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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by sabre on September 24, 2004, at 16:43:25
Hello, I'm new to this forum. I just posted this message in psychobabble social and was directed here:
I have just stopped taking Lexapro because it was steadily making my social anxiety worse.
I started with only 2.5mg daily and this made me very energetic but increased my anxiety level and made it become generalised rather than just being evoked by social encounters. The nausea and dizziness settled after a couple of weeks but the headaches and gut problems just got worse.
I increased the dosage to 5mg at 4 weeks but this made me sedated and sleepy (all day). I kept this going for a week but became progressively depressed (hadn't been at all) and more anxious. I had to take propanolol to go to work, to make eye contact etc. My gut and headaches also became worse. I decided to stop taking it when I started experiencing depersonalisation for the first time in 10 years.
I have tried paxil. I also found I was more socially anxious and I developed slurred speech and the staggers on the lowest therapeutic dose. I found it frightening.
I took Serzone for six months after suffering a bout of reactive depression (one and only). It stopped the depression and also motivation, energy and just about any emotion except of course, social anxiety. I also had memory problems on this drug. Serzone was withdrawn in Australia a few months ago.
Valium etc turns me into a zombie.
Social anxiety is such a cruel, hidden, lousy disorder.Propanolol is the only drug that has helped. I have used it on and off for over 20 yrs. It helps me get by by controlling physical symptoms (of panic attacks) however it does nothing for anticipatory anxiety and I am unable to speak up in groups, talk to a group, go to the dentist or hairdresser etc. Lately it has been making me very tired and dizzy. I suspect it is lowering my BP too far even though I only use about 15mg on work days. My vision also becomes blurred.
I was thinking of asking my gp if I could trial Reboxetine or Moclobemide. I read somewhere that if you are unsuccessful with SSRIs for SA, than Reboxetine is often useful. What do you think?
Thanks for all the terrific posts and this excellent forum!
Sabre
Posted by partlycloudy on September 24, 2004, at 16:54:44
In reply to Socially fearful, posted by sabre on September 24, 2004, at 6:33:13
Hello, Sabre (great name! are you a tiger or a sword??). What I would recommend to get the most comprehensive response to your post is to redirect it to the main Psycho-Babble board, as it deals exclusively with medications. You have given lots of information in your post, so I would just paste the same information over there and see what happens.
pc
Posted by sabre on September 24, 2004, at 16:54:44
In reply to Re: Socially fearful » sabre, posted by partlycloudy on September 24, 2004, at 10:14:01
> Hello, Sabre (great name! are you a tiger or a sword??). What I would recommend to get the most comprehensive response to your post is to redirect it to the main Psycho-Babble board, as it deals exclusively with medications. You have given lots of information in your post, so I would just paste the same information over there and see what happens.
> pcThankyou partlycloudy. Neither. I named myself after a mangy, neurotic stray cat that lurks on our back doormat. It cringes everytime we open the door but hunger forces it to stick around.
I thought it in keeping with my ailment.Are you a meteorolgist or a little depressed (or a little happy)?
Posted by theo on September 24, 2004, at 18:42:35
In reply to Socially fearful, posted by sabre on September 24, 2004, at 16:43:25
I had the same problem with Lexapro, it amplified my social anxiety. The only SSRI that helped me was Paxil, but stopped it due to sexual side effects.
I'm currently taking Keppra (750mg) and Lamictal (100mg) and have had my doubts for the past 12 months, but am now finding myself speaking up in large groups, which I have never done before.
It's very hard to be patient with these meds because it takes a while before they work. I've been on Keppra for about 4 months and Lamictal about 3 months and a few days ago I just started feeling good for a change.
The only thing my doc might do is add a very small dose of a stimulant, which I've never tried before.
This was so radically different for me because I've tried every SSRI several times, hoping they "may work this time." It was really hard for me to put my trust into this new doc I've been seeing because of past experiences with others, but I think she's onto something because I'm feeling more level headed and comfortable in my own skin.
Don't be scared to break away and try something besides SSRI's and SSNRI's.
Posted by jparsell82` on September 24, 2004, at 19:49:10
In reply to Re: Socially fearful » sabre, posted by theo on September 24, 2004, at 18:42:35
I've had the same troubles with SSRI's. Klonopin helps a lot but causes some depression and memory problems for me. You might try a stimulant like Adderall. Myself on it, I was a lot more social but very anxious and maybe a tad bit paranoid occassionally. Provigil might be worth a try too. I'm not sure about Keppra but I found Lamictal to make my social anxiety worse. Also, I wouldn't recommend Reboxetine from my personal experience... I wasn't very sociable on it. Moclobemide might be worth a try albeit you'll probably have to work up to a higher dose for social anxiety. Good luck.
