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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 32. This is the beginning of the thread.
Posted by cirrus6000 on November 22, 2001, at 14:10:27
i suffer from social anxiety disorder AKA S.A.D. AKA social phobia please assist me in picking out a med tell me what works for you and why you picked it... i am currently on effexor and do not feel like it is hacking it before that i was taking paxil for a couple of years that failed on the social anxiety part but worked for my depression... the only anxiety the effexor helped was my sexual urges...it made it extremely difficult to come. please assist me in finding a drug that will work help me
Posted by 3 Beer Effect on November 22, 2001, at 16:19:15
In reply to ive got social anxiety please help me pick a med, posted by cirrus6000 on November 22, 2001, at 14:10:27
The best medication for social phobia is Klonopin (clonazepam) a total of 1 to 2 mg divided into two doses each day.
Celexa (citalopram) works well with Klonopin and causes the least amount of anxiety of all the ssri's- starting dose 20 mg, work up to 40 mg slowly.
(I've tried Effexor XR, Zoloft, & Paxil & couldn't tolerate them b/c of the anxiety, but i've had NO anxiety with celexa).Also, although I haven't tried it, Neurontin is supposed to be very effective for social phobia, I think the starting dose is a total of 900 mg per day split into 3 doses.
The hands down best medication for social phobia is Nardil (Phenelzine) an MAOI but this is an old heavy duty drug with some serious side effects. If you eat a piece of cheese or any other tyramine containing foods while taking this medicine it can kill you! This should be a very last resort if the combination of the above medications doesn't work.
Posted by sar on November 22, 2001, at 18:40:36
In reply to Re: ive got social anxiety please help me pick a med, posted by 3 Beer Effect on November 22, 2001, at 16:19:15
my daily dose for depression/ general anxiety/social phobia:
40 mg prozac
2 mg klonopin
1800 mg neurontin
50 mg lamictal (soon to increase).these drugs have helped to relax me, make me more talkiative, and smile. in certain situations i still feel social anxiety, but i believe that is normal (and perhaps it might lower with the ramping-up of lamictal).
when i started klonopin i felt like a cuddly cat. i let people play with my hair w/out jumping or feeling nervous. made jokes out loud.
prozac helped with my social phobia by giving me a backbone. i look and act very--sweet?--but now talk smack to folks, and they laugh; it makes us equals.
i found social anxiety extremley debilitating and i hope you find the right medication as soon as possible. remember, AD's take up to 6 weeks to kick in. benzos start much faster than that.
i hired the best docs i could for a short period of time then took their suggestions to a free clinic.
best of luck to you,
sar
Posted by geno on November 22, 2001, at 20:41:50
In reply to Re: ive got social anxiety please help me pick a med, posted by 3 Beer Effect on November 22, 2001, at 16:19:15
> The best medication for social phobia is Klonopin (clonazepam) a total of 1 to 2 mg divided into two doses each day.
>
> Celexa (citalopram) works well with Klonopin and causes the least amount of anxiety of all the ssri's- starting dose 20 mg, work up to 40 mg slowly.
> (I've tried Effexor XR, Zoloft, & Paxil & couldn't tolerate them b/c of the anxiety, but i've had NO anxiety with celexa).
>
> Also, although I haven't tried it, Neurontin is supposed to be very effective for social phobia, I think the starting dose is a total of 900 mg per day split into 3 doses.
