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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Mookie on September 24, 2003, at 12:25:27
I’ve been through nearly every med in the book and just can’t seem to find the right combination. About fifteen years ago I went to pdoc because I was depressed, sleeping all the time, hyper-reactive to insult, and obsessive.. (I’ve had hypersomnia for as long as I can remember) I had an avoidant personality and was extremely social phobic. To self medicate I drank, smoked and used caffeine…a lot. Alcohol did wonders for me to get me to actually speak to other people and socialize normally. The nicotine and caffeine would keep me awake. Over the years, I went through trials of all of the tricyclics, then paxil, prozac, zoloft finally settling on celexa. My increased use of Alcohol eventually landed me in a treatment program. I’ve been sober ever since (4years) A pdoc in rehab added low dose risperdal to my celexa. The risperdal helped a lot with my obsessive thinking. But the combination still left me sleeping all the time and unable to work. After a while I was diagnosed with ADD and was given stimulants. At first the (stimulants worked wonders as they so often do) I was more productive, was able to read and understand things better and eventually landed a great job thanks to my new stimulant induced abilities. This went so well for couple of months but eventually the stimulants (60mg adderall a day) stopped working as well. More importantly the stimulants made me even less social. I could focus on projects for long hours at a time and ignore the world. Stimulants would also make me even more obsessive. If I had work to do this obsessiveness came in handy. I would focus on a project so intensely that my work became truly exceptional. However whenever I was not working my obsessiveness just drove everyone around me nuts. Recently I convinced my pdoc to get me off the stimulants and try nardil. I was so hoping that nardil would be the answer ive been waiting for all my life, but after 8 weeks on it, it has fell short of my expectations. The nardil worked wonders for my personality. I feel less obsessive,(so much so I stopped taking the risperdal.) I’m happier. I now eat lunch and socialize with my coworkers and I’m generally more fun to be around. The only problem (and it’s a significant one) is that I can’t work. I can’t seem to concentrate and focus like I did on stimulants. I haven’t completed one task since I’ve been on the nardil. I feel as if I’m going to be smiling all the way to the unemployment line. I’ve tried without my pdocs knowledge to add a little stimulant to the nardil. I would take a miniscule dose and check my blood pressure every hour. But even tiny 2-3mg of adderall raised my BP enough that I had to abandon that idea. So here’s my problem how do I stay awake, social, un-obsessed, focused and productive all at the same time. It seems that my choices are to be focused, anti-social, obsessed and productive or happy, social, unproductive and unemployed. Any ideas?
Posted by matthhhh on September 24, 2003, at 12:55:19
In reply to ADD/SocialPhobia/OCD, posted by Mookie on September 24, 2003, at 12:25:27
i have ocd, and social phobia too. ive tried all the ssris too- it was like taking a whole bunch of sleeping pills- way too sedative!
The only stimulant that ive tried is ephedrine which completely relieves my ocd symptoms and has given me the impression that i might have some form of add as well. but i havnt tried dexedrine or adderall or any of those. Im not sure if they would have the same effect as ephedrine would
Im currently on wellbutrin and klonopin and still feel very uptight and physically tense and anxious.
I am looking to take parnate or nardil, have heard some good things, so it seems to be working pretty good for you! what type of ocd do u have? i usually obsess about my appearance BDD. U might want to try to augment a stim to your nardil if you can. Have any thoughts about my situation?
Posted by Mookie on September 24, 2003, at 16:14:43
In reply to Re: ADD/SocialPhobia/OCD, posted by matthhhh on September 24, 2003, at 12:55:19
Matt,
In your case it would seem to me that nardil or parnate would really be worth a try. Nardil did wonders for my obsessive symptoms and it was less sedating than any ssri i've tried. I think it would eliminate your need for klonapin. Wellbutrin didn't do anything for me when I tried it. It sounds like it aint doing much for you either. But when you add ADD symptoms to this mess...that's where the problems start.
Stimulants are the best drugs for my ADD.
Nardil is the best drug for my social phobia/OCD.
