Posted by rick_number1001@yahoo.com on August 19, 2001, at 3:31:16
In reply to SP Cocktail - Your Questions+Surprise Enhancer (?) » rick_number1001@yahoo.com, posted by Rick on August 18, 2001, at 16:40:07
Rick:
I want to thank you for your post.
There was a lot there. I hope you saved it in
case you ever want to re-use it! In any case,
I am going to print out your post after this
reply and look at it later. You are the first
person I've communicated with who has a similar
history to mine in many ways. Like youself, I
tend to avoid the Internet but occasionally come
back to it and have at times spent more time than
I intended on it. This still happens to me, in fact
this weekend is a good example.However, I really do appreciate the comprehensive
info. In fact I read your post with much
optomism. And there really should be! I don't
know how bad your SP was untreated but mine was
very severe (according to Liebowitz test anyway)
and if my improvement is 50% or 90% (it's hard
for me to judge too - the symtoms can be treated
well but sometimes I don't feel I have a good handle
on my state of emotional health and "normalcy".
This is a topic I've been discussing the past
couple of times in CBT ("normalcy") - and I'm
getting quite a bit out of it (good things).Anyway - I (probably like you), could write books
on SP. But I'll just curtail this now and thank
you again for the post I'll print out.I wanted to mention also that I posted here
because I was impressed a couple months ago by
some of the threads, they were far more positive
(people getting good results with educated
polypharmacy and experimenation) than posts
I'd seen in the past, mostly several years ago
when I was on newsgroups for a few months.I'm still waiting for someone to tell me how
great Paxil works (still) for their uncomplicated
severe SP.I also wanted to mention that I will see if your
email is on the thread (I'm new here and not
familiar) - but if not I wanted to invite you to
send me a note sometime (I suppose since you've
reviewed my website (THANKS!! one of the very few
...), and my email is there that can work.So I hope to exchange notes (shorter for us both
:) sometime and in the meantime I will keep a
copy of your post saved and printed out for
my own reference.(I'm curious how I'd respond to your regimen -
yours seems to yield excellent results with low
doses of generally very safe and mild medications.)
I am impressed! Congratulations on your continued
discoveries!!!Craig
(rick_number1001 is a pseudoname I invented
for purposes of my website).
> NOTE: THIS IS A LONG POST!
>
> rick_number1001:
>
> Symptom-wise -- which is my priority now that I’m middle-aged and in a stable relationship and career -- I’d say my improvement is about 80-85%, although for the past few weeks it feels more like 90-95% (more on that in a moment). For a slew of reasons, it’s hard to assess “overall” improvement, e.g. including the desire to seek a larger social network and get involved in outside-of-work social situations. There’s a complex mix of rational, irrational (but not psychologically abnormal), and lingering abnormal avoidant/compulsive tendencies that keep me from proactively seeking out social situations, and cause me to turn down invitations. The net result is that most of my fear of social situations has abated, as well as most of the anticipatory anxiety, but I still lean towards a desire to be with myself and those closest to me. Unlike before, though, when I do, say, have to go to a party I don’t worry about it in advance (although I may “resent” it), I’m comfortable when I’m there (a HUGE improvement), and I often end up really enjoying myself instead of dying to make my way to the door. Yet I’m still relieved (and pleased by how I handled it vs. the “old days”) when it’s over, because I can return to my greatest comfort zone.
>
> Sorry about babbling, but that in itself is an indication of how “overall improvement” is hard for me to put a number on (anyone have a Liebowitz scale lying around?). Ironically, this ties in with a much-improved but still lingering SP-related factor: my concern – real or imagined -- that I often have trouble expressing myself.
>
> Regardless, the botom line is that I’m thrilled with the amount of mental burden that has been lifted through my treatment, and the fact that I can really be “me” around other people instead of constantly worrying about what others think and suffering abnormal, troublesome physical and panic-like reactions. (Ironically, perhaps because of my OC tendencies which are still very much at play, when I’m in a previously-fear-inducing situation I sometimes spend an unreasonable amount of time marvelling at how well I’m handling them...kind of an ironic flip-flop of the excessive self-scrutinization that is part of social phobia.)
>
> Believe me, if my current regimen wasn’t working so well, I wouldn’t still be taking the same three meds
> after more than a year. Prior to that, I was on the meds merry-go-round so many of us have dealt with. I’ve experimented with timing and dosages, but that’s it.