>
>
> The hands down best medication for social phobia is Nardil (Phenelzine) an MAOI but this is an old heavy duty drug with some serious side effects. If you eat a piece of cheese or any other tyramine containing foods while taking this medicine it can kill you! This should be a very last resort if the combination of the above medications doesn't work.Extacy and ghb
Posted by PaulB on November 23, 2001, at 12:19:34
In reply to Re: ive got social anxiety please help me pick a med, posted by geno on November 22, 2001, at 20:41:50
A combination of antidepressant medication and benzodiazepine therapy is not unheard of. Klonopin, Nardil and Paxil come to mind when I think of the specific medications of different classes that are commonly used to treat social phobia. I would say in the short-term SSRI antidepressant medication is not as effacious as benzodiazepines. Furthermore I have found that although antidepressants can alleviate social anxiety they can cause agitation which can be unpleasnt. On the other hand benzodiazepines work on anxiety by calming me down or slowing down the central nervous system. I think the psychiatrist I see now would agree that benzodiazepines are more effective but does not prescribe them to me because of their addiction potential. I think Valium is very addictive and the newer higher potency benzodiazepines can present high addiction problems. Klonopin, one of the high potency benzodiazepines may also be a more favourable drug treatment because it may present less addiction than benzodiazepines with shorther half-lives[Ativan, Xanax]?. Alternatively there is the option of trying a beta-blocker or a small dose of a major tranquilliser which can help to take the edge off the symptoms of anxiety by blocking norepinephrine and/or dopamine receptors in the brain.
PaulB
Posted by cirrus6000 on November 23, 2001, at 13:28:00
In reply to Re: ive got social anxiety please help me pick a med, posted by 3 Beer Effect on November 22, 2001, at 16:19:15
> The best medication for social phobia is Klonopin (clonazepam) a total of 1 to 2 mg divided into two doses each day.
>
> Celexa (citalopram) works well with Klonopin and causes the least amount of anxiety of all the ssri's- starting dose 20 mg, work up to 40 mg slowly.
> (I've tried Effexor XR, Zoloft, & Paxil & couldn't tolerate them b/c of the anxiety, but i've had NO anxiety with celexa).
>
> Also, although I haven't tried it, Neurontin is supposed to be very effective for social phobia, I think the starting dose is a total of 900 mg per day split into 3 doses.
>
>
> The hands down best medication for social phobia is Nardil (Phenelzine) an MAOI but this is an old heavy duty drug with some serious side effects. If you eat a piece of cheese or any other tyramine containing foods while taking this medicine it can kill you! This should be a very last resort if the combination of the above medications doesn't work.i always thought neurontin and klonopin were anti-convulsants how do they help you with social anxiety please explain this to me??? and thank you for the helpful suggestions
Posted by Alan on November 23, 2001, at 14:05:42
In reply to Re: ive got social anxiety please help me pick a med, posted by cirrus6000 on November 23, 2001, at 13:28:00
The BZD "addiction" thing is a red herring. There are just as many problems discontinuing ssri's the research is finally showing. Medically dependent is the less obsolete term used since if one has chronic anxiety, they need a constant dose of BZD's. There is after a 40 year track record of using BZD's in the general poulation very LITTLE problems with tapering off of the drug or with escalating doses such as in the narcotics.
The World Health Organisation even approves the studies that show short AND long term BZD monotherapy is safe and effective.
Alan
Posted by Alan on November 23, 2001, at 14:09:27
In reply to Re: ive got social anxiety please help me pick a med, posted by cirrus6000 on November 23, 2001, at 13:28:00
Cirrus. Try:
http://bearpaw8.tripod.com/pd.html
AND
http://www.socialanxietyinstitute.org/medication.html
This should clear up any confusion about the old fashioned thinking about the pejorative "addiction" with all of its OTT implications.
Alan
Posted by sar on November 23, 2001, at 16:13:12
In reply to klonopin and neurontin for social anxiety???WHY?, posted by cirrus6000 on November 23, 2001, at 14:18:15
i hope that someone else can explain the scientific aspects of this, but medications can be used for various things. i am on both neurontin and klonopin...not for convulsions (i've never convulsed!), but for general and social anxiety. they help to calm me down.
Posted by 3 Beer Effect on November 24, 2001, at 0:42:42
In reply to ive got social anxiety please help me pick a med, posted by cirrus6000 on November 22, 2001, at 14:10:27
Klonopin (a benzodiazepine) & Neurontin are anti-convulsants, but they help greatly with social anxiety because like alcohol, they increase or enhance the effects of GABA in the brain, making you calmer, less anxious, & more sociable.