I can have one or the other but I cant have both.Sure, some people have posted here that they have added low dose stimulants to nardil. Each person is different. For me the combonation would probebly land me in the ER. Ive added up to 5mgs of adderall and watched my blood pressure go up to 147 over 105. Also 5mgs of stimulant doesn't do much for someone who was used to taking up to 80mg a day. However in your case, I think nardil will work much better for you then wellbutrin and klonapin.
Posted by matthhhh on September 24, 2003, at 16:18:47
In reply to Re: ADD/SocialPhobia/OCD, posted by Mookie on September 24, 2003, at 16:14:43
what type of ocd do u have. i seem to have body dysmorphic disorder, obsessions of my appearance or parts of my body
Posted by jparsell82 on September 24, 2003, at 17:25:13
In reply to ADD/SocialPhobia/OCD, posted by Mookie on September 24, 2003, at 12:25:27
> I’ve been through nearly every med in the book and just can’t seem to find the right combination. About fifteen years ago I went to pdoc because I was depressed, sleeping all the time, hyper-reactive to insult, and obsessive.. (I’ve had hypersomnia for as long as I can remember) I had an avoidant personality and was extremely social phobic. To self medicate I drank, smoked and used caffeine…a lot. Alcohol did wonders for me to get me to actually speak to other people and socialize normally. The nicotine and caffeine would keep me awake. Over the years, I went through trials of all of the tricyclics, then paxil, prozac, zoloft finally settling on celexa. My increased use of Alcohol eventually landed me in a treatment program. I’ve been sober ever since (4years) A pdoc in rehab added low dose risperdal to my celexa. The risperdal helped a lot with my obsessive thinking. But the combination still left me sleeping all the time and unable to work. After a while I was diagnosed with ADD and was given stimulants. At first the (stimulants worked wonders as they so often do) I was more productive, was able to read and understand things better and eventually landed a great job thanks to my new stimulant induced abilities. This went so well for couple of months but eventually the stimulants (60mg adderall a day) stopped working as well. More importantly the stimulants made me even less social. I could focus on projects for long hours at a time and ignore the world. Stimulants would also make me even more obsessive. If I had work to do this obsessiveness came in handy. I would focus on a project so intensely that my work became truly exceptional. However whenever I was not working my obsessiveness just drove everyone around me nuts. Recently I convinced my pdoc to get me off the stimulants and try nardil. I was so hoping that nardil would be the answer ive been waiting for all my life, but after 8 weeks on it, it has fell short of my expectations. The nardil worked wonders for my personality. I feel less obsessive,(so much so I stopped taking the risperdal.) I’m happier. I now eat lunch and socialize with my coworkers and I’m generally more fun to be around. The only problem (and it’s a significant one) is that I can’t work. I can’t seem to concentrate and focus like I did on stimulants. I haven’t completed one task since I’ve been on the nardil. I feel as if I’m going to be smiling all the way to the unemployment line. I’ve tried without my pdocs knowledge to add a little stimulant to the nardil. I would take a miniscule dose and check my blood pressure every hour. But even tiny 2-3mg of adderall raised my BP enough that I had to abandon that idea. So here’s my problem how do I stay awake, social, un-obsessed, focused and productive all at the same time. It seems that my choices are to be focused, anti-social, obsessed and productive or happy, social, unproductive and unemployed. Any ideas?
Why don't you continue to take Nardil and add a Nootropic drug(smart drug) to it. Piracetam is really good and it shouldn't increase your blood pressure.
Posted by rianny on September 24, 2003, at 17:49:26
In reply to Re: ADD/SocialPhobia/OCD, posted by matthhhh on September 24, 2003, at 16:18:47
I've SP and OCD too.
What's ADD anyways?I have tried Paxil and Celexa, and they were only like sleeping pills.
I stopped taking SSRI's, and started to take Klonopin a week ago. I have taken .5mg in the morning and another .5mg at bedtime.
Now, it's been over 2 weeks since I tappered off SSRI, so I started to take Nardil 2 days ago.
I'm starting with very little dosage, which is 15mg. Also, I was recommended to take .5mg of Klonopin at bedtime only since it makes me sleepy.
