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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by intheclouds on May 10, 2004, at 8:45:05
Hi, I just posted a question about Lamictal (I am taking it for depression/bipolar) but I have another, separate question about social anxiety.
I asked my psych dr. what meds were available for social anxiety (after he agreed that my symptoms do indicate this) and he said that he will only prescribe SSRI's for it. I know that these don't work for me because I was on them for years for depression.
He said anti-anxiety meds are too addictive, but I have heard of people having good results from meds such as klonopin or ativan. I don't have any history of addiction, however my brother was an alcoholic.
How can I get him to listen to me and prescribe something other than SSRI's? Is there any other meds that aren't addictive but aren't SSRI's? Any help or experiences would be greatly appreciated!!!
Posted by King Vultan on May 10, 2004, at 9:17:23
In reply to social anxiety meds, posted by intheclouds on May 10, 2004, at 8:45:05
Traditionally, the MAOIs have been considered to be the most effective meds for social phobia/social anxiety. I have relatively bad social anxiety and am currently on Nardil, one of the two MAOIs still available in the US, and I would say that it has been extremely effective for me in that regard. It has also been good for my long term unipolar depression.
Todd
Posted by SLS on May 10, 2004, at 10:01:19
In reply to Re: social anxiety meds, posted by King Vultan on May 10, 2004, at 9:17:23
> I have relatively bad social anxiety and am currently on Nardil, one of the two MAOIs still available in the US,
When was Marplan discontinued? I haven't looked into it myself, but I have seen conflicting stories here on PB.
- Scott
Posted by harryp on May 10, 2004, at 10:42:07
In reply to Re: social anxiety meds, posted by SLS on May 10, 2004, at 10:01:19
The impression I get was that there just wasn't any significant demand for it. I have heard it described as "Nardil lite"--similar to Nardil, but gernally less effective. Its only benefit was sometimes milder side effects when compared to Nardil.
Posted by SLS on May 10, 2004, at 10:50:11
In reply to Re: social anxiety meds, posted by SLS on May 10, 2004, at 10:01:19
> > I have relatively bad social anxiety and am currently on Nardil, one of the two MAOIs still available in the US,
>
> When was Marplan discontinued? I haven't looked into it myself, but I have seen conflicting stories here on PB.http://www.oxfordpharm.com/marplan.htm
It looks like Oxford Pharmaceuticals is still selling Marplan, as it continues to appear on their website. I sent them an e-mail requesting information on its availability.
I know that Terrence Ketter, MD, a respected research clinician at Stanford, prefers to use Marplan over Nardil because of its more favorable side-effect profile. However, the old way of thinking of Marplan was that it was a "weaker" Nardil. I don't know if there is any difference in the risks of hepatotoxicity between these two hydrazines.
I do remember reading of some instances where a person who did not respond to Nardil went on to respond to Marplan. I wish I could produce some documentation of this. I guess this would not be too surprising given the great interindividual differences in response to any one drug. I hope Marplan is still around. I may want to hava a go of it myself. I am a partial resonder to Nardil and Parnate.
- Scott
Posted by SLS on May 10, 2004, at 10:51:28
In reply to Re: social anxiety meds » SLS, posted by harryp on May 10, 2004, at 10:42:07
Posted by harryp on May 10, 2004, at 11:01:46
In reply to Re: social anxiety meds, posted by SLS on May 10, 2004, at 10:50:11
Have you tried augmenting a MAOI with lithium? I've hear that sometimes is great for partial response.
I've also heard of triiodothiadine used as an augmentor.
The most intriguing MAOI augmenting agent described by Bernstein was Permax! He hypothesized that some of his patients (who were partial responders to MAOI's, but didn't respond to any of the serotonergic or NE drugs) were responding to increased levels of dopamine. He tried adding Permax, and about 75% got a favorable response, with about 50% claiming a significant improvement.
Posted by harryp on May 10, 2004, at 11:28:22
In reply to Re: social anxiety meds » SLS, posted by harryp on May 10, 2004, at 11:01:46
That's triiodothyronine 25mcg
Then trifluoperazine 1-2mg bid
Posted by SLS on May 10, 2004, at 11:37:13
In reply to Re: social anxiety meds » SLS, posted by harryp on May 10, 2004, at 11:01:46
Hi Harry.
Your recommendations are EXCELLENT and worth a try. Unfortunately, I already have.
> Have you tried augmenting a MAOI with lithium? I've hear that sometimes is great for partial response.
Adding lithium on multiple occasions has made me feel worse, not better. Parnate is the MAOI that my old doctor reported having the most success with when adding lithium. I have tried it with both Parnate and Nardil.
> I've also heard of triiodothiadine used as an augmentor.My only occasion to use Cytomel produced a severe exacerbation of depression. It was withdrawn for awhile and reintroduced with the same result. Interestingly, I found T4 (Synthroid) somewhat helpful.
> The most intriguing MAOI augmenting agent described by Bernstein was Permax!
I didn't try Permax, but I did try adding bromocriptine (Parlodel) to a trial of Parnate 120mg + desipramine 300mg. I also tried adding amphetamine (Dexedrine) into the mix. Both bromocriptine and amphetamine produced a moderate antidepressant response that lasted for 3 days each. I guess I would still be receptive to using either Mirapex or Requip, two other DA receptor agonists. My main apprehension with this strategy is that somnolence will eventually emerge as a side effect.
I really appreciate your input!
