![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by S. Howard on October 26, 2000, at 16:31:31
Has anyone had luck with medication for social anxiety besides Paxil? I've been taking it for some months and expected to be hosting Tupperware parties by now, but there has been little if any improvement. In fact, I seem to be getting worse. I avoid my neighbors, I ignore the telephone and I hate work because making "small talk" is a nightmare for me. I even hate talking to my psychiatrist. I believe benzos might help but she will not prescribe them because I have a history of substance abuse. Most of all I feel sorry for my husband, who has to constantly make excuses for my absence. He's a very social person, and this is putting a great strain on our marriage. I'm even considering changing psychiatrists and denying any previous treatment or drug abuse so he might prescribe benzos. Of course I realize this is unethical and I might not get away with it, but I'm in a spot.
Posted by Ted on October 26, 2000, at 18:39:15
In reply to Social anxiety and Paxil, posted by S. Howard on October 26, 2000, at 16:31:31
First, stay away from the benzos because they won't help and you will just end up addicted to them.
FWIW, I hated paxil and will never use it again unless desperate.
My wife ended a lifelong social phobia with the combo of zoloft (175 mg) and wellbutrin (150 mg bid). She went from afraid to talk to anyone to hosting the playgroup for our son and going to storytime at the library and meeting new friends. She is a wonderfully new person now.
As always, YMMV.
Good luck,
Ted
Posted by LISABECK on October 26, 2000, at 21:12:48
In reply to Social anxiety and Paxil, posted by S. Howard on October 26, 2000, at 16:31:31
S. HOWARD,
I can tell you that from experience when I was taking Prozac for anxiety attacks, my social anxiety disappeared completely. I was in school at the time, and for me to read in front of a class of people was unheard of, but while I was on Prozac, I never gave it a second thought. And, it helped in every other aspect of my life as well. Also, I wanted to tell you that I am weaning off Paxil now. It was also give to me for generalized anxiety and panic disorder; however, it made me worse too-much worse, so don't feel alone. It's like any other medication. It works for some, but not for others. On the other hand, my best friend went on in for social anxiety, and she is a changed person!!! Good luck to you...Lisa
Posted by S. Howard on October 26, 2000, at 21:20:40
In reply to Re: Social anxiety and Paxil » S. Howard, posted by Ted on October 26, 2000, at 18:39:15
Of course you are correct about benzos, and my doctor is right not to give them to me as I don't even trust myself to take them as prescribed if I get nervous or depressed. However, I have tried prozac (and St. John's Wort) with no effect, and I am now taking depakote and seroquel along with the paxil, which has helped somewhat with general but not social anxiety. That's why I thought benzos might be necessary, foolish as that is, especially for someone like me. The only thing that's ever boosted my confidence around people is alcohol, but I know from personal experience that this road can lead to hell.
Now for the questions: why did you hate paxil and what do you mean by "unless you're desperate?"
Because I'm desperate.
Second, aren't zoloft and wellbutrin pretty much the same thing? I'm asking this because I was prescribed zoloft at one time by my regular physician to help me quit smoking. My health insurance company would not pay for zoloft(which seems idiotic, considering the medical consequences of smoking) so my doctor prescribed wellbutrin instead. I didn't quit smoking, so I stopped taking the wellbutrin after awhile.
Finally, I know what FWIW is, but what's YMMV?
-SGH
P.S. I'm truely glad for your wife. I don't avoid people because I dislike them and I'm always happy to hear that someone found help - and relief.
Posted by JackD on October 26, 2000, at 21:47:55
In reply to Social anxiety and Paxil, posted by S. Howard on October 26, 2000, at 16:31:31
I have some of the same problems you do. SSRI's don't seem to help with me either. I would really consider trying klonopin, and even though it's a benzo, it has the least abuse potential. It is also supposed to be one of the best treatments for social anxiety (Best meaning most effective). If worse comes to worst, and your social anxiety is really a problem, try Nardil, or Parnate. They also are among the top choices in terms of efficacy for social phobia, but they come with a big catch: food restrictions. Good luck.