>
> That last thought leads me to the even-futher increase in benefit “80% to 90%” that I’ve seen symptomatically in the last few weeks. I hesitated to bring this up for several reasons. One is that I sometimes go through periods where there is a little fluctuation in symptomatic relief, although I’m always far better off than before the combo. But usually these unexplained up-or-down blips last for hours-to-days, not weeks. Now it’s two weeks, and I haven’t experienced even that occasional, minor symptom (e.g., a slight tremor in my voice when I’m put on the spot and someone’s staring in my eyes waiting for me to respond). Another reason I hesitate is because I haven’t been taking the supplement I’m about to mention long enough to assess whether the effect will last. And I’m slightly concerned about safety, since this is not a well-known supplement in the US (it’s widely used in Europe and Japan for various indications). Indeed, I’ve always been skeptical of herbs and “fringe” supplements, and haven’t seen any benefit whatsoever in the past. (“Fringe” is an important word there – I take many supplemets and a multi-vitamin for physical and mental health benefit/protection, including B-Complex, Vit E, One-a-Day Over-50 – even though I’m NOT over 50 – alpha-lipoic acid, and more. It’s likely that in some way these -- and more importantly a few common prescription meds that interact with Serzone -- add to the effectiveness of my SP cocktail, as did weight-loss and caffeine reduction. Now, if I could only get ioff my lazy butt and exercise!)
>
> This over-the-counter supplement is called VINPOCETINE. (I put it in caps in case you or other readers wanted to wade through my excessive babbling and cut to the chase.) It’s a mostly-synthetic derivitive of the Periwinkle plant. I’ve always been skeptical of herbally-based meds (in terms of effectiveness, safety, and product control), but I wanted to see if something might help with the mild memory impairment that is likely due to my meds. (Despite Klonopin’s reputation, some personal experimenting seemed to indicate that the memory impairment was attenuated when I stopped taking Serzone for awhile (but not surprisingly this made my SP treatment somewhat less robust). I also note that I saw no such memory loss until 6 months after adding Serzone and Provigil– after almost a year on a substantially larger dosage of Klonopin. As an aside, I saw one post where someone complained of memory deficit from Provigil , despite its purported memory-enhancing benefits...hmm).
>
> Anyway, I *may* be seeing a litte memory benefit with Vinpocetine, but I’m not so sure. What I *have* noticed – even though this isn’t generally mentioned for this supplement – is added “fortification” of my already-strong Social Phobia cocktail. It seems to iron out the chinks that remain, add a smoothness and consistency. The purported cognitive benefit of Vinpocetine was originally (and sometimes still) thought to come from increased blood circulation and glucose utilization localized to the brain (vs. Ginkgo, which has a similar effect but throughout the whole body). Now the memory impact is thought to likely derive from neuronal protection.
>
> What I’m seeing from Vinpocetine (Nature Made brand) is a simultaneously stimulating but calming effect, kind of like something that takes up where Provigil leaves off. I’m getting way out of my league here, but the American Journal of Psychiatry recentlt had an article detaining reduced blood flow in SP subjects vs. normal subjects when forced into a public speaking situation. SP’s started out with lower flow in many areas of the brain, and during the challenge SP cerebral blood flow actually dropped some, while there was a sahrp increase among normal subjects. While cause-vs.-effect isn’t clear, and I hardly understand all the nuances and might be drawing some overly-simplistic or plain-wrong conclusions, but is it possible Vinpocetine’s increased cerebral blood flow is compensating for an SP-induced decline that may accompany my “chink in the armor” moments? I also note that the med (it really *is* more of a drug than an herb) has been used in epilepsy, and there seems to be a strong overlap between meds that can be useful in epilepsy and social anxiety, e.g. Klonopin, Neurontin.
>
> While there could be a placebo effect here, the mild-stimulation effect feels very real. And Vinpocetine is clearly doing *something* because I’ve had a 10-15 point drop in my blood glucose across the board. (I’m not diabetic – at least not “officially” -- but had one high reading during a test a few years ago. That’s when I started my diet and anxiety treatment, and I still monitor every few days. I’ve been normal to high-normal all along, but since staring Vinpocetine I’ve been in the low-normal range, which is the best place to be in most cases.) And maybe this is just by chance again, but for the last few weeks I’ve felt a lot more sexually charged, if you will (there was no dysfuntion before; I’m speaking of enhancement).
