Posted by JonW on November 10, 2002, at 23:05:39
In reply to Re: Lexapro and social phobia, posted by utopizen on November 10, 2002, at 21:17:42
> Pretty much anything's a shot in the dark for SP except Klonopin.
Hi utopizen,
It's true that everyone has a unique brain chemistry and response is very individual. However, I don't think that means all drugs are equal. I think it makes sense to try the drugs with the most data to support their efficacy first. I'm very happy to hear you've found something that works for you (Klonopin). I suffer from sever SP myself and know what a horrible and disabling illness it is.
> I once told him, "Um, what's really so bad about just taking Klonopin for the rest of my life?" And he goes "um, I don't know, I suppose that's not so bad." Yet he still refuses to let me have Klonopin.
If things don't seem quite right with your pdoc, I'd consider seeking out a new one.
> Frankly, I'm not so sure what an SP specialist would know that a regular p-doc wouldn't. Apparently, there's no magical script that he knows to give that has a secret codename in his PDR... unless he's giving you special cognitive behaviorial therapy, I'm not so sure how "special" he is as a specialist...
I think the caliber of the pdoc is the most important thing. It's true that the same drugs are available to everyone, but someone with experience has a better sense of which avenues are worth pursuing and which are likely to be a waste of time. They are more skilled at making the correct diagnosis, and know the right questions to ask. They know more about psychopharmacology and have experience with more complex "cocktails". Someone who knows anxiety disorders is going to know best how to design a treatment program that suits you best and gives you the greatest chance of accomplishing your goals. Obviously, there are exceptions, but as a general rule you get what you pay for. That's an unfortunate reality in healthcare.
The pdoc I work with is Dr. Michael R. Liebowitz from Columbia in NYC. He was the pdoc who first brought Social Anxiety Disorder to light in 1985, and started the first anxiety disorders clinic in the United States. He also chaired the comittee that developed the criteria for the DSM-IV definition of Social Anxiety Disorder. If you'd like to find out more about his background, you can go to:
http://www.bestdoctors.com/en/doctors/mrliebowitz.htm
The point I want to make is that Dr. Liebowitz's experience and track record has separated him from first-line pdocs. Seeing a pdoc of this caliber can really benefit people with serious and intractable illnesses. I also work with a CBT therapist who's an expert in treating people with SP, Carla Daichman. Both my pdoc and therapist are part of Klein, Liebowitz Psychiatric Associates. They communicate and work together so the best decisions for medication, therapy, and my life in general are made. To each their own, but this has saved my life and I would urge anyone who hasn't gotten better to seek out this type of care. If you would like to read more about my situation, you can read this response I posted earlier today:
http://www.dr-bob.org/babble/20021108/msgs/127194.html
> good luck trying out meds. You're on the right track. But SSRIs tend to be rather similar. After the second or third, you'll probably be put on Wellbutrin or Effexor, maybe later on a combo including one of these...
Keep at it, Boba. Persistence will save you! If you live near Philly, Temple's social anxiety disorder program (under Dr. Richard Heimberg) is one of the best places to get CBT for social anxiety. If you haven't combined meds with CBT, you might want to consider it. Good luck with everything!
Jon
poster:JonW
thread:127106
URL: http://www.dr-bob.org/babble/20021108/msgs/127207.html