Posted by King Vultan on September 24, 2004, at 20:04:07
In reply to Socially fearful, posted by sabre on September 24, 2004, at 6:33:13
In the antidepressant class, the MAOIs are still the most effective drugs for social phobia. Nardil and Parnate are the two available in the US, and I have tried them both and found them quite effective. Parnate, which I've only been on for a month, seems to be working better for me because its dopaminergic effect seems to increase my self confidence and assertiveness significantly. Nardil has a different set of strengths and is probably better for people who have fundamentally high levels of anxiety to begin with, as it also works on GABA, the neurotransmitter that benzodiazepines work on.
My opinion is that the reboxetine doesn't necessarily sound like a great choice for you, as one if its main effects will be stimulation of the beta receptors that your propanolol generally helps you out by blocking. I took the relatively similar tricyclic AD desipramine last year and found it did increase my overall anxiety levels, almost certainly because of stimulation of these beta adrenergic receptors. Paradoxically, though, desipramine did greatly improve my social phobia, as did the other two tricyclics I tried. In my case, however, I also have panic disorder elements involved, as my anxiety will escalate to the point of inducing runaway, profuse sweating. This type of thing may have something to do with a malfunction in the norepinephrine system, which is why tricyclics worked relatively well for my problem. However, they don't appear to work as well as the MAOIs do in either panic disorder or social phobia.
Todd
Posted by sabre on September 24, 2004, at 23:10:09
In reply to Re: Socially fearful, posted by King Vultan on September 24, 2004, at 20:04:07
> In the antidepressant class, the MAOIs are still the most effective drugs for social phobia. Nardil and Parnate are the two available in the US, and I have tried them both and found them quite effective. Parnate, which I've only been on for a month, seems to be working better for me because its dopaminergic effect seems to increase my self confidence and assertiveness significantly. Nardil has a different set of strengths and is probably better for people who have fundamentally high levels of anxiety to begin with, as it also works on GABA, the neurotransmitter that benzodiazepines work on.
>
> My opinion is that the reboxetine doesn't necessarily sound like a great choice for you, as one if its main effects will be stimulation of the beta receptors that your propanolol generally helps you out by blocking. I took the relatively similar tricyclic AD desipramine last year and found it did increase my overall anxiety levels, almost certainly because of stimulation of these beta adrenergic receptors. Paradoxically, though, desipramine did greatly improve my social phobia, as did the other two tricyclics I tried. In my case, however, I also have panic disorder elements involved, as my anxiety will escalate to the point of inducing runaway, profuse sweating. This type of thing may have something to do with a malfunction in the norepinephrine system, which is why tricyclics worked relatively well for my problem. However, they don't appear to work as well as the MAOIs do in either panic disorder or social phobia.
>
> Todd
Thanks Todd. This is exactly the sort of information I'm after. I also have a panic problem although the social anxiety came first.
If the MAOIs are the drug class of choice, would it be a good idea to try a RIMA like Moclobemide first given you don't need food restrictions. I gather they don't work for everyone but they sound more benign. Is that the case?sabre
Posted by ace on September 24, 2004, at 23:18:46
In reply to Socially fearful, posted by sabre on September 24, 2004, at 6:33:13
Posted by sabre on September 25, 2004, at 1:55:27
In reply to Re: Socially fearful, posted by jparsell82` on September 24, 2004, at 19:49:10
Thankyou Theo and Jp82. I really appreciate your suggestions.
I think I will ask for the Moclobemide/Nardil or Parnate next week. My only fear with the Nardil is the threat of bloating like a toad. I'm a distance runner/racer and fat is a drag. Although I reckon running works miracles in keeping depression from SA at bay.
I'm not afraid to experiment with aternative drugs such as those for epilepsy, ADHD etc but my GP is not keen. Benzos are not a long term option with her either. Personally, I'd chew on rotten potatoes from the compost if they'd make a difference.
Thanks again for replying. I'll let you know how the journey goes.
sabre
Posted by partlycloudy on September 25, 2004, at 11:09:54
In reply to Re: Socially fearful, posted by sabre on September 24, 2004, at 16:37:30
Not a meteorologist, just have always equated my state of mind to terms of weather. I was rainyday when I started posting here, so the weather is improved.
Posted by King Vultan on September 25, 2004, at 12:25:18
In reply to Re: Socially fearful, posted by sabre on September 24, 2004, at 23:10:09
>
>
> Thanks Todd. This is exactly the sort of information I'm after. I also have a panic problem although the social anxiety came first.