My OCD symptoms are varieties. It's mostly body-posture-related. I mean I keep trying to be consicous about the position of my body, and see if it's in perfect or good position or not. Body parts are mostly eyes, neck, back, and legs. I also tend to check if anything(which I don't know) is wrong before starting something(even now, before I started this writing I halted for a few seconds). Others are like trying to think if things I do is ethical or not...and so on. Also, after I smile or laugh, I get this confusing or fearsome feeling. I wish I could explain what it's like, but even I don't know. But, I believe it's because I'm depressed or too anxious because it seems like happen only when I'm down.
I could not figure out what I'm obsessed or compulsed to before I read this book about OCD. This book lists all common kinds of OCD symptoms. It really relieved me because I now know what my OCD symptoms are. If you'd like to read here's the title:
Obsessive-Compulsive Disorders (A complete guide to getting well and staying well) - Fred Penzel, Ph.D.
It provides guides to relieve OCD symptoms, but it's really complicated and time-consuming. I think I'll try sometime tho.
So, I started Nardil. Hopefully this will work. It should work. I read that Nardil works for 80%~90% of ppl, but ppl quit because of its side effects. I'm set and ready to overcome those side effects.It seems like we have very similar symptoms. So, I'll report regularly how I'm doing with these drugs. Just to remind you, I'm now taking 15mg of Nardil in the morning and .5mg of Klonopin at bedtime.
Posted by matthhhh on September 24, 2003, at 19:40:14
In reply to Re: ADD/SocialPhobia/OCD, posted by rianny on September 24, 2003, at 17:49:26
hey there, yeah it seems like you have a similar condition to me- body dysmorphic disorder and ocd.
My bdd used to be really bad, i used to have these bad thoughts about my appearance (obsessions) about certain parts of my body and have to check the mirror constantly to reassure myself that they were not true (compulsions). I would think weird things that my nose was too big, my eyes were too big, my posture looked funny, my adams apple looked big.
Anyways, so i went through all the ssri's and it was like taking a whole bottle of sleeping pills! and the ignorant doctors said " oh well sleepiness is usually not a side effect of this drug, and if u do have it it will definately go away the longer you are on it." What a bunch of bullshit that was, i was on off them for like three years. They did, however, control my bdd, ocd symptoms great for the first couple of months but then went downhill from there. I got a glimpse of what it was like to be normal, and then they stopped working and i got overwhelmed by the side effects. No wonder people commit suicide or feel depressed after taking these drugs!
Ive read books on the disease too, Jeffrey Swartz and the broken mirror, and have used some of the things they said to do, like avoid compulsions of checking the mirror and stuff and so my symptoms have diminished a bit from that. I still feel social anxiety phobia though. I mean when i talk to people i cant seem to connect and stay with what they are saying. I feel very tense physically, and just really disconnected.
Ive experimented with ephedrine ( a herbal stimulant) and it relieves ALL of my symptoms, and makes me really confident. Its kind of interesting because stimulants are usually only supposed to be for those with ADD.
There was also a period when I was taking marijuana for a couple months. It helped with my ocd a lot, i was more confident and able to speak fluently with other people. But it made me kinda tired, but not nearly as tired as the ssris.
Ive also tried all the herbal stuff, 5htp, st johns wort, sam e, tyrosine, dlpa you name it- didnt really help.
Anyways, about a month and a half ago i started klonopin 1 - 1.5 mg which has helped a bit with my social phobia, but i still feel i cant really connect with other people, or feel the need to socialize. About a month ago i augmented it with wellbutrin which has helped somewhat in the connection part of things, but still feel anxious/disconnected around other people, and still feeling some drowsiness from the klonopin.
Another thing that i notice and wondering if you do too, is that certain parts of my body are very tense a lot of the time, sort of like im hyperaware of them. I think this triggers negative thoughts that particular body part. Does this happen with you?
Well thats my life story on my symptoms and what ive done to try to get rid of them and i think i may try nardil or parnate next.
Posted by wsj on September 24, 2003, at 22:39:03
In reply to ADD/SocialPhobia/OCD, posted by Mookie on September 24, 2003, at 12:25:27
since parnate is more stimulating have you talked with you pdoc about the possibility of switching to it to help you focus?
