Posted by Chairman_MAO on April 26, 2005, at 12:10:31
In reply to Social phobia/anxiety and drugs/meds [long], posted by not_so_pro_social on April 24, 2005, at 1:48:15
I am a tranylcypromine success story for lifelong social phobia and treatment-resistant dysthymia/double depression. At 24 years of age, last August, after over three years of trying every medication in the book--and a lifetime of baseline high anxiety, low self esteem, social phobia, and generalized hopelessness and inability to maintain a long-term interest in nearly anything--I clamored and clamored until I had the good fortune of moving to the New Brunswick, NJ area. Here, even the public clinic has top-notch psychiatrists because of their affiliation with the state medical university.
Even though the doctor I saw was barely out of residency, she consulted with her supervisor and prescribed me Parnate out of compassion. Man, what an ultimately ineffable difference! I could walk around, head up high, generally happy about what was going on. It's the classic SP remission story: being able to look people--esp attractive members of the opposite sex--in the eye, etc. My self-image began to accomodate for the fact that other people liked me and/or found me attractive and fun to be around.
It wasn't long, however, that I found that the Parnate didn't provide constant relief throughtout the day. The MAOI effect was always there, but the dopaminergic punch faded a few hours after the last dose. The insomnia was also horrible, and I had to take Cialis to get it up. Parnate is also quite expenisve at the minimum effective dose for me (60-80mg/day). I took things into my own hands, read about high-dose tranylcypromine, and brought the dose up gradually all the way to 200mg/day. WOW!
I purchase tranylcypromine powder through a chemical broker in order to afford this (no insurance).I am fully convinced that the reason so many people do not have success with Parnate is that their dose is too low. In my opinion, anyone not completely satisfied with their response to Parnate should shoot for a target dose of AT LEAST 90mg, preferably 120-200mg/day.
Moreover, the side effects lessened somewhat instead of increased the higher I went. Very strange. I only had to take Cialis sometimes. The insomnia lessened somewhat, but remained. I thought I had the best pharmacological solution available. I was wrong.You see, I also have a history of moderate-to-severe drug addiction (controlled substances of all kinds) which began due to a failed quest to self-medicate my unlivable mental condition coupled with too many doctors that only knew how to script SSRIs. Even though I was on the Parnate, that remained. So did my procrastination and "reward deficiency syndrome". Don't get the wrong idea: I was hardly ever depressed, and it never stopped working for social phobia. It aggrivated my predisposition toward anxiety late at night when it wore off, but some seroquel before bed took care of that.
But things were still not good. I was still getting high to cope, and the stress of school was overwhelming. I began to isolate, etc. And you probably have no idea how weird it feels to feel hopeless, frustrated, and cornered by life while also feeling somewaht upbeat and sociable due to taking such an effective medication.
To make a long story short, I sought out treatment with Suboxone (sublignual buprenorphine) to deal with drug cravings and to prevent my getting high on opiates (my "drug of choice" when I try to maintain functionality despite the demons in my head). The ironic thing is that I never really wanted to get high in the first place; I was just buying the dope--and taking all associated risks--just to be able to shut the "demons" up so I could function.
I told this to an extremely compassionate addictionologist that works at another clinic around here, and he put me on Suboxone. It's been one moth since I started it, and I'm happy to say I am done with the medication thing. I feel great. My cravings for drugs have been lessened by--conservatively--75%.. Not only that, but it's slightly sedative effect is just enough to counteract any overstimulation from the Parnate. Buprenorphine is also so effective for depression and anxiety in and of itself that I have been able to cut the tranylcypromine back to 120mg/day, looking for a further reduction back to around 60-80mg/day; I simply don't think I need that much punch from tranylcypromine anymore now that I have the bupe on board. Furthermore, buprenorphine actually corrects my "reward deficiency"--the core problem that lead to all of my academic failures--such that I now enjoy even the previously insurmountable yet simple task of cleaning up my room, which used to always be a mess.
I cannot stress it enough: I had no idea it was possible to live this way. I had no idea such a state of normalcy was something I'd ever experience. I thought it was reserved for "them", and that I was destined to exist on the fringe of society, forever a dilettante, unable to actualize his vast array of talents because of mental illness. I pray daily that God allow me to continue to have access to this medication, because without my meds, I would likely be in a virtual gutter in 10-20 years. I am not being hyperbolic at all in saying that, either. With it, I will now most liekly be able to finish my undergrad degree, go to grad school, and have a rewarding life.
At any rate, the point of my post is this: If anyone thinks they've tried every combination of psych meds for depression/social phobia, if you haven't tried buprenorphine + tranylcypromine, you are doing yourself a grand disservice. I only wish it were easier and cheaper to get so that more people could benefit from it.
IMHO, buprenorphine alone is safer and far more effective than any antidepressant out there besides perhaps the MAOIs. 80% of the ADs and other psych drugs on the market are utterly useless for populations such as those that make up a large portion of people on this board: the "treatment-resistant".
P.S. Even though I now feel sublimely "OK" and often elated just to be alive, I still can cry and get frustrated when appropriate. When I was taking SSRI-poisons, I had no ability to cry. It's quite ironic that the meds I take now--including the opiate, which would make me a virtual pariah if the average person knew why I took it (ie, not for physical pain)--which are so effective at raising my mood, still allow me to feel down whenever it's appropriate.
If you have any questions/comments, please let me know. I don't post here much anymore because I just don't have the time, but if my experiences could help anyone achieve full remission like I have, it's worth my spending a little time here.
poster:Chairman_MAO
thread:488651
URL: http://www.dr-bob.org/babble/20050423/msgs/489818.html