- Scott
Posted by intheclouds on May 10, 2004, at 13:05:10
In reply to Re: social anxiety meds, posted by King Vultan on May 10, 2004, at 9:17:23
Thanks for the Nardil suggestion, King Vultan. Is this hard to get your dr to prescribe? Does anyone know of any other options?
Posted by SLS on May 10, 2004, at 16:25:15
In reply to Re: social anxiety meds, posted by intheclouds on May 10, 2004, at 13:05:10
I recieved a reply from Oxford. Marplan is still available. In case anyone has trouble getting it from their pharmacy, you can call:
877-284-9120
- Scott
Posted by Keith Talent on May 11, 2004, at 5:11:08
In reply to social anxiety meds, posted by intheclouds on May 10, 2004, at 8:45:05
The psychiatric literature and the posters here suggest that the gold standards for social phobia are clonazepam and phenelzine. If my psychiatrist was too nervous to prescribe safe, proven medications then I would tell her that you will be seeking a second opinion. Many posters here are on a combination of clonazepam, a stimulant and an SSRI.
Posted by btnd on May 11, 2004, at 19:48:18
In reply to Re: social anxiety meds, posted by Keith Talent on May 11, 2004, at 5:11:08
Seems like the most beneficial effect on social-anxiety and overall pro-sociability has combo of Klonopin (clonazepam) + Adderall (amphetamine).
MAOis are also a good option : Nardil (phenelzine), Parnate.
Amisulpride worked fantastically for my social anxiety, but in the end stopped working.
Posted by Viridis on May 13, 2004, at 4:44:05
In reply to social anxiety meds, posted by intheclouds on May 10, 2004, at 8:45:05
I am not aware of any credible evidence that benzos like Klonopin are "addictive" for the vast majority of patients, although they may induce medical dependency, which is a different issue. SSRIs and many other meds also cause dependency, and SSRIs are especially notorious for this. This just means that if you discontinue the med, you need to do so very gradually.
The benzo addiction myth is often repeated (especially by doctors!), but if you ask them for proof, the best that most can say is something vague like, "it's common knowledge" etc. This is something they've heard from pharmaceutical company reps trying to push still-patented drugs, and it's become sort of an urban legend. The bottom line is that for many anxiety patients, benzos are the best treatment, and have proven safe and effective for decades.
I'd find another doctor if I were you, ideally an older one who knows from experience how well some of the time-tested drugs can work.
Posted by utopizen on May 14, 2004, at 16:21:15
In reply to Klonopin+Adderall, posted by btnd on May 11, 2004, at 19:48:18
> Amisulpride worked fantastically for my social anxiety, but in the end stopped working.
>Okay,
first off, my social anxiety was terrible as a little kid. My psychologists relates my obsessional thoughts and social anxiety to a possibly benign case of Asperger's (a trendy dx I initially dismissed, until I read the DSM-IV criteria of it like someone had diagnosed my childhood).
Makes sense, sense humans are adapative, and now that I'm 20, I have been able to realize what people's facial expressions mean. I guess, early as a little kid, I didn't, possibly, and this left me anxious due to the confusion. (That, plus a speech impediment that went away later in life). Anyhow, point is anyone suffering from social anxiety will assume they have it worse than anyone else, but once I got to college I slowly realized after a long while others around me had it so bad my friends would come up to me and point examples of someone acting akward out to me to joke about it with me. And that was before I went onto Klonopin, after failing the antidepressants and such.
Klonopin's not bad, Adderall has no point and I really hated it because it made me anxious-- more so than Desoxyn, which I take now for ADD. The idea that because you have social anxiety, you need to take a med that will make you more talkative, is really misguided.
Klonopin helps you realize you don't need to talk as much as your perfectly imagined self expects you to do-- and that simply being calm, appearing calm, and listening to others without feeling the urge to speak as if speaking anxiously would hide the fact that your anxious-- is all you really need.
But I would just go on an antidepressant along with Klonopin, because generally you probably are a "unique" person and the social anxiety could be a symptom/diagnosis indicating something needs some modulating in the long-term.
Abilify, an antidepressant, and Klonopin, possibly Straterra along or instead of an antidepressant, should do wonders-- I regret thinking Klonopin+Desoxyn alone for my anxiety+ADD would do the trick, because I did lapse into depression.
And hello? If you have social anxiety, chances are your 'support group' is rather limited, as much as you want to deny thinking about counting how many friends you have. If it wasn't for college and being forced to have roommates and then my likability leading me to be friends with them down the road and them introducing to their friends (apparently this is how social networks work, go figure, simpler than they make it out to be!) I'd have no friends at all.
Mainly, I have roommate friends, kids I either continue to room with or roomed with before, and they are slowly becoming comfortable enough with me to introduce them around their friends as I get better at controlling my social anxiety through CBT+meds.
Oh, it's brand name, but I suggest getting Klonopin wafers for at least a month if you get on Klonopin. You can always save some leftovers for emergency cases in your jacket pocket, then go back to TEVA generic (the only decent generic Klonopin).
Posted by Kon on May 14, 2004, at 16:55:11
In reply to Re: Klonopin+Adderall, posted by utopizen on May 14, 2004, at 16:21:15
>The idea that because you have social anxiety, you need to take a med that will make you more talkative, is really misguided.
Excellent point. Too many people are looking for "cosmetic surgery" of their personality instead of just being happy with who they are (but without the anxiety). They're nothing wrong with being quiet and less social as long as anxiety isn't the cause. If you remove the anxiety and you still aren't inclined to be a social butterfly, then that's probably who you really are.
This is the end of the thread.
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