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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Budgie on August 30, 2003, at 22:27:38
Hi everyone,
I've had Social Anxiety for about 8 years now or so. Meds are now finally helping heaps with the depression. Positive lifestyle changes and endurance have completely wiped out any general anxiety years ago. With my SA, I feel like I can endure and even sometimes control all of my symptoms- increased heartrate, muscle tension, self-consciousness- except one.
I get bad facial ticks when I'm really nervous, and to me, it's the most blatant sign that I've got serious mental problems. It's so humiliating, that the moment I feel them coming on, I have to look away or even abruptly end the conversation and get away from people.
The ONLY thing that's worked (I've tried several ADs, acupuncture, massage, meditation) has been Zyprexa. But the stuff knocked me out so much that I needed several cups of caffeine just to get through the daylight hours. This, of course, completely negated any gains from the Z. Going back on that is not an option at all.
Matt's persuaded me to try Klonopin (if I can convince my doc) for SA in general. Could a low dose of this help with the tics? Anyone have similar problems or any success with this? Oh yeah, I should also mention that I'm on the MAOI Parnate.
A million thanks for any help,
Budgie
Posted by mattdds on August 31, 2003, at 0:44:31
In reply to Facial twitches in SA, posted by Budgie on August 30, 2003, at 22:27:38
Hi Chris,
Sounds like the tics are causing you a great deal of distress. Sorry to hear that.
I can sort of relate. I was raised with the belief that I should always smile at people in social situations. So, often, I will smile so much (perhaps a defense mechanism for nervousness or insecurity) that my facial muscles get very fatigued, and the corners of my mouth start to twitch. I've looked in the mirror, and they don't seem noticible though. But a part of me believes people see right through me. This led to a spiral of worsening anxiety and more twitching.
The way you described yours sounds like they are more noticible than mine. Have others commented on it? Are they obviously visible to anyone else?
My hypothesis? We just get better at "hiding" our underlying SA as we get older, unless we work on the core beliefs (or biological problems) that lead to them. You mentioned you got rid of most of your symptoms except the facial tics. Perhaps you still have the same insecurities you've always had, but have just gotten somewhat better at controlling the physiological anxiety response?
Benzos may very well help, because they have muscle relaxing properties. Valium, in particular has this property. Klonopin, to a lesser degree has it, but I think tolerance builds to this effect.
Much more importantly, benzos may get to the heart of the anxiety that is provoking them in the first place. And tolerance typically does *not* build to anxiolytic effects in benzos.
I would also recommend CBT. Not because CBT will directly reduce the tics, but because you may be able to reduce your anxiety a bit about them. It may help to break the cycle of anxiety --> tics --> more anxiety (about tics) --> more tics!
In other words attack this with all guns blazing, so to speak. I have some specific cognitive therapy techniques which worked for me. Medications also certainly could help.
Best of luck,
Matt
P.s. Have you ruled out any neurological problems? I doubt that is the cause, but if it were, it would change things a bit. Yours sound like they are 100% anxiety induced.
Posted by bookgurl99 on August 31, 2003, at 22:24:00
In reply to Facial twitches in SA, posted by Budgie on August 30, 2003, at 22:27:38
Budgie,
All I can say is that I'm perceived as being calm, except by those close to me -- who see me as 'nervous.' My eyes blink a lot, an unusual amount, and have since late adolescence. It happens much more when I'm nervous or even just making a joke in public, but I'm often not aware of feeling nervous or even of the blinking when it's happening.
One thing though -- it is SURE to happen more if I'm more aware of it.
I notice that sometimes other people with tics will start ticking more around me; I think they feel self-conscious and just start doing it. My poor professor started doing it in the first meeting of a class the other day -- I hope I don't keep setting him off that way!
Posted by GreatDaneBoy on September 1, 2003, at 20:17:50
In reply to Re: Facial twitches in SA, posted by bookgurl99 on August 31, 2003, at 22:24:00
Posted by Budgie on September 1, 2003, at 21:17:13
In reply to Re: Facial twitches in SA » Budgie, posted by mattdds on August 31, 2003, at 0:44:31
> Hi Chris,
Hi Matt, it's good to be back. Visiting wasn't as bad as I had feared!