>
> Perhaps most importantly, I’ve cut my Serzone back to 300 mg again, Klonopin to 1 mg, and haven’t felt the occasional need for a temporary boost in Provigil dose. AND...I’m now taking all of the psychotrpoics in the morning only (even though Serzone has a short half-life), while taking Vinpocetine three times a day. The ony exception was an extra .25 mg Klonopin before a party. It’s too early to judge, but right now I’m sticking with it. And if memory benefits DO kick in, that would be great – since that’s why I tried Vinpocetine in the first place! I seem to have a history of unexpected benefits from meds, especially Klonopin and Provigil. In fact, you are one of the few people besides myself that I’ve seen report sexual *enhancement* from Klonopin. Despite hundreds of references to Vinpocetine on Medline, I do wish I knew more about its long-term safety, and any “bad” interactions with other meds or supplements. In particular, there is “some evidence” that it has anticoagulant properties, which is probably good in general but I’d really like to keep taking my daily preventative baby aspirin yet I’m afraid of the risks associated with excessive blood-thinning.
>
> But with all my gabbing about Vinpocetine, I don’t want to lose sight of the more important point. Namely, that after more than a year I’m still thrilled with the combo of Klonopin, Provigil and Serzone for non-depressive Social Phobia. Not the slightest indication of poop-out.
>
> I’ve been warned that, “you WILL experience depression from Klonopin at some point.” And there have been occasional days that seemed pretty dark mentally (interestingly, this happened most recently when I had to go about five days without Provigil), but they pass quickly and I don’t think they really come close to clinical depression (if protracted, I guess they might qualify as dysthmia). In fact, largely due some lucky breaks in life, my Social Phobia has never led to clinical depression. There may have been one period where I could have had undiagnosed depression, during a period of deep grief exacerbated by a slew of factors surrounding my mother’s brain cancer that made it maximally shocking and difficult to deal with.
>
> As for serotonergic effects, the studies I've seen generally conclude that Klonopin causes anything from a mild decrease to a mild increase in serotinin availability. Klonopin apparently DOES cause an inhibitory pre-synaptic seorotin release, but this effect is balance by other, pro-serotnergic effects. As for Serzone, it IS a serotenergic (and somewhhat adrenergic) medication. First, it does have some serotonin re-uptake inhibition like the SSRI's. Secondly, it antagonizes certain post-synaptic serotonin receptors, so that more serotonin remains in the synapse where it can exert its antidepressive and anti-anxiety benefits. SSRI's didn't do much for me; my guess (and it's purely a guess) is that serotonin deficiency is not a mahor issue for me, and that unknown, perhaps "down-the-line" effects
> of Serzone are what benefit me. I get more of a direct physiological feel from Serzone than I do with the other meds, throughout my body. I feel it surprisingly quickly after taking Serzone, and is a kind of comforting, mildly cooling sensation. (Without Provigil, it might be a very sedating sensation, too!) Also, ss I've mentioned before, I think one of Serzone's main benefits for me is the way it interacts with, potentiates and extends the effects of other meds. That's one reason polypharmacy seems to work well for me. In my case (certainly not for everyone), the interactions and synergies are beneficial rather than detrimental. (I had some concern since Serzone interactions can have hepatic effects -- and it's even caused liver damage by itself in rare cases -- but my recent liver test showed everything to be deep within the normal ranges).
>
> Well, if you’ve made it this far in my “essay”, I admire your fortitude. That’s one of the irrational O/C tendencies I have – I feel bad if I leave anything out (Perfectionism? SP-driven approval-seeking?). And I’m a slow writer, to boot. No wonder I don’t have time to get out and do more – social or otherwise! So here’s my resolution: For the next few weeks, any e-mails or forum posts I write will be SHORT!!! (Always easy to say AFTER I finish the tome. Last night I promised myself I wouldn’t get near the internet today. Ha! Better add internet addiction to the list of possible factors. Of course, I go from periods of zero posting to spending all day. I guess you could say I suffer from Bi-Postal disorder.)
> Well, dammit, I’m not going to spell-check, even though Dr. Bob wants people to review their posts. So if you saw any mistakes above, you now know why.
>
> Rick
>
>
> > Thanks for the comments Rick!
> >
> > That was encouraging to hear and my
> > first feedback. I hadn't touched the site
> > for a couple months and just changed it a bit.
> >
> > Thanks for your own regimen info.
> >
> > Can I ask how you rate your improvement on
> > your current regimen? (symtom wise anyway);
> > it sounds like we both sense a big difference
> > between symptom abatement and 'total remission'
> >
> > I have to admit I'm surprised (but pleased!)