Posted by Sigolène on November 24, 2001, at 2:48:36
In reply to Re: ive got social anxiety please help me pick a med, posted by 3 Beer Effect on November 22, 2001, at 16:19:15
> The best medication for social phobia is Klonopin (clonazepam) a total of 1 to 2 mg divided into two doses each day.
>
I took it for 2 weeks for my social phobia, with also a trycyclic AD for depression (mild sedating AD). But after two weeks i became more depressed, and i think it's due to clonazepam. Can someone explain me that ?
Posted by Alan on November 24, 2001, at 9:47:28
In reply to Re: ive got social anxiety please help me pick a med, posted by Sigolène on November 24, 2001, at 2:48:36
> > The best medication for social phobia is Klonopin (clonazepam) a total of 1 to 2 mg divided into two doses each day.
> >
> I took it for 2 weeks for my social phobia, with also a trycyclic AD for depression (mild sedating AD). But after two weeks i became more depressed, and i think it's due to clonazepam. Can someone explain me that ?=============================================
You should try the other BZD's simce Klon is known to have that effect SOMETIMES. All of the BZD's effect one differently. This combined with the AD could have been too sedating for you also.
There's xanax, Ativan and Valium.
Alan
Posted by Snowie on November 24, 2001, at 13:36:19
In reply to ive got social anxiety please help me pick a med, posted by cirrus6000 on November 22, 2001, at 14:10:27
Let me try again.
Hey there! I understand what you're going through. I started taking Neurontin almost a year ago for anxiety, and noticed a great reduction in my anxiety. In some ways it has worked better for me than the benzos, but I also take 1 mg. of Xanax a day. I could probably wean off that with the Neurontin, but why? Celexa also worked pretty well with anxiety but I lost my libido ... not a good thing. Klonopin works well too, but for some reason it pooped out the second time I tried it. My sister takes Serzone, and likes that. I tried it once but got really dizzy. I may try it again. Anyway, Neurontin has been a Godsend for me. It doesn't work with everyone, but if it does work you should know pretty quickly, like with the benzos. My pdoc doesn't understand why it works for me, but it does. I take 300 mg. 3 x a day. Good luck!
Snowie
> i suffer from social anxiety disorder AKA S.A.D. AKA social phobia please assist me in picking out a med tell me what works for you and why you picked it... i am currently on effexor and do not feel like it is hacking it before that i was taking paxil for a couple of years that failed on the social anxiety part but worked for my depression... the only anxiety the effexor helped was my sexual urges...it made it extremely difficult to come. please assist me in finding a drug that will work help me
Posted by cirrus6000 on November 24, 2001, at 18:02:40
In reply to Re: ive got social anxiety please help me pick a med, posted by 3 Beer Effect on November 22, 2001, at 16:19:15
> The best medication for social phobia is Klonopin (clonazepam) a total of 1 to 2 mg divided into two doses each day.
>
> Celexa (citalopram) works well with Klonopin and causes the least amount of anxiety of all the ssri's- starting dose 20 mg, work up to 40 mg slowly.
> (I've tried Effexor XR, Zoloft, & Paxil & couldn't tolerate them b/c of the anxiety, but i've had NO anxiety with celexa).
>
> Also, although I haven't tried it, Neurontin is supposed to be very effective for social phobia, I think the starting dose is a total of 900 mg per day split into 3 doses.
>
>
> The hands down best medication for social phobia is Nardil (Phenelzine) an MAOI but this is an old heavy duty drug with some serious side effects. If you eat a piece of cheese or any other tyramine containing foods while taking this medicine it can kill you! This should be a very last resort if the combination of the above medications doesn't work.i appreciate your suggestions i have discussed them with my pdoc i have found your comments both insightful and wise and by the way you were dead on with your explaination of why klonopin and neurontin work thank you very much for your insights
Posted by denett on November 24, 2001, at 19:33:21
In reply to ive got social anxiety please help me pick a med, posted by cirrus6000 on November 22, 2001, at 14:10:27
> i suffer from social anxiety disorder AKA S.A.D. AKA social phobia please assist me in picking out a med tell me what works for you and why you picked it... i am currently on effexor and do not feel like it is hacking it before that i was taking paxil for a couple of years that failed on the social anxiety part but worked for my depression... the only anxiety the effexor helped was my sexual urges...it made it extremely difficult to come. please assist me in finding a drug that will work help me
I take
20 mg celexa
30 mg buspari have taken kolonpin in the past at night but have come back to buspar
Posted by Sigolène on November 25, 2001, at 5:00:53
In reply to Re: ive got social anxiety please help me pick a med, posted by denett on November 24, 2001, at 19:33:21
I'm interested in your experience with buspar. Because i take it since one week at 15mg, and up to now, there's absolutely NO effect on anxiety !