Yes, the tics are very obvious and people have commented on it before, which is maybe why I'm more self-conscious about that than anything else, why it's spiraled into such a big problem. The plan is to go at it with all guns blazing, as you said, with CBT and hopefully a benzo.
It's really remained a mystery to me, what the biological basis of it is. I always thought that twitches and neurologic problems like that are caused by too little dopamine in one's system, as with Parkinson's. The Parnate, while raising dopamine, hasn't helped the problem at all. Zyprexa, a dopamine ANtagonist was the only thing that helped (it also helped with other anxiety symptoms). I really don't understand. Am I right that Parnate doesn't affect GABA at all, that it could be why I'm still anxious even though I'm pretty happy?
Perhaps the Zyprexa just made me stop thinking and giving a **** what everyone thought. So the self-conscious spiral was stopped. That stuff is really good if you over-think and analyze everything to death, as I do.
Posted by mattdds on September 2, 2003, at 14:59:25
In reply to Re: Facial twitches in SA, posted by Budgie on September 1, 2003, at 21:17:13
Hey Chris,
Glad you enjoyed your break.
>>Yes, the tics are very obvious and people have commented on it before, which is maybe why I'm more self-conscious about that than anything else, why it's spiraled into such a big problem.
In CBT, your therapist will likely help you work on coming to a complete (or as close to it as you can get) acceptance of the tics. We can talk a lot more about this on psychological. I know this approach may sound insensitive, but since the tics seem somewhat stubborn, and resistant to current medical methods, it may be advantageous to attack *not* the tics, but the thoughts about the tics, which according to CBT ideology, is what really causes the unhappiness and anxiety. I'm not at all minimizing your suffering that's resulted from this problem. I understand SA very well, and have some very deep seated insecurities of my own (real and imagined). I'm just suggesting the path that led me to feel a whole lot better.
>>It's really remained a mystery to me, what the biological basis of it is. I always thought that twitches and neurologic problems like that are caused by too little dopamine in one's system, as with Parkinson's
You are absolutely right. This just goes to show how little we understand about movement disorders in general. In Parkinson's, like you mentioned, the therapeutic goal is usually to *enhance* dopaminergic transmission. Weird, eh?
But the bottom line is that it helped. My only concern about trying those (the reason I haven't) is because they can sometimes *cause* serious movement disorders, sometimes irreversible ones. I'm not an expert on this class of drugs, but maybe in your case the benefits would outweigh the risks. So I would say that another trial is something to talk to your doc about. Be sure to discuss all the pros and cons. I think the Zyprexa sedation subsides after a while, as with most drugs.
Before doing that (trying Zyprexa) again, I would certainly give the benzos a shot.
Oh yeah. Do these tics only happen when you're anxious in social situations? Or do they happen spontaneously, like while you're alone?
From the little I understand about MAOI pharmacology, phenelzine (Nardil) and the other hydrazine MAOI isocarboxazid also inhibit GABA transaminase, increasing GABA transmission. This is thought to be why phenelzine is good for panic and SA. Parnate is a non-hydrazine, and does not directly increase brain GABA (although I think I've read that it does *indirectly* somehow).
But before you ditch the Parnate for Nardil, I'd try to augment with a benzo, namely Klonopin.
Best of luck to you,
Matt
Posted by Budgie on September 2, 2003, at 17:09:05
In reply to Re: Facial twitches in SA » Budgie, posted by mattdds on September 2, 2003, at 14:59:25
Hi Matt,
Well I had a bummer of a day. My psychiatrist won't prescribe me a benzo, at least until he does some more research on it. I think I'll complain about him in a new post, though. :)
Re Parnate and GABA: Have you heard of supplementing the first with the second? It'd be a lot easier to walk into a health food store than to convince my stubborn doc. Guess I should start doing more research!
How was your first day of class? I find it interesting how people with SA wind up in the professions they choose. It seems like dentistry requires one to interact with lots of people- is this a problem for you?
See ya,
Chris
Posted by Budgie on September 2, 2003, at 17:11:03
In reply to The same exact thing happens to me! (nm), posted by GreatDaneBoy on September 1, 2003, at 20:17:50
Hi,
So what do you do about it? If we've got the same problem, maybe we could share information and experiences!
