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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Boba Fatt on November 10, 2002, at 4:36:45
I am currently on 10mg of lexapro for Social Anxiety. Should I be increasing the dose as the therapeutic effect for SA with most SSRI's is double that of the depression dose.
Posted by JonW on November 10, 2002, at 16:44:19
In reply to Lexapro and social phobia, posted by Boba Fatt on November 10, 2002, at 4:36:45
My pdoc (a specialist for SP) had me on 20mg before I stopped due to sexual dysfunction. He may have increased it more, I don't know. I do know that he felt Lexapro was kind of a shot in the dark because the results of the study that showed it effective for social phobia weren't very impressive. I hope it works for you, though.
Jon
Posted by utopizen on November 10, 2002, at 21:17:42
In reply to Re: Lexapro and social phobia, posted by JonW on November 10, 2002, at 16:44:19
> My pdoc (a specialist for SP) had me on 20mg before I stopped due to sexual dysfunction. He may have increased it more, I don't know. I do know that he felt Lexapro was kind of a shot in the dark because the results of the study that showed it effective for social phobia weren't very impressive. I hope it works for you, though.
>
> JonPretty much anything's a shot in the dark for SP except Klonopin.
My doctor never gives me more than enough for take as needed klonopin, and even that's little.
I once told him, "Um, what's really so bad about just taking Klonopin for the rest of my life?" And he goes "um, I don't know, I suppose that's not so bad." Yet he still refuses to let me have Klonopin. I've tried Celexa, Paxil, Neurontin, now on Effexor XR 225/day, waiting to see if it does anything.
Oh and I've tried Buspar.Frankly, I'm not so sure what an SP specialist would know that a regular p-doc wouldn't. Apparently, there's no magical script that he knows to give that has a secret codename in his PDR... unless he's giving you special cognitive behaviorial therapy, I'm not so sure how "special" he is as a specialist...
good luck trying out meds. You're on the right track. But SSRIs tend to be rather similar. After the second or third, you'll probably be put on Wellbutrin or Effexor, maybe later on a combo including one of these...
Posted by JonW on November 10, 2002, at 23:05:39
In reply to Re: Lexapro and social phobia, posted by utopizen on November 10, 2002, at 21:17:42
> Pretty much anything's a shot in the dark for SP except Klonopin.
Hi utopizen,
It's true that everyone has a unique brain chemistry and response is very individual. However, I don't think that means all drugs are equal. I think it makes sense to try the drugs with the most data to support their efficacy first. I'm very happy to hear you've found something that works for you (Klonopin). I suffer from sever SP myself and know what a horrible and disabling illness it is.
> I once told him, "Um, what's really so bad about just taking Klonopin for the rest of my life?" And he goes "um, I don't know, I suppose that's not so bad." Yet he still refuses to let me have Klonopin.
If things don't seem quite right with your pdoc, I'd consider seeking out a new one.
> Frankly, I'm not so sure what an SP specialist would know that a regular p-doc wouldn't. Apparently, there's no magical script that he knows to give that has a secret codename in his PDR... unless he's giving you special cognitive behaviorial therapy, I'm not so sure how "special" he is as a specialist...
I think the caliber of the pdoc is the most important thing. It's true that the same drugs are available to everyone, but someone with experience has a better sense of which avenues are worth pursuing and which are likely to be a waste of time. They are more skilled at making the correct diagnosis, and know the right questions to ask. They know more about psychopharmacology and have experience with more complex "cocktails". Someone who knows anxiety disorders is going to know best how to design a treatment program that suits you best and gives you the greatest chance of accomplishing your goals. Obviously, there are exceptions, but as a general rule you get what you pay for. That's an unfortunate reality in healthcare.
The pdoc I work with is Dr. Michael R. Liebowitz from Columbia in NYC. He was the pdoc who first brought Social Anxiety Disorder to light in 1985, and started the first anxiety disorders clinic in the United States. He also chaired the comittee that developed the criteria for the DSM-IV definition of Social Anxiety Disorder. If you'd like to find out more about his background, you can go to:
http://www.bestdoctors.com/en/doctors/mrliebowitz.htm
The point I want to make is that Dr. Liebowitz's experience and track record has separated him from first-line pdocs. Seeing a pdoc of this caliber can really benefit people with serious and intractable illnesses. I also work with a CBT therapist who's an expert in treating people with SP, Carla Daichman. Both my pdoc and therapist are part of Klein, Liebowitz Psychiatric Associates. They communicate and work together so the best decisions for medication, therapy, and my life in general are made. To each their own, but this has saved my life and I would urge anyone who hasn't gotten better to seek out this type of care. If you would like to read more about my situation, you can read this response I posted earlier today:
http://www.dr-bob.org/babble/20021108/msgs/127194.html
> good luck trying out meds. You're on the right track. But SSRIs tend to be rather similar. After the second or third, you'll probably be put on Wellbutrin or Effexor, maybe later on a combo including one of these...
Keep at it, Boba. Persistence will save you! If you live near Philly, Temple's social anxiety disorder program (under Dr. Richard Heimberg) is one of the best places to get CBT for social anxiety. If you haven't combined meds with CBT, you might want to consider it. Good luck with everything!
Jon
Posted by Boba Fatt on November 11, 2002, at 8:52:55
In reply to Re: Lexapro and social phobia » utopizen, posted by JonW on November 10, 2002, at 23:05:39
I suppose I take cipralex (luxapro) for general depression and anxiety as much as SA. I will probably up the dose from the current 10 to 20 as the side effects are not too bad for me. As for other drugs I've tried I've done them all. Including all the other SSRI's, Effexor, and a couple of MAOI's. Having said that I have felt a huge amount of agitation from the first few weeks of lexapro, something I have never experienced before. My Doctor says that this is a sign that the drug is working. As for the Klonopin, I have to order it on the grey market, because doctors will not prescribe them in the UK. I would like to try CBT again but it is not being offered me at the moment, perhaps I should get a book. Any recommendations anyone?
Posted by utopizen on November 12, 2002, at 16:40:59
In reply to Re: Lexapro and social phobia, posted by Boba Fatt on November 11, 2002, at 8:52:55
I know it may sound "sketchy" to you, but if I were you, I'd do the "clean" version of "doctor shopping." I know the UK suffers from benzo scares from former users a lot, but surely a doctor is out there who thinks it's okay for you given your medical record and patience in trying everything only to find it fail. I can't give you advice, since I've never done this before... I don't consider my problem severe enough to switch p-docs after a year just for some Klonopin, but it sounds like you're willing to spend hundreds on an online pharmacy... I mean, if it's that important to you, check out some hospitals in your area and ask some teaching docs for referrals-- explain you're situation, that you've patiently tried many drugs, that your problem is disabling, and they should realize you're not a "drug seeker" (especially since you're asking for Klonopin... although why not Tranxene if they're still up-tight? junkies consider that the most boring one)
good luck
oh, and think about dilantin. you and your doctor may want to consider it as a shot in the dark...
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