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Social Anxiety: BillB

Posted by AndrewB on August 19, 2000, at 13:43:00

In reply to Re: AndrewB, JohnL, Social Anxiety (long), posted by Billb on August 11, 2000, at 15:42:55


Sorry to take so long to reply to your post, I was out of town camping. It seems like you have already received some good advice though. I would also like to chip in my suggestions here but I want you to know that I have no professional training and that my opinions are not in line with mainstream thought. The suggestions I give are no substitute for your own diligent research combined with the counsel a psychiatrist experienced with social anxiety and psychopharmacology.

That being said, I think it is clear that social anxiety can be symptomatic of dysfunction within various receptor systems; dopaminergic, serotonergic, GABA, noradrenergic and, quite likely, others. The social anxiety many experience often consists of, in part or whole, a cognitive/psychological component that responds well to therapy. Others however find their social anxiety seemingly of the a wholly physiological variety that is impervious to therapy.

With the above considerations in mind, and also due to the fact that many social anxiety meds are fast acting and have a quick wash-out period, it is my belief that an aggressive approach towards treating social anxiety is called for when there is no concurrent serious mood disorder. Such an aggressive approach would consist of the trialing of selected anti-anxiety meds and med combos in rapid succession. The hoped for result of such an approach would be the timely identification of the most efficacious med or med combo for treating one’s social anxiety.

To follow through with this approach, a person first needs to obtain a variety of meds to trial, your ‘tool kit’, so to speak. Some of these meds can be obtained through your doctor, others need to be obtained overseas, with or without a prescription.

Bill, I have read your posts carefully. Thank you for being so candid, I know it can be hard for those of us with social anxiety to be so revealing. I think your detailed responses to my questions will help me give you some useful suggestions. So let’s delve into some specific medicine trial suggestions. Remember to add only one medicine at a time, allow a washout period, and try to remove a medicine for each one that you add. Research each drug for possible interactions with the drugs you are already taking.

Adrafinil: Your results with adrafinil are so very encouraging. You may want to try varying the dosage of the adrafinil to identify at which dosage you benefit most.

Provigil: Provigil’s active ingredient is modafinil. Modafinil is a metabolite of adrafinil. Provigil, being related to adrafinil, may offer you as good as or better anxiety relief as adrafinil. I’d suggest a three day trial at 100mg. and, if the side effects are minimal, a further 3 days at 200mgs.

Klonopin (Clonazepam): Some claim that klonopin is the most effective social anxiety medicine out there. It works on the GABA receptors. Apparently, its potential for addiction is minimal if doses are kept below twice daily dosing of 2mgs. Rick, another poster, noted that the combination of klonopin (1mg. in the morning, .25mg in the afternoon) is very effective for his social anxiety with no associated sleepiness or cognitive deficits. You may have the same luck with this combo or a klonopin/adrafinil combo. For more info, look at Rick’s posts entitled ‘Social Phobia Cocktail-- Wow’ on June 8th-12th. Another option is to take kloniopin (.5mg-2mg.) a couple of hours before bedtime for a restful sleep instead of taking trazadone. I do this myself. It makes me feels rested and rejuvenated with no morning grogginess. You may find it interesting that a Chronic Fatigue Syndrome specialist, Dr. Cheney, recommends taking 1mg. klono at night for a restorative sleep and taking .25mg or .125mg in the morning and evening to improve energy and clarity! (He believes that klono acts as an NMDA receptor antagonist at such low doses.) You can try trialing klonopin at a variety of dosages and timings over a 2 week period, You will need approximately 30 to 40 .5mg. tablets for the trial

Stimulants: Your improved confidence on the diet pill as well as adrafinil indicate that a stimulant may be able to increase your social confidence. I have noticed that adderall increases my social confidence significantly, though I haven’t been taking it long enough to say whether this effect will stay or fade away. Irritability does not have to be a side effect. From what I have read, given a choice of stimulants to trial (dexedrine, ritalin, adderall), I would trial adderall first. Stimulants also may improve your mood response with Paxil. Adderall is normally taken once in the morning and once shortly after noon. The dosage would be either 10 or 20 mg. For a four day trial you would need up to 16 x 10mg. tablets.

Buspar: Didn’t work at first, no reason to try it again.

Piracetam: I have tried this med as well as read much about it. It is inappropriate for what you are seeking.

Paxil: It sounds like you have something that works here. No reason to change it. Do ask yourself though whether Paxil contributes to your feelings of emotional detachment.

Amisulpride: Amisulpride can be effective for negative thoughts, social anxiety, feeling of social detachment (makes a person feel socially open). It also can improve one’s mood, especially the persistent low mood associated with dysthymia. It is prescribed overseas for social anxiety, dysthymia and atypical depression. Personally I have found it incredibly effective in turning off the negative self talk, To receive an information piece on amisulpride I have put together, email me at A trial with amisulpride will take two weeks. Dosage starts at 25mg. for 4 days, escalating to 50mg for 5 days and then to 100mg. for the final 5 days. A person will need 17 x 50mgs tablets for their trial.

Beta-andrenergic blocker: For your physical symptoms of social anxiety (i.e. facial trembling, blushing) you are likely to respond to a beta blocker. Several options are out there. Someone relayed to me that Dr. Jensen (whom JohnL is such a fan of) thinks Kerlone is by far the most effective. I don’t have details on its usage. But the pharmacist that sells this (i.e. xxx) will be able to answer dosing questions. I think you will know immediately whether this med. is effective for you.

Other anti-anxiety meds not mentioned: If you are still with social anxiety after trying the above meds you can look into trying: kava kava, neurontin, clonidine, and selegiline. If all else fails, you can try Nardil, the ‘gold standard’ for social anxiety meds that unfortunatley has significant side effects and dietary restrictions.

Ordering Info.: The above meds can all be obtained through your doctor except for amisulpride, which is available overseas. Amisulpride can be obtained without a prescription from xxx, Kerlone and (I believe) klonopin can also be obtained from xxx. The pharmacist there is helpful and will try to answer any questions you have. Great service. xxx.

Best wishes, feel free to ask further questions,





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