain, posted by Phillipa on April 10, 2014, at 19:48:31
I'd try Inderal at a lower doseage, as little as 10mg twice a day can help facial flushing.
Are you sure it isnt rosacea?
Posted by phidippus on April 11, 2014, at 14:36:16
In reply to Supplement to Paxil for facial blushing?, posted by TubalCain on April 9, 2014, at 20:28:40
>First, why would the Paxil become less efficacious over time?
This can sometimes be caused by depletion or marked reduction of the amount of neurotransmitter responsible for creating the drug's effect, or by the depletion of receptors available to which the drug or neurotransmitter can bind. This depletion is caused by the cells reducing the number of receptors in response to their saturation.
>Are there additional medications I could try that might restart Paxil's potency?
Why not just try another similar medication, such as Prozac, Zoloft, Luvox, Viibryd, Lexapro, Celexa, Brintallix, etc.
>Second, would trying a different SSRI be a good idea?
It would be the best idea.
>Or have I probably built up a tolerance to all of them?
No, each SSRI is a unique molecule which your body hasn't responded to yet.
>Third, are there any other medications you think might help with this condition?
http://eredicane.com/?gclid=CLGUroWX2b0CFYdFMgodBngALA
Eric
Posted by TubalCain on April 11, 2014, at 18:05:26
In reply to Re: Supplement to Paxil for facial blushing?, posted by jono_in_adelaide on April 11, 2014, at 0:49:22
> Are you sure it isnt rosacea?
I don't have any other symptoms that make me think it's rosacea. I've read that blushing or flushing can be the first sign of rosacea so it's impossible to rule out completely.
Posted by Phillipa on April 11, 2014, at 21:24:35
In reply to Supplement to Paxil for facial blushing?, posted by TubalCain on April 11, 2014, at 18:05:26
See a dermatologist? Phillipa
This is the end of the thread.
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