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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by utopizen on January 31, 2003, at 21:14:35
I have social anxiety disorder and ADD (inattentive).
What should I expect? All that works is Klonopin, so my p-doc wants me on a low-dose of Abilify, regular dose of Nardil, and Zoloft, and Straterra.
Will Abilify help me concentrate better like the website says, or are they meaning more like "as in be normal" and not referring to ADD? And will I be more socialable?
Posted by JonW on January 31, 2003, at 21:34:48
In reply to Social Anxiety, about to go on Abilify- questions, posted by utopizen on January 31, 2003, at 21:14:35
> I have social anxiety disorder and ADD (inattentive).
>
> What should I expect? All that works is Klonopin, so my p-doc wants me on a low-dose of Abilify, regular dose of Nardil, and Zoloft, and Straterra.
>
> Will Abilify help me concentrate better like the website says, or are they meaning more like "as in be normal" and not referring to ADD? And will I be more socialable?I don't know, but I think it's crazy to go on Nardil and Zoloft at the same time. Even if your pdoc is an expert, it is still risky that you will develop serotonin syndrome. If I were you, I would flat out disagree to take an MAOI the same time as an SSRI. Why not try to give it a go without Nardil? That's an aweful lot of meds you're starting at once. One at a time seems more sensible to me, and that's how the best pdocs I've seen have operated. Well, be careful... I know Dr. Liebowitz wouldn't go near MAOI + SSRI and he wouldn't allow me to start Nardil until the SSRI had cleared, and he's certainly an experienced psychopharmacologist.
Jon
Posted by cosis on January 31, 2003, at 23:31:20
In reply to Social Anxiety, about to go on Abilify- questions, posted by utopizen on January 31, 2003, at 21:14:35
Taken from zoloft.com
"While you are taking ZOLOFT, you should never take a monoamine oxidase inhibitor (MAOI) medicine. MAOI medicines are used to treat depression and other conditions. If you have been taking an MAOI, you must stop the MAOI at least 14 days before you start taking ZOLOFT. In addition, you must wait at least 14 days after stopping ZOLOFT before you can safely start taking an MAOI medicine. A very serious reaction or even death could occur if ZOLOFT is taken at the same time as an MAOI medicine. Be sure to ask your doctor or pharmacist if any medicine you are taking is an MAOI."
What is your doc thinking?
Posted by utopizen on January 31, 2003, at 23:57:23
In reply to Re: Social Anxiety, about to go on Abilify- questions, posted by cosis on January 31, 2003, at 23:31:20
Oh- well so many drugs were being thrown around as possibilities- he must of meant trying Zoloft separately.
But he did want me to try Nardil plus an antipsychotic. He was concerned that my paranoia from Gabitril (and by paranoia, as in I thought I was either going to die that night or be committed for the rest of my life) indicated I might get too activated on Nardil, and the antipsychotic would help to slow that down. But at a very low dose.
Posted by jodie on February 1, 2003, at 1:11:58
In reply to Social Anxiety, about to go on Abilify- questions, posted by utopizen on January 31, 2003, at 21:14:35
Utopizen,
Its true, someone isn't thinking logically or safely about your meds... But you are here for support, even though you are receiving it, just don' t listen to every word "someone" is saying. They obviously have issues!!!
Jodie
Posted by jodie on February 1, 2003, at 1:15:11
In reply to Re: utozipen..., posted by jodie on February 1, 2003, at 1:11:58
> Utopizen,
>
> Its true, someone isn't thinking logically or safely about your meds... But you are here for support, even though you are receiving it, just don' t listen to every word "someone" is saying. They obviously have issues!!!
>
> JodieBTW: that thing I typed about having issues, that was not directed to Jon or cosis, just wanted to clarify that.
Posted by viridis on February 1, 2003, at 6:49:26
In reply to Social Anxiety, about to go on Abilify- questions, posted by utopizen on January 31, 2003, at 21:14:35
Wow -- if you already know that Klonopin works, couldn't you just take that instead? I'm not qualified to challenge your pdoc, but it seems like that would be a lot safer (and less complicated). Or is he benzophobic too?
Posted by utopizen on February 1, 2003, at 13:57:02
In reply to Re: Social Anxiety, about to go on Abilify- questi » utopizen, posted by viridis on February 1, 2003, at 6:49:26
> Wow -- if you already know that Klonopin works, couldn't you just take that instead? I'm not qualified to challenge your pdoc, but it seems like that would be a lot safer (and less complicated). Or is he benzophobic too?
>Well actually this is a doc from Beth Isreal. He consulted for an hour, and will now talk to my benzophobic doc (which knows him) and talk about me. Basically a way for my benzophobic doc to be able to charge me a $75 doctor phone talk charge instead of actually treating me.
Um, anyway, hopefully this doc will let my benzophobic doc realize my case ain't typical, and it's severe. In fact, at the end of the consultation, he goes, "so it looks like you have a unique form of social anxiety." And that comes from a guy who's in a hospital, so you know he's seen his case of wackos. Anyway, he's concerned that my treatments cause paranoia and vivid nightmares so often.