> If the MAOIs are the drug class of choice, would it be a good idea to try a RIMA like Moclobemide first given you don't need food restrictions. I gather they don't work for everyone but they sound more benign. Is that the case?
>
> sabre
I don't know if moclobemide would necessarily work as well as Nardil or Parnate for social phobia and/or panic disorder, but if it's available, it might be worth trying. It is certainly true that it is more benign than either Nardil or Parnate, both in terms of general side effects (particularly compared to Nardil) and the issue of hypertensive crises (particularly compared to Parnate). If it doesn't work out, the other drugs are still available and do not require a long wait to transition to after ending moclobemide treatment.Todd
Posted by woolav on September 25, 2004, at 13:51:30
In reply to Re: Socially fearful » sabre, posted by King Vultan on September 25, 2004, at 12:25:18
Hi, i was just reading your posts. And am curious about this med..Is it like lamictal (an augmenting drug) or is it different. I read one website that said prozac and moclobemide was a good combo for panic disorder? I take prozac and lamictal. Are they similar?
Thanks
S
Posted by yznhymer on September 25, 2004, at 14:32:00
In reply to Re: moclobemide??, posted by woolav on September 25, 2004, at 13:51:30
> Hi, i was just reading your posts. And am curious about this med..Is it like lamictal (an augmenting drug) or is it different. I read one website that said prozac and moclobemide was a good combo for panic disorder? I take prozac and lamictal. Are they similar?
> Thanks
> SHowdy,
There are people here who know more about the chemistry of this than I do and hopefully will give you a better and more accurate explanation. Also, my apologies if I'm repeating something you've read elsewhere.
I've been on maclobemide for a few years until very recently. My understanding is its not intended as an augmenting agent or as a mood stabilizer, but is rather an antidepressant. Its an MAOI of sorts... selective (it works on just MAO A or B, I forget which) and a reversible MAOI at that, so the hypertensive dangers are not as severe as other MAOIs. I was hoping for a robust response with maclobemide similar to that which I got with Nardil, but that didn't happen. On the other hand, the side effects were minimal, though in retrospect, some headaches I was getting more recently may have been related to the drug. No sexual side effects at all. Woohoo!
My pdoc found it difficult to get reliable information about augmenting moclobemide in the US, since its not sold here. Like me, he'd find individual reports of augmenting strategies on the internet but didn't feel he could rely on them to precribe. Roche, in Canada, refused to provide anything other than the monograph to him since he is in the States.
Good luck,
Mark
Posted by iris2 on September 25, 2004, at 20:32:24
In reply to Re: Socially fearful, posted by King Vultan on September 24, 2004, at 20:04:07
When I was on Panate I now realise that I had no problem with social anxiety. I always knew how well it did for my depression but until I read this post I never put the two together and realised how it made all the social stuff disappear. Which would explain why now seemingly out of no where I have this terrible social phobia. It did not come into play at all until I went off the Parnate. I never realised that I had this problem. Actually it has become a lot worse in the past couple of years. I am in the midst of trying new meds and wonder what other medications might be good for social anxiety. I was going to try amineptine agian. Anyone think this would be helpful?
Any suggestions would be appreciated. Right now I am tyring to deal with the depression but if I do not deal with the social anxiety also it will not do me a lot of good.
Thanks,
irene
Posted by Sad Panda on September 26, 2004, at 8:44:14
In reply to Socially fearful, posted by sabre on September 24, 2004, at 6:33:13
Nortriptyline is a good one to start on, it's called Allegron here.
Cheers,
Paul.
Posted by King Vultan on September 26, 2004, at 9:46:18
In reply to Re: moclobemide??, posted by woolav on September 25, 2004, at 13:51:30
Moclobemide is a reversible inhibitor of MAO-A, the variety of monoamine oxidase that is mainly responsible for metabolizing serotonin and norepinephrine. There are several advantages to this from a safety standpoint. One is that because it's reversible, when the dreaded tyramine from some cheddar cheese comes around, the moclobemide can detach from the MAO-A molecule and allow the MAO to gobble up the tyramine. Another is that because moclobemide does not affect MAO-B, this enzyme is still available to metabolize tyramine. Yet another is that if treatment of moclobemide is discontinued, MAO-A activity returns to normal much more quickly than it does after ending treatment with an irreversible MAO inihibitor like Nardil or Parnate, which render the MAO molecules they bind to (which includes both MAO-A and B because Nardil and Parnate are also nonselective) permanently useless.
