Posted by JohnX2 on March 5, 2002, at 4:52:52
In reply to John X2, posted by Jill K. on March 5, 2002, at 2:12:10
Hi Jill,Seems this thread has made a few leaps. ;)
I'm not a self proclaimed wizard on Social Phobia.
I'm hoping others will post some of their own
experiences as they read this.Curiously when I was a young child I did have
social phobia symptoms and GAD, but it seems
coincident with my teenage years and developing
bipolar that most of it went away. I feel real
at ease in group settings , but I do get nervous
in one on one situations which sometimes really
bugs me. Gets in the way of building close
relationships to lean on. Kinda shitty. Hmm, lack of
motivation and drive to get out and do things,
meet people can't be making things any easier.Here are some thoughts I'll throw out about
medication. I really don't think you've investigated
too far down the AD route. I see relief.-) Your Klonopin depression problem.
I had this problem too, and other people have noted
it. Klonopin is a pretty strong anti-manic agent
and can have depressant properties at higher dose.
I'm really glad the Neurontin is working out, this
is just fantastic!- would you be against giving another
medicine like Effexor a trial? (a serotonergic
medicine that also boosts norepinephrine). A lot
of people that don't respond to one SSRI/SNRI respond
to another. I stunk at Paxil but liked Zoloft.
Ross on another thread was experimenting with
Nardil an MAOI for social phobia, but didn't find
it as effective as Effexor (which is also FDA
approved for GAD).- Wellbutrin can definately help with your depression,
motivation, confidence problems. It seems to have a coin toss effect on anxiety.
In most studies of the medicine, it is indisputed
that it inhibits firing of neurons in an anxiety
center of the brain for those that respond well.
(This is the norepinephrine action, much less controvery
than the dopamine action).
If you want to give that one a shot per your pdocs recommedation
you might want to start at a low dose say 100 mg SR
tablets and test the waters in terms of tolerability.
If the neurontin is really doing wonders on the anxiety
front then maybe wellbutrin is a good route. I can't
predict what would happen, you'd have to give it a trial.
If the anxiety stinks, you could go back to offsetting
it with Klonopin or try another route. Again, ask your pdoc about the potential
for reemergence of anxiety.- Atypical Anti-psychotics. Don't let the name scare
you. These medicines like Zyprexa can have a pretty good
anti-depressant effect and are great for anxiety (at
the lower doses). At the really high doses they are more for
bipolar/mania/psychosis. Slight risk of something called
tardive dykinesia. I remember at least one person
with Panic and Social phobia really touting the
effectiveness of Zyprexa.- MAOIs. You really haven't gone hear yet.
It seems the more prescribed medicine is Nardil.
Parnate is also popular. Nardil gets more scripts
because its a bit less agitating. Downside to these
meds is that you have to follow a special diet.
Selegiline and Parnate are good for atypical
depression but can tend to cause agitation.- Less agitating stimulating Pstims like Provigil?
Remember everyone's experiences are different.
There are a lot of medicines you haven't tried
and I think odds are with a couple expirements
you will feel well.I have seen people do well on all these routes.
I have also seen failures. Just need to go through
the "wringer" so to speak and test it out. This
is probably why your pdoc recommended Wellbutrin
over going with another SSRI type medicine, just
to change gears.Best wishes. Please hang in there.
John
> > Now were missing some pieces of the Jill K
> > puzzle in these areas:
> >
> > 1) maybe a little more insight into your depression/anxiety
>
> I was shy and introverted growing up. I was always anxious in social situations. Last year in grad school I started getting panic attacks and I met my pdoc who started me on klonopin. With 0.5 mg, the panic left, with depression remaining.
>
> > Would you categorize it as Major Depression (feeling
> > really empty inside, can't experience pleasure at all,
> > think about dying)? Or are you primarily anxious and
> > maybe lacking motivation, interest in life, fearful
> > of social settings etc?
>
> I was primarily anxious and fearful of social settings. With the 0.5 mg klonopin, much of the anxiety is gone. Now with 200mg of neurontin three times a day, it is all gone. Now I am just depressed. Sleep when I get home and on weekends. All my hobbies and interests and friends I have dropped ... no energy or motivation.
>
>
> > 2) What were all the medicines you tried in the past
> > and what were the outcomes?
> >
> > Have you tried any of the default SSRIs (Zoloft,Celexa,etc).
> > Failures?
>
> I tried zoloft to 200 mg, feel numb and remained depressed. I also tried lamictal with no benefit and ritalin which increased my anxiety and then crashed after six hours.
>
> >
> > Tried MAOIs (Nardil is often prescribed for social phobiam
> > Parnate, Deprynyl are other options)?
>
> No
>
> > Ever tried an atypical antipsychotic like
> > Zyprexa/Geodon?
>
> No
>
> > What are your main concerns regarding starting a new
> > medication? That it will have bad side effects, it won't
> > effectively address your depression, etc?
> >
> > What kind of pain symptoms are you having?
>
> Pain is pure psychologic. I am so isolated and alone.
>
> > Of all your problems, were are you hurting most?
> >
> I think I have 2 main problems (1) panic/social anxiety (2) apathic depression. If I increase klonopin/neurontin no more anxiety, but more depression. When I tried ritalin and zoloft less depression, but HUGE anxiety.
>
> > Sorry for all the questions. But I think they
> > really would help us to give you better support.
> >
>
> No Problem. I love the fact that someone is helping me. If anyone can help me, I will owe then my life, because I haven't had a life for so many years.
>
> Your Friend,
>
> Jill
poster:JohnX2
thread:96450
URL: http://www.dr-bob.org/babble/20020301/msgs/96467.html