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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by jonh kimble on September 4, 2002, at 17:48:39
Hello everyone. I've been dealing with a problem now for four years and still havent found any relief. I know this not usual, but if anyone could offer any insight i would love that. My basic symptoms are excessive daytime sleepiness, poor motivation, overworrying, low self esteem and social anxiety, although i do realize im a decent person with many potential talents. I also have a very poor appetite, poor concentration, and i feel like i am responsible for other peoples problems(overly guilty) although i realize all these things are irrational, and have been to several psychologists and do my best on my own.
Whats strange is that i havent responded to any ad's, only dexedrine, which worked well for a day then pooped out. my tolerance to stimlants is very high, although when they do work, they help every symptom.
My current knowledge tells me that a mood stabilizer or klonopin would help with the tolerance and maybe other symptoms. if you have any info or suggestions at all, i would love to hear them. Thank you
Posted by B4YS74RS on September 4, 2002, at 20:00:12
In reply to tuff case, posted by jonh kimble on September 4, 2002, at 17:48:39
i see why you say its a tough case.
i am in a very similar situation right no myself, and it is not getting very much better, despite seeing the psychotherapist and the pdoc.
for me, i know what is wrong, and i dont believe that it is something that medication or speaking with a psychotherapist can fix.
i have to work evryday to try to get things in order. it takes a lot of effort, and i have attendency to get lazy.
so what happens?
the cycle of unhappiness, and lethargy, and frustration continues on.
now that is just me, i cannot speak for you, but for me, i know that i must change my habits, and change my thought patterns, and accept myself for what i am, accept my problems for what they are, and accept that there are certain things that are not easily changed.
you are lethargic, and unhappy, and so am i; what i try to figure out for myself is the underlying cause to it, and from there, work to deal with it. i believe strongly that many problems that we face are treatable with no medicine necessary.
understanding what causes our unhappiness, and a positive thinking approach to adressing those issues that make us unhappy can make all the diffenece in the world.
its hard work, the road is lonely, but we have it in oursleves to overcome.
find a new person to talk to, the on you speak to now may be a moron, or simply may not care at all for your feelings and your welfare.
</comeback>
Posted by B4YS74RS on September 4, 2002, at 20:28:39
In reply to Re: tuff case, posted by B4YS74RS on September 4, 2002, at 20:00:12
whats troubling you?
dont answer in the forum if you dont want, im just saying, think of whats troubling you, and attempt to get underneath it.
work from there.living on this earth, in my opinion, is a heavan, but not everyone shares that feeling, and people dont know what to do with it, and thus...the way the world is!
forgive me if i make no sense and have you aggravated.
i wish i could help!
Posted by B4YS74RS on September 4, 2002, at 20:45:27
In reply to Re: tuff case, posted by B4YS74RS on September 4, 2002, at 20:28:39
there are only a few very small things that one must do in life to achieve happiness.
1.understand that this world is imperfect heavan. 2.adjust to, the "ways of the common world", adapt, and being willing to work for that which you need.
3.appreciate the wonder of life itself.look at failure as a blessing, for it will always grant you an opportunity to learn and grow. calmly and gently find yourself become relaxed and at ease in the caring and loving hands of god.
imagine that all will be well, regardless of what the situation is now. imagine peace and happiness and see yourself as someone who is loved and adored. know that it is only the ignorant who would persecute you and pass judgement upon you.
Posted by oracle on September 5, 2002, at 0:39:52
In reply to tuff case, posted by jonh kimble on September 4, 2002, at 17:48:39
Would you mind listing the AD's and doses you
have taken ?
Posted by action_jackson on September 5, 2002, at 8:44:49
In reply to tuff case, posted by jonh kimble on September 4, 2002, at 17:48:39
Jon -
I recall you from earlier. (ps - I am now re-emerging back onto treatment after hiatus since Feb 2001 to figure out better the problem with amisulpride caused tardive movements). Things looking more clear (and getting better) now and am re-starting treatment which has helped me greatly last 7-8 years. I have similar symptoms - I think - to you - maybe less of the naturally low energy and depression though.
Anyway - you said you pretty much tried everything I think - even wanted to try amisulpride or other antipsychotics at low dose.
YOu said I think you tried even Nardil to no avail.
I think your comment on Klonopin is probably right - at reasonable sustained dose - for social anxiety, worry, and general anxiety, and some for self esteem, also fear, and dependency or fear of change.. (if that is an issue - ie; moving or changing life situations ... etc).
