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Re: An update SLS

Posted by tensor on February 17, 2023, at 4:28:18

In reply to Re: An update tensor, posted by SLS on February 16, 2023, at 18:19:24

> Nardil (phenelzine), an irreversible monoamine oxidase inhibitor (MAOI). It is perhaps the best treatment available for social anxiety / phobia. It is also effective to various degrees to treat GAD, Panic Disorder, and OCD.
> Would you describe your anxiety as being the result of social phobia or social anxiety? If not, under what circumstances do you experience anxiety?
> Some people use propranolol as a PRN to be taken before being exposed to an anxiety-provoking situation. It is sometimes used by people who engage in public speaking.
> Which benzodiazepines have you tried? Your doctor is absolutely right with the way he portrays Lyrica (pregabalin). My experience with it was pretty bad. After my first few doses, it made me feel less depressed and somewhat calmer. However, after a few more days, I felt dysphoric and smothered by severe brain fog. I became numb to the world around me. After discontinuing Lyrica, it took three weeks for these mental aberrations to dissipate. The drug is unpredictable. I am going to suggest another unpredictable drug - Gabitril (tiagabine). Gabitril is a GABA reuptake inhibitor - the only drug of its type available. GABA is the most ubiquitous inhibitory neurotransmitter found in the brain, and offsets overactivity - anxiety. Some people report a positive outcome with Gabitril. However, it can also produce what is likely to be a disinhibition phenomenon that manifests as anger, irritability, agitation, hostility, and rage. Given your dwindling alternatives, I think Gabitril is worth a try. If you react badly to it, you will know quickly.
> - Scott

Hi Scott! Always nice to see a reply from you!
I have tried Parnate which worked for my depression and also had anxiolytic properties, esp for panic. That first golden week is possibly the closest I have been feeling "normal". But dose escalation and afternoon crashes rendered it useless over time. I have thought about Nardil and it's likely the most efficacious med out there for anxiety. However, MAOIs tend to lose efficacy over time and they are not without s/e. It's an option that remains on the table though.

What makes me anxious about being away from home most likely (if not certainly) stems from panic disorder, I remember having panic attacks as a kid. Felt like I couldn't breathe and thought I was going to die and also had vertigo. Never told anyone, just kept it to myself, with the "logic" being, don't want doctors to find something is wrong with me, didn't know about panic disorder and thought it was something physiological and dangerous.
I regret this, it could have saved me from a lot of pain growing up. My social phobia, which appeared when I hit puberty, is still kept under control with clonazepam, I will never speak in front of people but I have no problems going to the grocery store for instance. In my late teens my SP was so bad I couldn't sit in a class room, clonazepam really fixed this. It's interesting and intriguing that other benzos were virtually useless for this (of the ones I have tried).

I do use propranolol, it's in my arsenal :)

I have tried at least :
lorazepam (Ok, IV after surgery so doesn't really count)
nitrazepam for sleep
(zopiclone, zolpidem)

I must be one of quite few people that prefer 30mg of oxazepam over diazepam and Xanax. I have a slight paradoxical effect from latter two. Some residual (or added?) anxiety that I don't feel on oxazepam or clonazepam. Maybe they are slightly activating? IIRC Xanax does something to NE.
Sorry to see you had a bad experience with Lyrica, it's really unpredictable as you said. I have read about people taking it for SP and GAD and had a really difficult time coming off it, one person had withdrawals for nine months. It's a shame it's such a poison (as my doc called it), its anxiolytic properties for me are great short-term. With short-term being the keyword here.
When I talked to my pdoc yesterday, she said she would arrange for me so that I could get a second opinion (more like 14th, but anyway) from another senior psychiatrist that I haven't met before. Will bring up Gabitril with him for sure, thanks for the tip. Could Trileptal be useful? So there may still be changes done to my regime before this is all said and done. My current psychiatric regime is:

fluoxetine 60mg for depression and anxiety
clonazepam 2mg (will increase to 3 or 4mg for traveling) for SP, also GAD.
mirtazapine 7.5mg + nortriptyline 25mg, these two mainly to offset sexual s/e.
melatonin 5mg for sleep

PRN chlorprothixene, propranolol, oxazepam, Seroquel (may discontinue this one). I sometimes take 15mg oxazepam with 25mg Seroquel for moderate anxiety producing situations, quite effective combo.

I say "psychiatric regime " because there other non-psychiatric medications I take regularly, here's a list:

1. omeprazole

> By the way, the GABA receptor is the site where benzodiazepines act to amplify GABA inhibitory (anti-anxiety) neurotransmission. The site where bendzodiazepines bind to is actually offset from the GABA binding site of the GABA receptor complex. It functions as a co-receptor to increase the sensitivity of the GABA receptor complex to the GABA neurotransmitter molecule.

Didn't know this, thanks for the info.

Wish you all the best, Scott!





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