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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Dr. Bob on December 19, 2003, at 19:57:32
In reply to Looking to turn my life around (social anxiety), posted by mrgeek on December 19, 2003, at 10:12:00
> Hello, I'm new to posting here. I've found a lot of good information though and everyone seems very friendly so I thought I might be able to get some good opinions.
>
> Sorry if this ends up being a book, I'll try to keep it concise.
>
> First off, I know that I have social anxiety. I self-diagnosed myself during my senior year in high school. I went to my doctor and briefly described my symptoms to him. He put me on a trial of Paxil. It definitely did something to me which "improved" my mood, but nothing for my anxiety. In one instance I recall sitting at a table during lunch with a group of about 10 people. I proceeded to tell the entire table about how I was "so happy" because I was on antidepressants for social anxiety. In retrospect, I feel like a complete idiot. This coming from someone who used to obsess over whether or not people were judging the way he ate soup. Needless to say, these were not the results I was looking for. My doctor next put me on Zoloft, which was the most successful SSRI i've tried, but it was still giving me basically the same effect as the Paxil. Also, the sexual side effects of both were something I could not deal with. After this I tried Celexa, which I stuck with the longest. I think the only reason for this was because I started college and I felt like I needed something If I was going to do good at all. It gave me anxiety attacks, made me even more irritable than normal, and continued with the sexual side effects which in turn took a toll on my confidence. It was bad. Coming off it was probably the worst time I have ever had in my life. I didn't do it right, I just stopped taking it. Since then I have been off any kind of drugs for 2 years. After my failure with SSRI's I was hopeless. I thought they were the only possibility and I figured I just had to deal with this on my own. I never went back to my doctor about my anxiety.
>
> 2 years later: I got kicked out of college after my second year. Both semesters of this year I stopped going to classes about half-way through the semester. I failed everything. Time and time again I would try to convince myself that I just wasn't supposed to be in College, that I wasn't smart enough for it or something along those lines. After I got kicked out of school, I continued to live in the town my school was located in. Both to be near my girlfriend and because of a lease I had commited to before I was kicked out. I had intentions of getting a job, but I just could not bring myself to seek viable employment. The only jobs I am interested in are ones that deal with computers (something I'm very good at), or ones with little to no social interaction required. Anyway, I basically isolated myself in an apartment for about 4 months doing nothing. This lead to the worst and scariest episode I have ever had where I scratched my wrist and hand up with a broken CD. I threw objects around my room and broke things. I felt so out of control for the short period it was going on. Worst of all, my girlfriend was there witnessing the whole thing. We had been together for a rocky 4 years, rocky I believe due to my anxiety problems. Now she has left me because she doesn't think I have any goals in life and doesn't think we are right for each other. This has absolutely crushed me, but I can't blame her. I need to do something.
>
> Since I'm out of school I have no medical insurance, but I've recently applied for a state-run health program that I should be accepted to without any problems. I am so eager to see my doctor. I want to get reffered to a phychiatrist so badly and just spill everything in my head out. I've spent the past two months doing research on my disorder and i've come to understand it a lot better. I've come to a few interesting conclustions about myself, which I believe to be true.
>
> First off, I agree with anyone who says SSRI's are for the most part useless for social anxiety. I don't think they are the right drug and even if they do bring some improvement, it's either because they're indirectly acting on the problem or just simply numbing you emotions down so you dont give a crap.
>
> I believe my problem has specifically to do with some sort of dopamine problem in my brain. I have no clue if theres too much of it, too little, or if it's something to do with the receptors. Heres what I do know:
>
> A night or two of sleep deprivation for me, will virtually completeley elimate my anxiety. I feel confident, outgoing (albiet tired), and basically happy about life. I've scoured the internet in search of studies that examine the effects of sleep deprivation as an antidepressant. The few studies I've been able to find all point to the fact that sleep deprivation results in an increase in dopamine levels in the brain.
>
> My mother is a smoker. She has been my whole life and while she was pregnant with me. I also have reason to believe that both her and my father smoked marijauna while she was pregnant with me, as well as when I was growing up. Again, it is well-accepted that Nicotine and THC raise dopamine levels in the brain, hence the good feelings the drugs are associated with.
>
> Next, I have read that Zoloft inhibits the reuptake of dopamine moreso than other SSRIs. Now while I have also read that SSRIs dont really affect dopamine enough to matter anyway, perhaps this is why it was the most successful drug I have tried.
