Posted by Alan on June 30, 2001, at 19:21:07
In reply to your problem » Alan, posted by Elizabeth on June 30, 2001, at 17:47:37
> > The partial problem is that the shorter acting Ativan is needed at about 5 MGS on only 3 - 4 days per week for performance anxiety (eves.)while the other days it would be too much.
> >
> > To keep from being overmedicated on the other days, only 3 MGS are needed. This is where the Nurontin comes in to mediate.
>
> Huh. So it doesn't work to just take the Ativan as needed -- 5 mg on the days you need that much, 3 mg on the other days? I can see how that could cause some ups and downs -- Ativan is pretty short-acting.
>
> The Neurontin idea might be worth a try. It's kind of short-acting too. I've heard of some people taking the entire dose at bedtime, but I don't know how well that would work for your purposes. My other thought would be to use a small dose of a long-acting benzo (Klonopin, Tranxene) -- not enough to cause sedation, ataxia, or other unwanted side effects -- in the "background," and take the Ativan on top of that as needed. That might smooth things out.
>
> > It's kind of a special social anxiety subcatagory that I have not been able to treat any other way.
>
> Can you tell me more about that? Have you tried antidepressants? That might seem like overkill, but some of them (phenelzine especially) can be extremely effective for social anxiety, especially if you take benzos along with them.
>
> > Alan (a fellow Chicagoan!)
>
> Oops, didn't mean to mislead. I'm afraid I'm not from Chicago: I was recommending it as a place to find good doctors in the Midwest. Our own Dr. Bob, for example. < g >
>
> best,
> -elizabeth
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I like your idea of Kl. or Tr. in the background.One other problem with this though is that sleep architecture is already disturbed by relatively higher dosages of a benzo (which Neurontin counteracts to some degree) and therefore fatigued during the day from waking early and not enough deep sleep.
Neurontin has already been tried and works to a fair degree as long as taken 3x's a day but doses above 300 per dose causes psychomotor disturbance which is not cool for professional reasons.
Been through all the AD's and too stimulating for the type of anx. been treated. Remeron, Luvox considered but not tried yet. Every one of them have sexual side effects (including with the neurontin above 900 a day) unsuccessfully treated with all sorts of things.
Might have to consider MAOI's at some point but very hesitant because of similar side effects to previous tries with TCA's that can't be tolerated (dry mouth, const, dizzyness).Considered a low dose neuroleptic (Zyprexa) but afraid of TD. It really is for depression anyway isn't it?
Infrequent depression, just when spikes of anxiety drive it....
Any thoughts???? Thanks.
best,
Alan
poster:Alan
thread:1356
URL: http://www.dr-bob.org/babble/20010625/msgs/68532.html