Posted by GreatDaneBoy on September 2, 2003, at 23:59:14
In reply to Re: The same exact thing happens to me! » GreatDaneBoy, posted by Budgie on September 2, 2003, at 17:11:03
> Hi,
>
> So what do you do about it? If we've got the same problem, maybe we could share information and experiences!Well, I am trying to treat it along with my tremors and restless leg syndrome (both of which are seriously bothered by all of the meds I take) with a neurologist and my psychiatrist in tandem. So far I have tried Mirapex (a parkinson's disease drug that does something or other with dopamine), which was pretty good, but after three days I had CRAZY visual hallucinations...I have never done LSD or Mushrooms or anything like that, but I imagine that this is what it must be like. Everything was flowing and twisting and different colors.....okay, back to the topic now. After that I tried Requip, which is in the same class as Mirapex, but it did not do a single thing for me (no effects and no side-effects). The next alternative will either be mysoline (which appearantly turns into phenobarbitol in your system or something like that) which is what my neurologist wants me to take, or Valium, which my psychiatrist would rather I take. They are currently "conferencing" on this issue and together they will decide by next week, when I have my next neuro appointment.
I'll let you know what they decide and how it's going...either drug they perscribe will start working right away so it will be easy to tell.
Best of luck to you,
Dane =)“I hope I didn’t brain my damage.”
-Homer Simpson
Posted by jimbow on September 5, 2003, at 1:57:26
In reply to Re: Facial twitches in SA » Budgie, posted by mattdds on September 2, 2003, at 14:59:25
hi,
I get the same problem, when I try to smile a lot, my mouth will twitch. What CBT techniques and medication worked for you? Right now I'm taking 75mg of Effexor, it works great for other anxiety related symptoms but does not help with the mouth twitching. Thanksjimbo
> Hey Chris,
>
> Glad you enjoyed your break.
>
> >>Yes, the tics are very obvious and people have commented on it before, which is maybe why I'm more self-conscious about that than anything else, why it's spiraled into such a big problem.
>
> In CBT, your therapist will likely help you work on coming to a complete (or as close to it as you can get) acceptance of the tics. We can talk a lot more about this on psychological. I know this approach may sound insensitive, but since the tics seem somewhat stubborn, and resistant to current medical methods, it may be advantageous to attack *not* the tics, but the thoughts about the tics, which according to CBT ideology, is what really causes the unhappiness and anxiety. I'm not at all minimizing your suffering that's resulted from this problem. I understand SA very well, and have some very deep seated insecurities of my own (real and imagined). I'm just suggesting the path that led me to feel a whole lot better.
>
> >>It's really remained a mystery to me, what the biological basis of it is. I always thought that twitches and neurologic problems like that are caused by too little dopamine in one's system, as with Parkinson's
>
> You are absolutely right. This just goes to show how little we understand about movement disorders in general. In Parkinson's, like you mentioned, the therapeutic goal is usually to *enhance* dopaminergic transmission. Weird, eh?
>
> But the bottom line is that it helped. My only concern about trying those (the reason I haven't) is because they can sometimes *cause* serious movement disorders, sometimes irreversible ones. I'm not an expert on this class of drugs, but maybe in your case the benefits would outweigh the risks. So I would say that another trial is something to talk to your doc about. Be sure to discuss all the pros and cons. I think the Zyprexa sedation subsides after a while, as with most drugs.
>
> Before doing that (trying Zyprexa) again, I would certainly give the benzos a shot.
>
> Oh yeah. Do these tics only happen when you're anxious in social situations? Or do they happen spontaneously, like while you're alone?
>
> From the little I understand about MAOI pharmacology, phenelzine (Nardil) and the other hydrazine MAOI isocarboxazid also inhibit GABA transaminase, increasing GABA transmission. This is thought to be why phenelzine is good for panic and SA. Parnate is a non-hydrazine, and does not directly increase brain GABA (although I think I've read that it does *indirectly* somehow).
>
> But before you ditch the Parnate for Nardil, I'd try to augment with a benzo, namely Klonopin.
>
> Best of luck to you,
>
> Matt
>
Posted by bookgurl99 on September 5, 2003, at 2:10:45
In reply to Re: The same exact thing happens to me!, posted by GreatDaneBoy on September 2, 2003, at 23:59:14
I made my professor blink more today. But noticing that made _me_ blink more! A vicious circle.
I really like him, though.
Dang, my eyes are dry.
This is the end of the thread.
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