Posted by S. Howard on October 26, 2000, at 21:59:05
In reply to Re: Social anxiety and Paxil, posted by JackD on October 26, 2000, at 21:47:55
I can handle any food restrictions other than chocolate or coffee. Thanks-SGH
Posted by Ted on October 26, 2000, at 23:25:58
In reply to Re: Social anxiety and Paxil, posted by S. Howard on October 26, 2000, at 21:20:40
>I am now taking depakote and seroquel along with
> the paxil, ...Why depakote? That is an antimanic (among other uses). Do you have bipolar disorder also? (I do, and I take depakote -- it has been wonderful for me).
> The only thing that's ever boosted my
> confidence around people is alcohol, but I know
> from personal experience that this road can
> lead to hell.And might very likely take someone innocent with you. You are wise to avoid it.
> Now for the questions: why did you hate paxil
> and what do you mean by "unless you're
> desperate?" Because I'm desperate.Side effects are miserable. Headaches, feeling very "drugged", neck & shoulder tingling sensations, really bad buzzing in my ears (this happens with most ADs, but not so bad for me).
And it *killed* all ability to have sex with my wife. Paxil and sex are incompatible; you will only get frustrated.If you are truly desperate, and have tried everything else, then you will have to put up with these side effects. I stand solidly behind my and my wife's AD combo: zoloft + wellbutrin. Neither worked alone, but the combo is great.
> Second, aren't zoloft and wellbutrin pretty
> much the same thing?No -- you're thinking of zyban. Zyban is wellbutrin -- they are identical. Zoloft is an SSRI antidepressent. The SSRIs include prozac, paxil, luvox, zoloft, and celexa. Wellbutrin is in a class called "atypical antidepressents" which also includes effexor, remeron, and serzone.
> Finally, I know what FWIW is, but what's YMMV?
Your mileage may vary
I wish you luck.
Ted
Posted by S. Howard on October 27, 2000, at 14:03:10
In reply to Re: Social anxiety and Paxil » S. Howard, posted by Ted on October 26, 2000, at 23:25:58
Oh, duh! Good thing (very good thing) I'm not in the pharmacy business! I WAS thinking of Zyban and not Zoloft.
I believe my psychiatrist thinks I'm bipolar and she probably bases this on the terrible sleeping problems I've had (it's hard to tell, because she much prefers asking the questions to answering them). I could stay up for a week or more with very little sleep, and then I would crash and burn. I'd sleep for most of a week, and then it would start over.
My aunt, who is a psychologist, doesn't think I'm bipolar. She thinks I have narcolepsy. So who knows.
Anyway, thanks for the tip. I will suggest the wellbutrin/zoloft to my doctor. -SGH
Posted by Ted on October 27, 2000, at 14:18:24
In reply to Re: Social anxiety and Paxil, posted by S. Howard on October 27, 2000, at 14:03:10
Hi SGH,
Your sleeping problems do sound like bipolar disorder to me -- ultra-rapid cycling, etc. When you are sleepless, are you (hypo-)manic? And your crash-and-burn -- is it terrible depression or just continual sleep? Or both?
> My aunt, ... She thinks I have narcolepsy.
Doesn't sound like narcolepsy to me. Narcoleptics will often pass out and sleep unexpectedly for a few minutes, then wake up. They usually have a trigger -- like laughing at a joke. I will check my Merck Manual and see if I can find anything that sounds like you.
BTW: You are not bipolar. You have bipolar disorder. We are not our disease.
Ted
Posted by R.Anne on October 27, 2000, at 18:10:30
In reply to Social anxiety and Paxil, posted by S. Howard on October 26, 2000, at 16:31:31
This is not a medicine but might help your social anxiety. An exposure therapy such as group therapy for social anxiety disorder. It would be a risk for you but also a very big step toward getting better. The paxil and therapy may be just what you need? Just trying to help. Good luck.