How long did you wait until it works ? and are you sure it works ?
Thanks
Posted by Denett on November 25, 2001, at 5:25:23
In reply to Re: ive got social anxiety please help me pick a med » denett, posted by Sigolène on November 25, 2001, at 5:00:53
> I'm interested in your experience with buspar. Because i take it since one week at 15mg, and up to now, there's absolutely NO effect on anxiety !
> How long did you wait until it works ? and are you sure it works ?
> Thanks
I started taking buspar august 2000 along w/ celexa. my 'social phobia' does getthe best of me on some days however, just being honest.
sometimes 'a pill' isnt a sure shot. for me anyhow/
it has been the best med for me as far as not feeling overly tired. IT DID however take a good 2-3 weeks to build up in my system...unlike other drugs that might work right away.
Posted by Alan on November 25, 2001, at 8:57:30
In reply to Re: ive got social anxiety please help me pick a med » Sigolène, posted by Denett on November 25, 2001, at 5:25:23
> > I'm interested in your experience with buspar. Because i take it since one week at 15mg, and up to now, there's absolutely NO effect on anxiety !
> > How long did you wait until it works ? and are you sure it works ?
> > Thanks
>
>
> I started taking buspar august 2000 along w/ celexa. my 'social phobia' does getthe best of me on some days however, just being honest.
> sometimes 'a pill' isnt a sure shot. for me anyhow/
> it has been the best med for me as far as not feeling overly tired. IT DID however take a good 2-3 weeks to build up in my system...unlike other drugs that might work right away.
=============================================
Buspar is used for GAD and not much else. Not effective outside of that realm. Also, if you've taken BZDs before the chances are that Buspar won't do it for you.Alan
Posted by Denett on November 25, 2001, at 13:27:46
In reply to Re: ive got social anxiety please help me pick a med, posted by Alan on November 25, 2001, at 8:57:30
> > > I'm interested in your experience with buspar. Because i take it since one week at 15mg, and up to now, there's absolutely NO effect on anxiety !
> > > How long did you wait until it works ? and are you sure it works ?
> > > Thanks
> >
> >
> > I started taking buspar august 2000 along w/ celexa. my 'social phobia' does getthe best of me on some days however, just being honest.
> > sometimes 'a pill' isnt a sure shot. for me anyhow/
> > it has been the best med for me as far as not feeling overly tired. IT DID however take a good 2-3 weeks to build up in my system...unlike other drugs that might work right away.
> =============================================
> Buspar is used for GAD and not much else. Not effective outside of that realm. Also, if you've taken BZDs before the chances are that Buspar won't do it for you.
>
> Alanalan,
for social anxiety would you then recommend
valium or klonopin?
man i need to check this out more because i had the understanding that taking buspar along w/ celexa would help w/ the social and the general anxiety....
Posted by 3 Beer Effect on November 25, 2001, at 15:03:28
In reply to Re: ive got social anxiety please help me pick a med » Alan, posted by Denett on November 25, 2001, at 13:27:46
>
> alan,
> for social anxiety would you then recommend
> valium or klonopin?
