Posted by Nixon on February 14, 2005, at 19:23:50
In reply to Re: Social Anxiety HELP » BobD, posted by Michael Bell on February 14, 2005, at 18:42:15
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> Your symptoms are classic SA disorder. I don't want to speculate about the possibility of other conditions, but SA seems without a doubt to be the primary problem. Now, as someone who has experienced very similar symptoms as yourself, to the same degree of severity, let me give you a treatment rundown. Keep in mind, we all react to meds differently, but if SA is truly your primary/only diagnosis (try to get a Psychiatrist who SPECIALIZES in anxiety) then here's how I believe the following classes of drugs will affect you. By the way, I've tried all of the below:
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> THEY'RE RATED ON A SCALE OF 1-10 (10 BEING BEST)
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> SSRIs (4 OUT OF 10:(Zoloft, Paxil, Prozac etc.): can be somewhat helpful, but new studies show efficacy to be less than originally thought , somewhere in the 40% range if not lower. Usually increase anxiety for the first couple of weeks, then create a sort of numb feeling that works pretty well against anxiety but tends to cause low affect. Big problems with sexual function. I don't recommend them, but they're a billion dollar industry, so many psychiatrists may want you to try one first.
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> SNRIs (reboxetine, etc.) 3 OUT OF 10: They inhibit the reuptake of norepinephrine. Not great for social anxiety, makes you feel removed from situations and somewhat less social. However, they don't seem to cause any increase in anxiety, not for me anyway. Cause problems with urinary retention, premature ejaculatory fluid (a.k.a messy sex, sorry but true).
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> ST JOHN'S WORT - 5 OUT OF 10: worked incredibly well for about a couple months, then pooped out never to give quite the same effects again. Eventually cause flattening of mood like SSRIs do. However, much less anxiety provoking than SSRIs and without the sexual side effects.
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> L-TYROSINE (1-3 OUT OF 10): amino acid precursor to dopamine creation. Can be beneficial as adjunct to other meds, but it is not good as monotherapy and has a rate-limiting effect that inhibits its effectiveness. DO NOT, I REPEAT, DO NOT COMBINE WITH DEPRENYL (SELEGILINE) TO TRY AND TREAT SA.
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> OPIOIDS (buprenorphine, percocet, codeine) initially 8-9 OUT OF 10, then drops to about 5 OUT OF 10: may be beneficial in the short term, but there is the risk of addiction and tolerance. The tolerance issue may be alleviated by taking memantine at the same time, but that is an expensive combo. Problem is that Opioids lower GABA levels in the long run, and you do NOT want to do that when you suffer from SA. More of an explanation on that below. Overall, I didn't take well to opioids as long term therapy b/c the anxiety relief has a surreal aspect to it. On opioids, I just don't give a sh*t about anything at all.
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> ATYPICAL ANTIPSYCHOTICS (Amisulpride, Mirapex, etc.)Range from 2 OUT OF 10 to 8 OUT OF 10: Hmmm... now these are strange drugs. At times they can seem a godsend and very effective for SA, alone or as an adjunctive drug. But... inconsistent results, big poopout factor, daytime sleepiness a big issue. As far as side effects go, they're very minor compared to some of the other devillish things out there. I recommend giving AMISULPRIDE a try and seeing if it works for you. Maybe you'll get consistent long term results.
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> NOOTROPICS (Adrafinil, Modafinil, etc.) 4 OUT OF 10, higher rating as adjunctive med: Don't let the websites fool you. No one knows how these drugs really work. But they very well for some people, while for others it's like taking a sugar pill. My experience - very inconsistent results. When they do work, they tend to wipe out SA completely for several hours and be very prosocial. But the effects are fleeting. ADRAFINIL + AMISULPRIDE is a pretty good combo. Again, maybe the effects will last for you.
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> NOW WE GET TO THE SERIOUS SA DRUGS!!!
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> BENZODIAZEPINES (Klonopin, Ativan, Xanax) 8-9 OUT OF 10: I give that rating based on my long-term experience with Klonopin. The following is a fact - for most SA sufferers, KLONO DESTROYS SOCIAL ANXIETY!! Let no one tell you differently... Benzodiazepines, particularly Klonopin, should be the FIRST LINE OF DEFENSE for social anxiety disorder. And don't get scared by some of the literature, b/c KLONO DOES NOT CAUSE ADDICTION! Especially if you truly suffer from an anxiety disorder. There may be some tolerance issues, but most reach an effective dose that lasts a very long time. They work by binding to the benzodiazepin sub-receptors, causing the GABA receptors to change shape and allowing more efficient transmission of GABA. HOWEVER - long term benzo use eventually causes the body to produce less GABA, hence rebound anxiety and tolerance may occur. Additionally, KLONO tends to cause low grade depression even in people who never experienced depression before.