Personally, I'm 19, so I think I have a form of paranoia, perhaps schitzo, lying underneath things. And the drugs, they just pick these things up. If I go schitzo, I'll be so pissed at my doctor not picking up on it for all this time.
Posted by utopizen on February 1, 2003, at 14:00:41
In reply to Re: Social Anxiety, about to go on Abilify- questi » utopizen, posted by viridis on February 1, 2003, at 6:49:26
> Wow -- if you already know that Klonopin works, couldn't you just take that instead? I'm not qualified to challenge your pdoc, but it seems like that would be a lot safer (and less complicated). Or is he benzophobic too?
>>He said he wanted to "think out of the box" on this, so I trust him. He's just being creative, and it makes sense that Nardil would make me paranoid enough to warrant an antipsychotic.
Posted by SLS on February 1, 2003, at 14:06:05
In reply to Re: Social Anxiety, about to go on Abilify- questions » utopizen, posted by JonW on January 31, 2003, at 21:34:48
> I don't know, but I think it's crazy to go on Nardil and Zoloft at the same time.
I agree. It is the only combination that I will not consider.Combining potent serotonin reuptake inhibitors with MAOIs (irreversible type - Parnate, Nardil, Marplan, Eldepryl > 3mg) is almost universally considered contraindicated. The statistical occurrence of serotonin syndrome with such combinations is very high. On the other hand, combining an SSRI with the MAOI moclobemide (reversible type - RIMA) is often used to treat treatment-resistant depression outside the United States. Of course, if the combination of Zoloft + Nardil works well and is safe for you, how could anyone argue the wisdom of its choice?
> I know Dr. Liebowitz wouldn't go near MAOI + SSRI and he wouldn't allow me to start Nardil until the SSRI had cleared, and he's certainly an experienced psychopharmacologist.
Jon - Michael Liebowitz? Private practice or a Columbia Presbyterian?
I am currently looking for another doctor whom is experienced in treating TRD (treatment-resistant depression). I live close enough to NYC to make it worth the trip. Can you suggest any names?
Thanks.
- Scott
Posted by SLS on February 1, 2003, at 14:48:35
In reply to Re: Social Anxiety, about to go on Abilify- questi, posted by utopizen on January 31, 2003, at 23:57:23
> Oh- well so many drugs were being thrown around as possibilities- he must of meant trying Zoloft separately.
> But he did want me to try Nardil plus an antipsychotic. He was concerned that my paranoia from Gabitril (and by paranoia, as in I thought I was either going to die that night or be committed for the rest of my life) indicated I might get too activated on Nardil, and the antipsychotic would help to slow that down. But at a very low dose.
I don't know what is the rationale of your doctor to connect your reaction to Gabitril to a possibly similar reaction to Nardil. He might be right. It seems like a bit of a stretch to me upon reading your post, though. Although both Gabitril and Nardil raise levels of GABA, they do so through different mechanisms and perhaps within different structures of the brain. Other drugs that potentiate GABA include Depakote, Topomax, Sabril, and Neurontin - all of which are also anticonvulsants. I don't think I have ever heard of a bad reaction combining any of these drugs with Nardil.I have heard of a term called GABA-overload. Perhaps this is the basis of your doctor's concern. However, lots of people have reacted badly to Gabitril, experiencing altered cognitive states, delirium, over-activation, insomnia, and anxiety. Gabitril might not be a valid index of one's relative sensitivity to Nardil.
Mechanisms for increasing GABAergic tone:
Gabitril (tiagabine): GABA reuptake inhibition
Nardil (phenelzine): GABA transaminase inhibition
Good luck.
- Scott
Posted by utopizen on February 1, 2003, at 16:06:11
In reply to Re: Social Anxiety, about to go on Abilify- questi » utopizen, posted by SLS on February 1, 2003, at 14:48:35
Well, I've gotten paranoid on cannabis before (not heavy smoker- smoked about a dozen times in lifetime) to the point where I thought the cops were coming to get me, that the laptop beep on my roommate's laptop battery was a smoke alarm, that the fire engines going down the street were coming because I set off the building's smoke alarm, that I took the pot and put it in the trashcan.
I've also heard voices during another episode, and was very frightened- had vague sense of being out of it, severe anxiety, paranoia, anxiety in a way I couldn't articulate to you, but saying it made me feel like I was in Hell should suffice. Although this was Vikodin (taken as prescribe) plus cannabis plus 2 beers (taken as my 17 year old state of mind prescribed). Also got shakes during this.
Vistaril (like Atarax, it's an antihistamine) for my anxiety gave me vivid nightmares, where I was suffocating. I would wake up with the blanket over my mouth and felt light-headed several times throughout the night.
Celexa and Paxil gave me vivid nightmares where I killed people or myself.