> man i need to check this out more because i had the understanding that taking buspar along w/ celexa would help w/ the social and the general anxiety....Denett,
It said in the APA clinical textbook of psychopharmacology that Buspar is "probably not effacious in social anxiety." I would stick with the Klonopin & Celexa combination it will help social & all other types of anxiety. Be sure to split the Klonopin into 2 doses, one in the morning & one at night every day. The most effective doses are 1 to 2 mg total per day, although a lower dose is taken for the first three days in order to build up to that level. Less than 1 mg/day is no more effective than placebo, over 2 mg/day will sometimes cause excessive somnolence/drowsiness. That way it will build up a constant level of Klonopin in your bloodstream & will be more effective. The half life of Klonopin can be as short as 18 hours or as long as 40 in some people. Twice daily dosage ensures a steady state blood level, kind of like how antidepressants are maintained at a steady state level after a week of administration.3 Beer Effect
Posted by Alan on November 25, 2001, at 21:52:09
In reply to Re: ive got social anxiety please help me pick a med » Alan, posted by Denett on November 25, 2001, at 13:27:46
> > > > I'm interested in your experience with buspar. Because i take it since one week at 15mg, and up to now, there's absolutely NO effect on anxiety !
> > > > How long did you wait until it works ? and are you sure it works ?
> > > > Thanks
> > >
> > >
> > > I started taking buspar august 2000 along w/ celexa. my 'social phobia' does getthe best of me on some days however, just being honest.
> > > sometimes 'a pill' isnt a sure shot. for me anyhow/
> > > it has been the best med for me as far as not feeling overly tired. IT DID however take a good 2-3 weeks to build up in my system...unlike other drugs that might work right away.
> > =============================================
> > Buspar is used for GAD and not much else. Not effective outside of that realm. Also, if you've taken BZDs before the chances are that Buspar won't do it for you.
> >
> > Alan
>
> alan,
> for social anxiety would you then recommend
> valium or klonopin?
> man i need to check this out more because i had the understanding that taking buspar along w/ celexa would help w/ the social and the general anxiety....
==============================================Why not just Klonopin? Why add Celexa? If you can get by with one, Klonopin is by far the most relable and works most effectively. It's an anxiolytic and Celexa is an AD. Why put up with the side effects of the AD if you don't need them? It's overkill. More side effects for the return on the investment.
Alan.
Posted by Denett on November 26, 2001, at 3:57:51
In reply to Re: ive got social anxiety please help me pick a med, posted by Alan on November 25, 2001, at 21:52:09
> > > > > I'm interested in your experience with buspar. Because i take it since one week at 15mg, and up to now, there's absolutely NO effect on anxiety !
> > > > > How long did you wait until it works ? and are you sure it works ?
> > > > > Thanks
> > > >
> > > >
> > > > I started taking buspar august 2000 along w/ celexa. my 'social phobia' does getthe best of me on some days however, just being honest.
> > > > sometimes 'a pill' isnt a sure shot. for me anyhow/
> > > > it has been the best med for me as far as not feeling overly tired. IT DID however take a good 2-3 weeks to build up in my system...unlike other drugs that might work right away.
> > > =============================================
> > > Buspar is used for GAD and not much else. Not effective outside of that realm. Also, if you've taken BZDs before the chances are that Buspar won't do it for you.
> > >
> > > Alan
> >
> > alan,
> > for social anxiety would you then recommend
> > valium or klonopin?
> > man i need to check this out more because i had the understanding that taking buspar along w/ celexa would help w/ the social and the general anxiety....
> ==============================================
>
> Why not just Klonopin? Why add Celexa? If you can get by with one, Klonopin is by far the most relable and works most effectively. It's an anxiolytic and Celexa is an AD. Why put up with the side effects of the AD if you don't need them? It's overkill. More side effects for the return on the investment.
>
> Alan.because i also have depression (reason for celexa)
I guess I have been "overly blessed" w/more than on illness.
Posted by Alan on November 26, 2001, at 11:57:51
In reply to Re: ive got social anxiety AND depression... » Alan, posted by Denett on November 26, 2001, at 3:57:51
> > > > > > I'm interested in your experience with buspar. Because i take it since one week at 15mg, and up to now, there's absolutely NO effect on anxiety !
> > > > > > How long did you wait until it works ? and are you sure it works ?