However klonpin alone won't help your energy or depression.
Low dose nardil (enough to be antiderpessant) will tend to boost energy, motivation, self-esteem. Combined with klonpoin (even high dose) - I believe usually this is not particularly sedating (the combo more than either alone but still I think pretty energetic - you might not even want to sleep more than 5-7 hours a night.
If is too sedating - or energy an issue. You might say you are treatment refractory (self described no?) - very low dose augmentation with dexedrine (you report benefit but then loss without dose increase) - or perhaps very low riatlin or low provigil.
All of those stimulatants - even with low dose nardil - dr's usually will be concerned - despite the lack of official contradication (with cautious use).
even nardil I understand now being pulled off austrailian shelves - apparently significant SP is not worthy of effective treatment in austrilia... nor TRD with neurotic symtpoms or TRD atyical depression (nardil acceptated best there)... - and good side effect profile particularly at less than highest doses.
I only suggest to consider what you already have thought - that klonopin, dexedrine, may help you - but than the maoi is missing - (the stimulating antidepressant is missing - esp. the one preferentially good for SP boosting 5ht-2, and to lesser extent dopamine.
chad
http://www.socialfear.com/
> Hello everyone. I've been dealing with a problem now for four years and still havent found any relief. I know this not usual, but if anyone could offer any insight i would love that. My basic symptoms are excessive daytime sleepiness, poor motivation, overworrying, low self esteem and social anxiety, although i do realize im a decent person with many potential talents. I also have a very poor appetite, poor concentration, and i feel like i am responsible for other peoples problems(overly guilty) although i realize all these things are irrational, and have been to several psychologists and do my best on my own.
>
> Whats strange is that i havent responded to any ad's, only dexedrine, which worked well for a day then pooped out. my tolerance to stimlants is very high, although when they do work, they help every symptom.
>
> My current knowledge tells me that a mood stabilizer or klonopin would help with the tolerance and maybe other symptoms. if you have any info or suggestions at all, i would love to hear them. Thank you
Posted by jonh kimble on September 6, 2002, at 19:28:01
In reply to Re: tuff case, posted by oracle on September 5, 2002, at 0:39:52
Thank you for your help. I have to say what you said wasnt what I really wanted to hear but Im beginning to see... Would you mind me asking you a couple of questions? I will post something in social babble. thanks jon
Posted by jonh kimble on September 6, 2002, at 19:43:11
In reply to Jon, stim, maoi, klonopin, i believe u treatable, posted by action_jackson on September 5, 2002, at 8:44:49
Thanks for your posts. Yes I did try amisulpride recently with no response. Not the miracle drug I was sure it would be. I have tried nardil 60mgs, parnate 50mgs, adrafinil 600mgs, effexor 225 mgs, dexedrine 30mgs, deprenyl 10mgs, welbutrin 300mgs, I have also tried paxil, luvox, ritalin, (dont know dosages. Probably more but i cant remember. Only dexedrine worked for a short while then pooped out. Nardil sounds ideal but it didnt do anything before so i dont think it will now.
Right now Im waiting to see a psychiatrist in end of october. my hope is to try klonopin or neurontin. what do you think? i feel so foggy headed and tired, although i slept 8 hours last night, i fell asleep on my desk and didnt wake up until 1. I have heard nmda antagonists can be quite effective for chronic fatigue. alcohol wakes me right up and makes my mind very focused. why would this be? it also takes away my stimulant tolerance, and i have heard alcohol is also an nmda antagonist. just trying to piece things together here. if anyone has any suggestions i would love to here them. thanks
jon
Posted by action_jackson on September 7, 2002, at 1:18:55
In reply to Re: I have tried..., posted by jonh kimble on September 6, 2002, at 19:43:11
Hi Jon -
IMO I think you can treat your SP with some good results. The meds and doses - IMO most of them wouldn't be expected to help much with moderate to severe SP.>>>>>>>>>>>>>>>>
... nardil 60mgs, parnate 50mgs, adrafinil 600mgs, effexor 225 mgs, dexedrine 30mgs, deprenyl 10mgs, wellbutrin 300mgs, paxil, luvox, ritalin.
>>>>>>>>>>>>>>>>
I tried all those for SP too - (except provigil instead of adrafinil) ... sometimes alone or in combo...
