Posted by blueboy on August 18, 2007, at 8:36:11
In reply to Friend needs alternative to SSRI/benzo for anxiety, posted by psychobot5000 on August 14, 2007, at 14:35:01
Okay, please don't take this the wrong way. I have to say this even though I don't know how to do it without sounding a bit like a jerk, but: make sure she has exhausted CBT possibilities. I'm a believer in meds when needed, but still, it's better if you can get by without taking anything.
I have two situations in which I use Klonopin. First, I will take 2.5-3 mg at night to relieve anxiety-induced insomnia and restless leg syndrome; the effect lasts all the next day. (I am a big guy and somewhat overweight.) This does cause some drowsiness but wow, what a relief to break an anxiety cycle.
However, I sometimes take 1 mg before I go out in the evening, which causes me absolutely no drowsiness but definitely relieves social anxiety. So 1/3 of the "normal" dosage for my body, that is, the dose that fully relieves GAD, has a marked temporary effect of relieving social anxiety. (Sometimes I will just put the pill in my pocket in case I start freaking out, withdrawing, etc.)
I should also say, I have an addictive personality, so I pick and choose my occasions carefully. I'm in a "club" where some members think I shouldn't take it at all.
> Hi,
>
> So here's a question: I've got a friend who's being medicated for social anxiety. She doesn't need anything too dramatic, but something to help frequent attacks at work or class without causing sedation (SSRIs and SNRIs make her very drowsy, and benzos make her feel drugged. Wellbutrin was not helpful.). Her provider, a psychiatric nurse practitioner, is one of these SSRI-brainwashed types with nothing more to offer beyond those options (zoloft and lexapro first, then cymbalta, then, reluctantly, wellbutrin and lorazepam). Everything (except the wellbutrin) worked very well, but the problem is the sedation (or druggy feeling with the lorazepam)--she'd nap a quarter of the day on zoloft or lexapro--a little less on cymbalta.
>
> Now her provider wants to start over with zoloft or cymbalta because "we've tried everything people usually try." She apparently seems very self-satisfied that the non-SSRI alternatives didn't work.
>
> Any suggestions for alternative social-anxiety meds? My thought was that she could try a tricyclic (a less sedating one), but unfortunately she has some -very slight- suicidal tendencies. Does anyone know a good alternative, or a way to make a tricyclic workable (she might need only a low dose, and thus not much medication on hand)? Some other popular antidepressants like Remeron or trazadone seem to me too sedating to be useful, but I thought there might be something else she could try.
>
> Might a different (short-acting) benzo feel less druggy than lorazepam? Or maybe modafinil might help the drowsiness side-effects of the SSRIs? Is there something else altogether to try?
>
> Any suggestions or comments would be very helpful!
>
> Thanks everyone,
> Psychbot5000
poster:blueboy
thread:776234
URL: http://www.dr-bob.org/babble/20070815/msgs/776910.html