***
> Has anyone had luck with medication for social anxiety besides Paxil? I've been taking it for some months and expected to be hosting Tupperware parties by now, but there has been little if any improvement. In fact, I seem to be getting worse. I avoid my neighbors, I ignore the telephone and I hate work because making "small talk" is a nightmare for me. I even hate talking to my psychiatrist. I believe benzos might help but she will not prescribe them because I have a history of substance abuse. Most of all I feel sorry for my husband, who has to constantly make excuses for my absence. He's a very social person, and this is putting a great strain on our marriage. I'm even considering changing psychiatrists and denying any previous treatment or drug abuse so he might prescribe benzos. Of course I realize this is unethical and I might not get away with it, but I'm in a spot.
Posted by AndrewB on October 28, 2000, at 5:45:40
In reply to Social anxiety and Paxil, posted by S. Howard on October 26, 2000, at 16:31:31
Social anxiety came be the result of a variety of underlying neurochemical dysfunction: dopaminergic, serotonergic, GABA, and norandrenergic.
Serotonin agents like Paxil work fine for a minority of patients, but others will have to look elsewhere for relief.
It is important to have a psych. familiar with psychopharmocolgy. Such a doctor will have more experience and assurance in prescribing meds other than SSRIs for social anxiety. Otherwise people may times get stuck with doctors that will prescribe one serotonergic agent after another. If one or two serotonerigic agents don't help it is time to move on and try something else.
Meds that may help your social anxiety include:
Benzos: Klonopin, it has a low addiction potential at low doses and has a great track record. Past history of drug abuse does not preclude the use of Klono. Some people say drug abuse is often our own attempts to self-medicate in order to feel normal. Once effective medication is found and normalcy is attained, many people no longer hunger for drugs. They are where they want to be.
Dopaminergics: Amisulpride, sulpiride, selegiline and stimulants. For an info peice on amisulpride email me at andrewb@seanet.com. Recent brain studies have shown hypofuntiion in the dopaminergic system in those with social anxiety.
Beta Blockers: Often effective for the physical symptoms of anxiety including blushing. Kerlone and propropanol are examples of beta blockers.
Others possible meds: Clonidine (alpha A2 antagonist), gabapentin (nuerontin), Nardil (many suggest you avoid this unless you have tried a variety of other meds due to its side effects, but it is very efficacious on average.)
It is my impression that social anxiety is a very treatable disorder. The key is locating a psychiatrist who will aggresively trial a variety of med.s in short order. Most of the meds listed above only require a short trial period.
AndrewB
Posted by S. Howard on October 30, 2000, at 19:29:14
In reply to Re: Social anxiety and Paxil » S. Howard, posted by Ted on October 27, 2000, at 14:18:24
Hi Ted
I guess you could say I was manic - I mean, that I have manic symptoms - during the first two or three nights of my sleepless cycle. Then I became too exhausted to do anything productive although I still couldn't sleep. After the big crash, I would crawl home from work and fall into bed and sleep as much as possible, or sit around in a near-coma and do nothing. I wasn't depressed so much as horribly lethargic. I didn't care how I looked and the house went to hell (which doesn't take long with kids and pets). Then I would "snap out of it" and before long, I was on my knees rubbing wax into the floor ala Martha Stewart, or staying up until nearly dawn to work on a painting (I am, or I was, a part-time artist. Unfortunately, this medication seems to have killed every last creative urge. I have read Kay Redfield Jamison's excellent book, "Touched With Fire", but while it substantiates a link between bipolar disorder and the artist, and that medication will often affect creativity, it presents the same problem as paxil and sexual dysfunction - mainly, you must choose between one and the other. If anyone has more info on this problem, PLEASE let me know.)I have a regular job in the medical profession. Someone on the board complained a few days ago that it was wrong of medical personnel to refer to a patient as "the gallbladder in room 2" and she is correct to be offended, although it is a common mistake in a busy hospital area and not intended to be offensive. However, I never thought of it as insulting to say, "Mrs. Harris is diabetic" instead of saying "Mrs. Harris has diabetes." It seems a little like splitting hairs but okay, your comment was duly noted. -SGH
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.