> > > > > > Thanks
> > > > >
> > > > >
> > > > > I started taking buspar august 2000 along w/ celexa. my 'social phobia' does getthe best of me on some days however, just being honest.
> > > > > sometimes 'a pill' isnt a sure shot. for me anyhow/
> > > > > it has been the best med for me as far as not feeling overly tired. IT DID however take a good 2-3 weeks to build up in my system...unlike other drugs that might work right away.
> > > > =============================================
> > > > Buspar is used for GAD and not much else. Not effective outside of that realm. Also, if you've taken BZDs before the chances are that Buspar won't do it for you.
> > > >
> > > > Alan
> > >
> > > alan,
> > > for social anxiety would you then recommend
> > > valium or klonopin?
> > > man i need to check this out more because i had the understanding that taking buspar along w/ celexa would help w/ the social and the general anxiety....
> > ==============================================
> >
> > Why not just Klonopin? Why add Celexa? If you can get by with one, Klonopin is by far the most relable and works most effectively. It's an anxiolytic and Celexa is an AD. Why put up with the side effects of the AD if you don't need them? It's overkill. More side effects for the return on the investment.
> >
> > Alan.
>
> because i also have depression (reason for celexa)
> I guess I have been "overly blessed" w/more than on illness.
*********************************************Yes I found that too...until I had the anxiety completely under control. Turned ou, my chronic anxiety was the root of my depression - at least in my case. I told my doc that if he were fighting a monster like anxiety all the time, he'd be depressed too.
So that's why we went with BZD monotherapy.
Alan
Posted by 3 Beer Effect on November 26, 2001, at 12:18:26
In reply to Re: ive got social anxiety AND depression... » Alan, posted by Denett on November 26, 2001, at 3:57:51
Celexa may cause more anxiety for the first month but after a month your body gets used to it and then it is an effective anti-anxiety & anti-depressant medication. The starting dose is 20 mg, & the normal effective dose is 40 mg. I do not tolerate the anxiety effects of depressants very well so for the 1st 7 days of Celexa I started w/ 10 mg, then bumped up to 20 mg. I am going to ask me doctor to change the dose to 40 mg in a few weeks, and to help adjust to this dose I am going to take 30 mg for 7 days, and then switch to 40 mg/day for the long term.
Klonopin is the most effective medication for social anxiety & is far superior to valium or xanax (which has far too short a half life & therefore rebound anxiety, & higher addiction potential).Here is the rest of the Klonopin (clonazepam) info I printed before. If you can afford the name brand Klonopin I would take that instead of generic. I have read some studies that said that generic benzodiazepines are not nearly as effective as the name brands (Roche Laboratories).
Klonopin should be split into 2 doses, one in the morning, one in the night every day. The most effective dosage is 1 to 2 mg total/day, although a lower dose is taken for the 1st 3 days in order to build up to that level. Less than 1 mg/day is no more effective than placebo! Over 2 mg/day will sometimes cause excessive somnolence/drowsiness, although one study I read (from the University of Brazil) recommended 3 to 6 mg/day for social phobia but i think the only people who could tolerate that and still be able to go to work & drive are those with extreme nervousness. (Keep in mind that Klonopin is a social disinhibitor so at a high dose like that you make act or do dumb things as if you are drunk). Klonopin should be taken every day NOT AS NEEDED but divided into 2 doses every single day because (its half life can be as short as 18 hours) then it will build up a constant level of Klonopin in your bloodstream in a fashion similar to antidepressants, & will therefore be more effective & effective 24 hrs per day. Also, using benzodiazepines on an as needed basis rather than on a strict scheduled basis w/ no variations is more likely to lead to abuse & then tolerance/dependence.
Posted by Alan on November 26, 2001, at 16:23:45
In reply to social anxiety depression...Celexa/Klonopin comb, posted by 3 Beer Effect on November 26, 2001, at 12:18:26
"Also, using benzodiazepines on an as needed basis rather than on a strict scheduled basis w/ no variations is more likely to lead to abuse & then tolerance/dependence."
This does not make any sense. Please explain?
Alan
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