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> Which is why I moved on to NARDIL (an MAOI):
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> MAOIs: there are three main ones out there. In simplistic terms, they inhibit the enzyme that breaks down neurotransmitters, making more of them available for the brain to use:
> 1) DEPRENYL - 1 OUT OF 10: Inhibits MAO-B at dosages under 10 mg/day and increases dopamine and PEA levels. Sounds good, right? Hell no! Stay AWAY from this drug as monotherapy for SA! Trust me, don't do it. Taking the similarity of your symptoms into consideration, I can guarantee that it will cause increased paranoia, increased anxiety, jitters. Bad drug for SA, period.
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> 2) PARNATE - Inhibits MAO-A, creates more norepinephrine, serotonin, dopamine and GABA. Never had experience with this one, but you should do a Google search to find out what others have to say
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> 3) NARDIL - 9 or 10 out of 10: Alrightythen. As many with SA can attest, NARDIL does not diminish SA. It does not alleviate SA. What it does is, it aims a nuclear warhead at SA and blasts the sh*t out of it. Add in a small dose of daily KLONO, and it's all over folks! Assuming the effects lasts, of course. It works similarly to PARNATE, but has the added affect of inhibiting the enzyme that breaks down GABA in the brain, creating a drastic rise in GABA levels. Not only does it kill the "physical anxiety" portion of SA, it also does away with the "phobic" part. More confident, more relaxed, more social, blah blah blah. BUT - Nardil has many problems, which it why it's not prescribed that often. First, there are risks of hypertensive crises with certain foods and meds. Also, it tends to decrease blood pressure, cause anorgasmia, may cause dizziness, temporary blurred vision, and a host of other things. Most of these side effects do go away after a couple of months, however.
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> Anyway, to make a long story longer: I've tried many other drugs not listed above, but I say try KLONOPIN first and add something if necessary to battle the depression it can cause. If all else fails, try Nardil.
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> Sorry for the novel. Good luck!
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> Hi, Im new to this board which i have been reading over for a while with interest. Im male, 22 and from the UK. I would like some advice, to discuss or hear from anyone with regards to effective treatment or even just discussion about my illness which is social anxiety (and maybe other illnesses im not sure of but think i may have). Here are my symptoms : on going anxiety in social situations (almost all) with varying degrees of severity depending on the type of situation and setting. (For those unfamiliar with SAD the anxiety manifests itself in the visible physical symptoms of shaking, voice distortion, sweaty palms, red face, and non visible psycological symptoms of panic and in general severe uncomfortable feelings) Had this since i was about maybe 16 (or even less if memory serves me right) I am 22 now and have self diagnosed SAD which isnt that hard to do as you can imagine given the obvious. It is severe but i am not bad at disguising it and tend to avoid contact with people. Now i crave to be normal!! the encouraging reports of people having relief with medication or therapy on this board has inspired me to write this as i long to be cured - it's just no life at all living the way i do now and have for so many years. I CAN leave the house and even held down a job for four years that didnt require much contact with people. But what also inspired me to seek help is that i now have much worsening of the condition (or other things wrong with me i dont know if they are seperate or related to SAD) but i will try my best to describe them.... recently i have experienced short term memory loss which is more annoying than severe , I have lost a lot of self confidence (not that I had much to begin with but I am more easily led and have far reduced decision making skills even in small matters and when i speak inferiority prevails) I get paranoid thoughts when outdoors that people (even on the other side of the street) are looking at/listening to me all the time, I have a lack of emotion and it shows when speaking - I almost seem robotic, I am tired during the day which doesnt really bother me all that much, I have strong difficulty finding the right words or just any words for a conversation: im often asked what im thinking - and usually its nothing at all! or just what do i say next? I also feel that I am very mentally slow (I know im not stupid but i come across that way to people) , I have a lack of attention span, much decreased libido - about 3/10 (although im in my 20's now so maybe thats just natural with age) and FINALLY mild depression, It may sound hard to believe but I want to socialise and mix with people, I think my life would benefit greatly from increased social contact and as they say you can never have too many friends! which i dont have many of at the moment as you can imagine. I would be v. grateful if any members could contribute any thoughts, suggestions or treatments which they found most effective and especially thoughts from those who have suffered or are suffering identical or similar symptoms. I do not have any problems going to my doctor for anything else but for SAD i wish to self medicate (i do most of the time anyway) or see a specialist who has a better understanding of the condtion(s) as I beleive most Doctors (especially here in the UK) have little or no understanding of it at all!! . Thank You all
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Hi,Bob if I were you I would print out the list Micheal provided, look at it, and then look for a Dr. that specializes in Anxiety Disorders. These meds he listed WILL help with your symptoms. It may seem simple but an ssri/benzo ie Klonopin should provide relief enough to get you on the right track. The other meds can also help either alone or in combination. JN
poster:Nixon
thread:457784
URL: http://www.dr-bob.org/babble/20050212/msgs/457875.html