Posted by rianny on September 24, 2003, at 23:11:25
In reply to Re: ADD/SocialPhobia/OCD, posted by matthhhh on September 24, 2003, at 19:40:14
yes, I guess I have some BDD, but about my eyes...I don't know how to name or describe it.
I've had this "dry eye syndrome" for about 5 years, and when this started first time, I was kind of embarrassed and panic at school all day because my tears came out because of pain and thought people would think I'm crying.
After that happened, all these symptoms started.
If I think now, I already had anxiety disorder and OCD since before that stupid "dry eye" problem. However, I think the "dry eye" thing triggered those disorders to be much more stronger and be conscious about them.
Anyway, after that, I try to notice where I'm looking at or how eye muscles move.
When I talk to ppl in face-to-face situation, I have body tension, too. The most annoying thing is I don't know where to look. I can do eye contact, but I don't know when to get out or get in. I mean normal ppl, when they talk, do eye contact for a few seconds and quit, and back again...but I cannot do that naturally.
I found out today that I really don't notice my eyes when I try to notice other things. For example, today, when I walk at school, I was thinking about my steps, and I noticed my eyes move naturally. So, I think it's ok when I become unconsicous about the body part. I'll keep practicing this kind of stuff.
I'd like to know what those herbal stimulants are. I hope they are not illegal. Anyway, I'll try this Nardil first, and think about others later...at least after a few months since Nardil takes long time to kick in, and I'm only on very low dosage at the moment.
Posted by DSCH on September 25, 2003, at 11:42:17
In reply to ADD/SocialPhobia/OCD, posted by Mookie on September 24, 2003, at 12:25:27
Mookie, I would ask your pdoc about the advisability of trying L-phenylalanine or DLPA (50% L-/50% D-phenylalanine) along with vitamin B complex and vitamin C supplements. The purpose being to "prime the pump" for dopamine and norepinepherine production. It's not tyramine, but I'm still concerned about possibile contraindication for this strategy with the MAOI.
I'm not well versed on the MAOIs. But isn't Parnate more activating than Nardil?
Posted by Mookie on September 27, 2003, at 12:10:10
In reply to ADD/SocialPhobia/OCD, posted by Mookie on September 24, 2003, at 12:25:27
Thank you all for your ideas and suggestions.
I think I will talk to my pdoc about parnate. I just fear losing some of the SP, anxiety, and OCD benefits of the nardil.Mookie
Posted by matthhhh on September 27, 2003, at 14:03:45
In reply to Re: ADD/SocialPhobia/OCD, posted by rianny on September 24, 2003, at 23:11:25
hey rainny, just wondering how your doing on the nardil. Is is there a lot of sedation like the ssris?
Posted by DSCH on September 28, 2003, at 8:00:58
In reply to Re: ADD/SocialPhobia/OCD, posted by Mookie on September 27, 2003, at 12:10:10
> Thank you all for your ideas and suggestions.
> I think I will talk to my pdoc about parnate. I just fear losing some of the SP, anxiety, and OCD benefits of the nardil.
>
> MookieOK, I can say where I picked this impression up about Parnate (tranylcypromine) being activating: Perrine's book (gee, I'm getting predictable these days I think).
Let me quote...
"Tranylcypromine can be seen either as a modification of phenethylamine [sic?] or as an amphetamine with the side chain cyclized into a cyclopropane ring; in larger doses than those used to treat depression, it can cause psychomotor stimulation, and the development of dependence occasionally has been reported." [no references cited]
Perrine, "The Chemistry of Mind-Altering Drugs...", American Chemical Society, 1996, p. 234.
Looking at the structural representations, phenelzine (Nardil) also appears somewhat similar to the amphetamines, but Perrine makes no mention of stimulant properties.
It's unfortunate IMO that he has not treated the MAOIs to as much discussion as he has the tricyclics.
You will probably want to be careful about how you broach the subject of switching to high-dose Parnate with your pdoc.
This is the end of the thread.
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