>
> Additionally, I have very recently come to realize that I may have a moderate case of ADD. I always though that I was simply lazy or had poor work ethic, but I have taken a few online tests for ADD and all suggest that I show the symptoms of it. Again, those with ADD are suspected by professionals to have problems with their dopamine.
>
> Now I understand that the brain is an extremely complicated organ and theres way more to it than just saying something might be wrong with my dopamine levels. I have read about the success people have had with Klonopin and various MAOIs, which both seem to primarily effect GABA. However, I have also read about many who have taken drugs used in the treatement of Parkinsons disease as well as Ritalin, Adderall, and other ADD drugs with great success.
>
> I guess what this long post is boiling down to is: Does anyone have a recommendation for what drug I should ask my doctor about when I finally have insurance available? I am very intrigued with the possiblity that Ritalin or Adderal may do some good for me, but I have also hear so many good things about Klonpin. I want to stay away from MAOIs at all costs, because I don't think I could live without cheese in my diet >:)
>
> Anyway, sorry for writing a book even though I promised I wouldn't. Any opinions, questions, insights, etc, etc are more than greatly appreciated. Just browsing the posts on here have been one of my only sources of hope for a better life over the past month. Thank you
>
Posted by brussell on December 19, 2003, at 22:38:38
In reply to Turning my life around (social anxiety « mrgeek, posted by Dr. Bob on December 19, 2003, at 19:57:32
I found your story very interesting and fun to read. The part about the Paxil was hilarious!
Seriously, I'm sorry you've had so many rotten things happen lately. I think you definitely need to treat this depression and social anxiety aggressively. Fortunately, there are a lot of meds you haven't tried yet.
In my experience, the only AD's that have minimal to no sexual side effects are Welbutrin and Parnate. Serzone isn't bad either, but it can cause liver problems.
I'm not a neurochemistry expert, but I think you've got some good ideas for meds. A stimulant might really help you, and I agree you should move to a non-SSRI antidepressant.
Welbutrin has an energizing effect for a lot of people, but it's AD effects are kind of subtle. Some people swear by Effexor. Just keep trying stuff, and don't give up.
If you keep having trouble, remember that MAOIs are a viable option. They have a great track record for working when all other ADs have failed.
Posted by cybercafe on December 20, 2003, at 10:26:12
In reply to Turning my life around (social anxiety « mrgeek, posted by Dr. Bob on December 19, 2003, at 19:57:32
> > Hello, I'm new to posting here. I've found a lot of good information though and everyone seems very friendly so I thought I might be able to get some good opinions.
> >
> > Sorry if this ends up being a book, I'll try to keep it concise.
> >
> > First off, I know that I have social anxiety. I self-diagnosed myself during my senior year in high school. I went to my doctor and briefly described my symptoms to him. He put me on a trial of Paxil. It definitely did something to me which "improved" my mood, but nothing for my anxiety. In one instance I recall sitting at a table during lunch with a group of about 10 people. I proceeded to tell the entire table about how I was "so happy" because I was on antidepressants for social anxiety. In retrospect, I feel like a complete idiot. This coming from someone who used to obsess over whether or not people were judging the way he ate soup. Needless to say, these were not the results I was looking for. My doctor next put me on Zoloft, which was the most successful SSRI i've tried, but it was still giving me basically the same effect as the Paxil. Also, the sexual side effects of both were something I could not deal with. After this I tried Celexa, which I stuck with the longest. I think the only reason for this was because I started college and I felt like I needed something If I was going to do good at all. It gave me anxiety attacks, made me even more irritable than normal, and continued with the sexual side effects which in turn took a toll on my confidence. It was bad. Coming off it was probably the worst time I have ever had in my life. I didn't do it right, I just stopped taking it. Since then I have been off any kind of drugs for 2 years. After my failure with SSRI's I was hopeless. I thought they were the only possibility and I figured I just had to deal with this on my own. I never went back to my doctor about my anxiety.
> >
> > 2 years later: I got kicked out of college after my second year. Both semesters of this year I stopped going to classes about half-way through the semester. I failed everything. Time and time again I would try to convince myself that I just wasn't supposed to be in College, that I wasn't smart enough for it or something along those lines. After I got kicked out of school, I continued to live in the town my school was located in. Both to be near my girlfriend and because of a lease I had commited to before I was kicked out. I had intentions of getting a job, but I just could not bring myself to seek viable employment. The only jobs I am interested in are ones that deal with computers (something I'm very good at), or ones with little to no social interaction required. Anyway, I basically isolated myself in an apartment for about 4 months doing nothing. This lead to the worst and scariest episode I have ever had where I scratched my wrist and hand up with a broken CD. I threw objects around my room and broke things. I felt so out of control for the short period it was going on. Worst of all, my girlfriend was there witnessing the whole thing. We had been together for a rocky 4 years, rocky I believe due to my anxiety problems. Now she has left me because she doesn't think I have any goals in life and doesn't think we are right for each other. This has absolutely crushed me, but I can't blame her. I need to do something.