> > that the regimen you currently take works so well,
> > only because it seems like there wouldn't be much
> > overall serotonin increase.
> >
> > In my case, Serzone and Klonopin both seem to
> > give me an anti-serotonin effect, such that either
> > one or both together will tend to cause a depression
> > in me that I don't have by nature (untreated). Both
> > of those meds also tend to reduce serotonin induced
> > sexual side effects in my case. Klonopin is
> > unquestionably pro-sexual in my case, and Serzone may
> > or may not be depending on dose and concurrent
> > medication.
> >
> > Provigil, on the other hand, does reported have
> > a pro-serotonin effect and I seem to sense some
> > serotonin (and dopamine) effect as well based on
> > it's effects.
> >
> > I did very well on Zoloft+Serzone+Klonopin
> > in the past except that laziness and sedation
> > were a bit problematic. I think that I probably
> > would do very well on Z50+S300+K2-4.5+P100-200.
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > > Thanks for posting!
> > >
> > > Finally, I find someone who has seen the anti-anxiety potential of the gentle stimulant Provigil! Getting pdocs (let alone GP's) to prescribe it is really tough, because they're unfamiliar with it and convinced it must *cause* anxiety. (I know that some Psycho-Babblers have ordered the related adrafinil from overseas for use in Social Phobia.)
> > >
> > > I am always interested in hearing how Provigil works in tandem with various AD's, and was especially interested in hearing about a Nardil/Provigil combo. Apparently, it's effective!
> > >
> > > BTW, I'm now at 1 mg Klonopin (occasionally 1.25 - 1.5); 300 mg Serzone (down again after having been up to 450 for quite awhile), and 100 mg Provigil (with an occasional "rejuvenating" spike to 200 for a day or two). Despite the lower Klonopin dosage, it's still the med I would stick with if I could only choose one. I believe drug interactions make my Klonopin blood levels more comparable to a somewhat higher dose. I've always insisted on branded Klonopin, but due to a recent mixup I ended up getting generic clonazepam a month ago (mf'd by Tiva -- their top-selling med), and it seems equivalent thus far. I don't like the fact that I'm usually left with some Klono-Dust when I split a generic pill, but that doesn't seem to have any theraputic significance.
> > >
> > > Congratulations on putting together a GREAT website that succinctly but thoroughly -- and without the typical biases -- covers the keypoints of SP and its treatment. Some may quibble with some of the individual treatment recommendations, but there's lots there to help social phobics begin reclaiming their lives. I can really relate to your observations about how it's easier to remedy the "fear of people" than it is to reverse the simple inertia of ingrained, avoidance-generated social habits.
> > >
> > > The only thing I might personally take issue with is the recommendation of considering caffeine when trying to treat an anxiety disorder. I had always found it hard to believe that caffeine could cause noticeably increased susceptibility to anxiety, but then discovered that it truly can have that effect, at least for me. I'm not saying caffeine reverses the medication benefit, but it does diminish it a bit, so I try to avoid it (or at least moderate my intake) on weekdays. Of course, some social phobic or otherwise anxious inividuals might be immune to caffeine-induced nervousness.
> > >
> > > BTW, Nardil was the first psychotropic I was ever prescribed, and I quit it because the side effects were intolerable. Back then I had newly-identified high blood pressure (has since gone away, largely due to weight and anxiety reduction), but Nardil took it so far in the other direction that I was spontaneously falling down from dizziness -- in public areas, no less -- and ended up hitting my head more than once. I now realize that I upped my Nardil dosage too quickly despite my pdoc's cautions, and also realize that most of the side effects might have abated with time as you describe (maybe not the sexual dysfunction, though). While I know that the food restrictions are overstated (which is NOT to say "unimportant"!!), and I didn't find them terribly burdensome, the food-fanatic within is glad he doesn't have to adhere to any restrictions at all.
> > >
> > > Speaking of Nardil and food, despite that med's reputation for causing big weight gain, I actually made my first successful (VERY successful, and sustained) attempt at weight loss while taking the MAOI. Again, YMMV.
> > >
> > > BTW, I'm glad you wrote this before the "my-deja" e-mail service (and thus the address I had been listing here) is shut-down in a few months. Otherwise, I wouldn't have received Psycho-Babble's automatic e-mail alert about your update to this thread. (I only check back here occasionally, and don't look at the archives.)
> > >
> > > Rick
poster:rick_number1001@yahoo.com
thread:36517
URL: http://www.dr-bob.org/babble/20010814/msgs/75562.html