For mod (especially severe) SP like I have without treatment - I do not think SSRI's usually help much. The stimulants - I think dexedrine has better mood lift than ritalin (better for SP) - but I don't think any stimulants tend to be good "taken alone" chronically for severe SP. That includes wellbutrin and provigil as well. Effexor I think most people like *less* than SSRI's for SP - tending to have more anxiety - although true that oddly Effexor often good for those with *specifically* "generalized anxiety" but *not* "primary social anxiety".
Elepryl at 10mg - most will find big energy boost - often prosexual - but unlikely help for SP taken alone.
Of the above, that leaves parnate (50mg) and Nardil (60mg). The Nardil dose was low - the Parnate dose is pretty high. But Parnate usually not much help for SP. No double blind studies, never heard of anyone reporting long term good effect myself - and there is a self employed "CBT guy in Pheonix - big website and lot of webpages who pushes Parnate - I say he is flat wrong about Parnate - I think only rarely it is the right choice for severe SP.
Nardil - your dose was low - I believe without question too low to even evaulate if it helps you for SP. You need to slowly push up the dose if you can tolerate it to 75, 90, occacionally it can take 115mg. I don't think people normally need to do this as the only option for good SP treatment - but I do think that for Nardil monotherapy to work for severe SP, it is usually going to work *IF* the dose is pushed up high enough - 60 is a low dose for most people - kind of a minimum antidperssant dose but for SP a higher dose normally required. For me, it was 90, which I did for 2.5 years (monotherapty) before switching things around, lowering Nardil and adding Klnopoin for the bulk of the time since... The high Nardil was really awesome for my energy and drive and motivation. I have heard many stories of people getting similar type results with high Nardil.
On Klonopin - you have missed perhaps the most effiective SP treatment there is - especially for those with a lot of anxiety / worry, etc. And absoulately you need to try Klnoopin - again being sure that if it doesn't work or stops working - to slowly push up the dose over time - just as with nardil. Klnoopin dose range from 1-6mg, I believe for most males 2-5. I am in 4-5 range myself, unless tweaked so I can lower dose.
Neurontin - I think is for mild cases - not severe - klonopin, nardil here. Not just because of my case. I hear this from many people. And the studies back this up - but you won't find new studies on either drug because they are "off patent" and the billions of dollars involved in pushing new drugs precludes anybody trying to effiecativly compare nardil or klonopin to zoloft or paxil for severe SP. The results would make the SSRI's look so bad ... Those studies will not happen - they have not and will not... if they did probably would be fixed somehow but won't happen anyway.
>>>>>>>
...Only dexedrine worked for a short while then pooped out. Nardil sounds ideal but it didnt do anything before so i dont think it will now.
>>>>>>>
Makes sense to me with dexedrine. But taken alone is "off/on" rebound depression and lethargy. I don't think monotherapy is going to work with dexedrine for severe SP. A very low dose agumenting other dopamine boost makes more sense so that the "peak and dips" are mild relative to overall serononin and dopamine boost. Like a very low agument to low Nardil for example. Someone else here I think did medium dexedrine + eldepryl - also would block major dopamine dip. Mild DA dip can work out though in PM - to help sleep.Dexedrine is used sometimes for "treatment refractory depression" - works during day - wears off at night to sedation / depression / sleep...
Still Dexedrine - I don't think can be a key drug for SP - only a tweak - not one to focus on as a main treatment med.
...my hope is to try klonopin or neurontin. what do you think?
If you haven't tried Klonpoin you must. The highest success rates over placebo in the available studies. Only some stimulant, non-axiogenic antidepressant probably will need to be added in your case if you have low energy and some depression - or you lose the benefit due to depression / energy problem. I highly suggest low Nardil here (ie; maybe 60mg) - otherwise low Parnate (ie; 20-40mg) with high Klonopin.
...foggy headed and tired
Yes - that is where MAOI's are superior to SSRI's (save PRozac maybe - and SNRI Effexor). But the latter don't boost dopamine like the MAOI's. MAOI's good for energy taken alone (elepryl 10mg a good example). But Eldperyl not the SP med of choice ... Nardil is (high dose taken alone - 75-115 ... slow taper up). and KLONPIN GOTTA TRY
Good luck!!!!! Hang in there don't give up.
Chad
http://www.socialfear.com/
Posted by sebastian on September 23, 2002, at 10:51:05
In reply to tuff case, posted by jonh kimble on September 4, 2002, at 17:48:39
Try to trace your problem, think of what your dreams were about, do something about it, don't just worry. If all else fails I found that 40mg of Celexa woke me up!!!
This is the end of the thread.
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