> >
> > Since I'm out of school I have no medical insurance, but I've recently applied for a state-run health program that I should be accepted to without any problems. I am so eager to see my doctor. I want to get reffered to a phychiatrist so badly and just spill everything in my head out. I've spent the past two months doing research on my disorder and i've come to understand it a lot better. I've come to a few interesting conclustions about myself, which I believe to be true.
> >
> > First off, I agree with anyone who says SSRI's are for the most part useless for social anxiety. I don't think they are the right drug and even if they do bring some improvement, it's either because they're indirectly acting on the problem or just simply numbing you emotions down so you dont give a crap.
> >
> > I believe my problem has specifically to do with some sort of dopamine problem in my brain. I have no clue if theres too much of it, too little, or if it's something to do with the receptors. Heres what I do know:
> >
> > A night or two of sleep deprivation for me, will virtually completeley elimate my anxiety. I feel confident, outgoing (albiet tired), and basically happy about life. I've scoured the internet in search of studies that examine the effects of sleep deprivation as an antidepressant. The few studies I've been able to find all point to the fact that sleep deprivation results in an increase in dopamine levels in the brain.
> >
> > My mother is a smoker. She has been my whole life and while she was pregnant with me. I also have reason to believe that both her and my father smoked marijauna while she was pregnant with me, as well as when I was growing up. Again, it is well-accepted that Nicotine and THC raise dopamine levels in the brain, hence the good feelings the drugs are associated with.
> >
> > Next, I have read that Zoloft inhibits the reuptake of dopamine moreso than other SSRIs. Now while I have also read that SSRIs dont really affect dopamine enough to matter anyway, perhaps this is why it was the most successful drug I have tried.
> >
> > Additionally, I have very recently come to realize that I may have a moderate case of ADD. I always though that I was simply lazy or had poor work ethic, but I have taken a few online tests for ADD and all suggest that I show the symptoms of it. Again, those with ADD are suspected by professionals to have problems with their dopamine.
> >
> > Now I understand that the brain is an extremely complicated organ and theres way more to it than just saying something might be wrong with my dopamine levels. I have read about the success people have had with Klonopin and various MAOIs, which both seem to primarily effect GABA. However, I have also read about many who have taken drugs used in the treatement of Parkinsons disease as well as Ritalin, Adderall, and other ADD drugs with great success.
> >
> > I guess what this long post is boiling down to is: Does anyone have a recommendation for what drug I should ask my doctor about when I finally have insurance available? I am very intrigued with the possiblity that Ritalin or Adderal may do some good for me, but I have also hear so many good things about Klonpin. I want to stay away from MAOIs at all costs, because I don't think I could live without cheese in my diet >:)
> >
> > Anyway, sorry for writing a book even though I promised I wouldn't. Any opinions, questions, insights, etc, etc are more than greatly appreciated. Just browsing the posts on here have been one of my only sources of hope for a better life over the past month. Thank you
> >
>
i don't find MAOIs to be any big deal... except that they work and i'm finally happy!!! yeah you can't take decongestants, but i don't touch those anyway .... and i've never had a problem with eating out and cheese (they use the cheap stuff undoubtedly)....current meds
Abilify 4 mg (mood stability)
Parnate 40 mg (depression/anxiety)
klonopin 2 mg bid (anxiety)
lorazepam 2 mg od (anxiety)
Ritalin SR 40 mg tidside effects? less need for sleep, increased energy, increased libido, all of which i credit parnate for
Posted by HappyGirl on December 20, 2003, at 13:10:44
In reply to Turning my life around (social anxiety « mrgeek, posted by Dr. Bob on December 19, 2003, at 19:57:32
Hi:
It sounds to me like your symtoms are pretty complex and complicated. As your's saying, any stimulant/ADD & ADDH's med. along with all of those SSRIs are out of the picture for your condition. First off, you need a competent and experienced psychiatrist who is able to provide you with a fair amount of time on evaluation along with right diagnose.
