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Hi from another 'symptomological soulmate'; my 2 Billb

Posted by S.D. on August 13, 2000, at 18:11:56

In reply to Cam and Others, Social Anxiety Cocktail Evaluation, posted by Billb on August 10, 2000, at 18:59:02

Your post, and AndrewB's reply, bring up a couple of questions I've had for a long time, which I'll post soon in separate new threads. One is how several here with SAD have spouses when I can't even get a gf...
Other than that bright spot in your life and perhaps the lower severity of your SAD that it implies to me (not to minimize your suffering; just envious), from your description of yourself we could almost be twins.

My 2...
As AndrewB and others can also tell you, there are a several meds that can fight SAD. Some specifics:

SSRIs can help and since one (Paxil) has helped you, but not for SAD, something to consider would be a switch to one of the other SSRIs. But I would empathize with reluctance to risking loss of the benefits that Paxil was able to provide.
Beta-adrenergic blockers work on your sympathetic nervous system to specifically inhibit physical symptoms of anxiety, which you described were prominent. These are usually used "as-needed" for particular "performance" situations such as speaking to a group of people. Inderal (generic name propranolol) is typical example of this type.
Some other meds fight SAD for some people. Particularly, perhaps, (my own impression) the symptom you described which is one of those with which I am agonizingly familiar:
"I was more apt to speak up in meetings, out of
apparent instinct, rather than the usual gut
wrenching decision making process that usually
proceeds speaking up"

Klonopin (generic = clonazepam, which might not be as strong/effective) - probably no med is more effective for more SAD people;

Kava-Kava (the 'herbal supplement') at 1000mg/day;

amisulpride or the similar sulpiride, at 50mg/day and 150mg/day, respectively - these are also effective against dysthymia and major depression in partial remission;

Neurontin (a non-benzodiazepine Anti-Epileptic drug effective in a smaller fraction of cases according to one clinical trial);
You should know that some Non-SSRI drugs labeled as antidepressants also fight SAD in some people:

Nardil (generic = phenelzine), an MAOI (monamine oxidase inhibitor). About as effective (and as often) as Klonopin, this is also an antidepressant as effective as SSRIs, but *more (or more often) effective* than TCAs (and maybe others) for 'atypical depression' - a feature of which is "rejection sensitivity", which will be familiar to many with a SAD diagnosis. Comes with drug-drug interactions, some diet restrictions and higher intolerance rate (side effects) but underutilized in my layman's opinion. Effectiveness of other MAOIs (for SAD) is less certain.

Reboxetine I think has some clinical trial support but is not available in USA. Wellbutrin (bupropion), Effexor (venlafaxine) and Serzone (nefazedone) may be considered "promising".
Wellbutrin affects norepinephrine and dopamine so may help similarly to why MAOIs do. I don't think there have yet been controlled trials with it for SAD.
Effexor effects all the 'big 3' neurotransmitters, to dose-dependant degrees, and has particularly difficult side- / withdrawal-effects for some people. Multiple studies using this med for SAD are currently underway.
Serzone (nefazedone) is similar to an SSRI but also blocks norepinephrine reuptake. It is more sedative, and would make your trazadone unneeded if you replaced Paxil with this. However, it is unlikely to cause the delay/anorgasmia that for you is a *positive* side effect. I believe there is at least one study underway using this med for SAD.

I have medical journal references for all the objective statements made here. When I get my sh!t together, I'll collect them all so I can provide a convenient way to point to all of them. Statements about studies underway are based on my personal knowledge from doctors or responding to "volunteers wanted" ads in San Diego where I live.

peace and health,


PS I feel like I have so much stuff to do, with few accomplishments ever to ultimately show for my efforts, so I think I should resist the compulsion to spend such time posting and reading here. The answer is to be more organized and efficient in doing something to help (and connect with) those who suffer like me - for of course that is why I do this.

- "SAD in SD"




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