When I was 12, I was telling an adult how how would have numbers flash quickly through my nightmares during a fever. He said how get got the same thing. Feeling like I connected to him, I naively continued by saying how I also killed people in these dreams. He stopped talking, and I realized my brain wasn't like others.
Virtually any psychotropic will give me vivid nightmares. If for no other reason that I should deserve Klonopin, I think it should be this.
Posted by JonW on February 1, 2003, at 20:50:16
In reply to Re: Social Anxiety, about to go on Abilify- questions » JonW, posted by SLS on February 1, 2003, at 14:06:05
> Jon - Michael Liebowitz? Private practice or a Columbia Presbyterian?
Yes. He sees me at his private practice on E 90th Street in Manhattan.
> I am currently looking for another doctor whom is experienced in treating TRD (treatment-resistant depression). I live close enough to NYC to make it worth the trip. Can you suggest any names?
If you can afford it, and sometimes it's worth it even if you can't, I highly recommend Dr. Liebowitz. He has saved my life. I've seen many pdocs over the last 10 years or so and have suffered my entire life, and I finally have a life and a future. He has a CBT therapist on his staff, Carla Daichman, who I also see. The two of them work together as a team to provide me with the best care. Meds help the therapy, and Carla's feedback to Dr. Liebowitz influences his decisions about meds. They've worked together for many years, and seem to have the art of effective treatment down to a science. Anyway, I highly recommend both of them. Obviously you don't *have* to see both of them, but it's been very helpful in my case. If you want contact information, etc., you can email me at jonw1978usa@yahoo.com. Good Luck!
Jon
Posted by utopizen on February 2, 2003, at 0:54:13
In reply to Dr. L » SLS, posted by JonW on February 1, 2003, at 20:50:16
Hey- Dr. L had astudy in '96 that said Zofran was great- unless he's changed his mind, I'm assuming his still thinks this about social anxiety- has he tried it on you?
Posted by JonW on February 2, 2003, at 12:43:19
In reply to Re: Dr. L and Zofran » JonW, posted by utopizen on February 2, 2003, at 0:54:13
> Hey- Dr. L had astudy in '96 that said Zofran was great- unless he's changed his mind, I'm assuming his still thinks this about social anxiety- has he tried it on you?
The only study I could find with Liebowitz was about Panic, but if you've read the study maybe it mentioned something about SP. There was a study in '94 in Puerto Rico for SP but Liebowitz wasn't involved with that. I don't suspect the results were very impressive. Even if they were, the cost is prohibitive and I'd guess that would halt research as well. As of now, there is no magic pill for SP, with Nardil being a possible exception. It's hard work overcoming severe SP, and meds can help a lot, but they mostly enable you to save yourself. Hang in there!
Jon
Posted by missinglynxx on February 2, 2003, at 20:42:31
In reply to Social Anxiety, about to go on Abilify- questions, posted by utopizen on January 31, 2003, at 21:14:35
> I have social anxiety disorder and ADD (inattentive).
>
> What should I expect? All that works is Klonopin, so my p-doc wants me on a low-dose of Abilify, regular dose of Nardil, and Zoloft, and Straterra.
>
> Will Abilify help me concentrate better like the website says, or are they meaning more like "as in be normal" and not referring to ADD? And will I be more socialable?I have this great feeling you will do well on Abilify,,,, Its very "grounding". Helps alot with your appetite,and public relaxation. Feel free to ask me anything about it , dosage wise or side effects wise (BTW,, Im allergic to Zoloft, Remeron etc) Ive been thru the ringer.It will help with attention a tad
Posted by comftnumb on February 2, 2003, at 23:35:18
In reply to Re: Social Anxiety, about to go on Abilify- questi, posted by utopizen on February 1, 2003, at 13:57:02
I'm 20yo and I have a mild case of schizo with extreme social phobia. I had my first and only psychotic episode a year ago. I can't focus/concentrate well for long periods and am extremely disorganized and forgetful of important details so I think I might have some undiagnosed ADD innatentive. Anyways, I think I can relate to your problems so if would like to discuss meds/problems, you can e-mail me at comftnumb@hotmail.com. I think social phobia might can be an early warning sign of schizo. I'm certainly cautious to say so, but my social phobia preceded my development of schizo by many years.
> Well actually this is a doc from Beth Isreal. He consulted for an hour, and will now talk to my benzophobic doc (which knows him) and talk about me. Basically a way for my benzophobic doc to be able to charge me a $75 doctor phone talk charge instead of actually treating me.
>
> Um, anyway, hopefully this doc will let my benzophobic doc realize my case ain't typical, and it's severe. In fact, at the end of the consultation, he goes, "so it looks like you have a unique form of social anxiety." And that comes from a guy who's in a hospital, so you know he's seen his case of wackos. Anyway, he's concerned that my treatments cause paranoia and vivid nightmares so often.
>
> Personally, I'm 19, so I think I have a form of paranoia, perhaps schitzo, lying underneath things. And the drugs, they just pick these things up. If I go schitzo, I'll be so pissed at my doctor not picking up on it for all this time.
This is the end of the thread.
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