From reading in your post that is quite long as for a message/asking, for that, you seem a quite intelligent individual in nature. However, this illness has been taking a toll on you, both personally and academically. Also, I suspect that you might have not only anxiety combined with depression, but other aspect, psychological issues such as ex-girlfriend and college. Then, you may need two different approch, one for med. regimen and other for counselling session to make you feel well/recovery.If you can, try to get a good pdoc. who is able to dx your problem as appropriately and accurately as possible, *ASAP.*
H.G.
Posted by billym on December 20, 2003, at 20:59:31
In reply to Turning my life around (social anxiety « mrgeek, posted by Dr. Bob on December 19, 2003, at 19:57:32
>First off, I agree with anyone who says >SSRI's >are for the most part useless for social >anxiety.Thanks for the thoughtful post. I think you're mostly right on the SSRI's for social anxiety. Doctors just don't get it.
I also agree with you on the sleep depravation aspect. I feel less anxious, more clear-headed when extremely tired or at least when having not slept a night. I am more comfortable around people. I have independently noticed this occuring a number of times and I've thought "If only I never had to sleep". Of course that is not an option, but there are some interesting effects that occur.
billy
Posted by btnd on December 21, 2003, at 1:19:45
In reply to Re: Turning my life around (social anxiety, posted by billym on December 20, 2003, at 20:59:31
>
> >First off, I agree with anyone who says >SSRI's >are for the most part useless for social >anxiety.Yupp, Klonopin and Nardil/Parnate in studies beat SSRIs hands down when it comes to SA/SP.
> I also agree with you on the sleep depravation aspect. I feel less anxious, more clear-headed when extremely tired or at least when having not slept a night. I am more comfortable around people. I have independently noticed this occuring a number of times and I've thought "If only I never had to sleep". Of course that is not an option, but there are some interesting effects that occur.
>
Same here. VERY strange thing - but sleep deprivation really does make wonders for my mood. Hmmm
Posted by scott-d-o on December 22, 2003, at 4:28:23
In reply to Re: Turning my life around (social anxiety » billym, posted by btnd on December 21, 2003, at 1:19:45
> > I also agree with you on the sleep depravation aspect. I feel less anxious, more clear-headed when extremely tired or at least when having not slept a night. I am more comfortable around people. I have independently noticed this occuring a number of times and I've thought "If only I never had to sleep". Of course that is not an option, but there are some interesting effects that occur.
> >
>
> Same here. VERY strange thing - but sleep deprivation really does make wonders for my mood. HmmmNot so strange really; this has been well established.
Therapeutic use of sleep deprivation in depression.
Giedke H, Schwarzler F.
Department of Psychiatry, University of Tubingen, Osianderstr. 24, Germany. henner.giedke@med.uni-tuebingen.de
Total sleep deprivation (TSD) for one whole night improves depressive symptoms in 40-60% of treatments. The degree of clinical change spans a continuum from complete remission to worsening (in 2-7%). Other side effects are sleepiness and (hypo-) mania. Sleep deprivation (SD) response shows up in the SD night or on the following day. Ten to 15% of patients respond after recovery sleep only. After recovery sleep 50-80% of day 1 responders suffer a complete or partial relapse; but improvement can last for weeks. Sleep seems to lead to relapse although this is not necessarily the case. Treatment effects may be stabilised by antidepressant drugs, lithium, shifting of sleep time or light therapy. The best predictor of a therapeutic effect is a large variability of mood. Current opinion is that partial sleep deprivation (PSD) in the second half of the night is equally effective as TSD. There are, however, indications that TSD is superior. Early PSD (i.e. sleeping between 3:00 and 6:00) has the same effect as late PSD given equal sleep duration. New data cast doubt on the time-honoured conviction that REM sleep deprivation is more effective than non-REM SD. Both may work by reducing total sleep time. SD is an unspecific therapy. The main indication is the depressive syndrome. Some studies show positive effects in Parkinson's disease. It is still unknown how sleep deprivation works.
Publication Types:
* Review
* Review, Academic
PMID: 12531127 [PubMed - indexed for MEDLINE]
Posted by Mimi on December 22, 2003, at 9:23:59
In reply to Turning my life around (social anxiety « mrgeek, posted by Dr. Bob on December 19, 2003, at 19:57:32
Buspar turned around my social anxiety. I do all sorts of social activities that I could not do before.
The atypical antipsychotics (Risperdal, Zyprexa or Seroquel) are the meds that turned my depression around. They elevate dopamine levels in the brain which works for me. Very low dose works for me.
And Strattera (25mg) takes care of PTSD symptoms (similar to ADHD symptoms).
There is hope. Took me years to find the right meds. Hang in there and keep trying.
Mimi
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