In practice, however, the ease with which moclobemide detaches from the MAO-A also implies that there is a possibility it may also detach in the presence of serotonin or norepinephrine. If that happens, the MAO-A is no longer being inhibited from an antidepressant standpoint and is able to carry out its normal function of wiping out serotonin and norepinephrine molecules. It's believed this does actually happen to some extent, not enough to prevent moclobemide from being an effective antidepressant, but probably one that does not have as robust an effect as Nardil, for instance, where any MAO molecule it binds to is out of commission forever.
The availability of MAO-B during moclobemide treatment to metabolize tyramine winds up not being much of a plus, because while both types of MAO have the ability to metabolize tyramine, 70% of the MAO in the gut is MAO-A, and this form winds up being by far the most important in relation to tyramine and resultant hypertensive reactions. However, the ease with which MAO-A activity returns to normal after cessation of moclobemide treatment is a real plus. According to "Clinical Advances in Monoamine Oxidase Inhibitor Therapies", normalization of the tyramine pressor response (the "cheese effect") was found to be approximately 3 days in a 1991 study (Bieck, et al).
Todd
Posted by King Vultan on September 26, 2004, at 10:05:20
In reply to Re: Socially fearful what meds? » King Vultan, posted by iris2 on September 25, 2004, at 20:32:24
Amineptine is a prodopaminergic agent not available in the US. The only other dopaminergic med I've tried besides Parnate was Wellbutrin, which did also increase my assertiveness, but it was not nearly as effective for my brand of social phobia as the tricyclics and MAOIs. The actions on norepinephrine by these drugs seem to knock out my panic-like symptoms. I found the SSRIs to only be marginally effective in my case, but the prevailing thought is that they are good for social disorders involving anxiety.
Todd
Posted by zero on September 26, 2004, at 12:51:20
In reply to Socially fearful, posted by sabre on September 24, 2004, at 6:33:13
I know I have bad Social Phobia. I am also diagnosed as being "bipolar spectrum".
All SSRI's, TCA's, Wellbutrin, Effexor, Serzone, Remeron, Lamictal and others, make me screamingly anxious (and hypomanic/manic, says my pdoc).
Paxil at the incredibly low dose of 1.5mg./day helped somewhat, but only w. Klonopin and Tegretol onboard. Stopped Paxil cause of irritability and side effects, and at the urging of my pdoc.
All antidepressants affect me the same way - only difference was Nardil, which totally cured my SP and depression. Then, after about 4 months, I became manic on it.
I am starting CBT, as meds. have given only partial relief at best.
I am currently very lost in the land of SP + Depression.
Meds.:
Klonopin (2mg., helps anxiety);
Tegretol (200mg. helps anxiety, I feel more "in control", makes me a bit depressed);
Neurontin (400mg., helped w. anxiety & depression for about 6 months, then "pooped", now I think it does nothing).Best,
z
Posted by zeugma on September 26, 2004, at 17:46:20
In reply to Re: Socially fearful what meds? » iris2, posted by King Vultan on September 26, 2004, at 10:05:20
My theory is that norepinephrine is more involved in the etiology of panic disorder than any other monoamine. nortriptyline put an end to the frequent panic attacks I have suffered from since childhood, but this action was independent of an anxiolytic effect. The sensations of impending doom which are characteristic of panic attacks are probably mediated by the locus coeruleus, which is the source of norepinephrine throughout the brain. SSRI's may block panic attacks through an indirect effect on GABA, but I think they are probably less effective than either benzos or TCA's for this disorder, and take longer to take effect, since the effect is indirect.
-z
Posted by Dave001 on September 27, 2004, at 14:28:01
In reply to Socially fearful, posted by sabre on September 24, 2004, at 16:43:25
> Hello, I'm new to this forum. I just posted this message in psychobabble social and was directed here:
>
> Valium etc turns me into a zombie.You might consider giving Baclofen a try. It's a very underutilized medication for this purpose.
Dave
Posted by sabre on September 29, 2004, at 2:51:10
In reply to Re: Socially fearful, posted by zero on September 26, 2004, at 12:51:20
Thanks for all the suggestions. I'm going to the gp to see where to go from here. It is a week since stopping the 2.5 mg Lexapro but I still feel cranky and agitated...loonier than ever.
It makes me feel sad to hear about so many people struggling to find an answer to social anxiety. Zero, I admire your courage fronting up to CBT. The gp has suggested this but to me even the thought of this is terrifying. My verson of
hell on earth would be to sit in a circle and to have to talk about your crazed thinking etc.
I have plenty of books on social anxiety etc but sometimes I feel like it isn't self esteem or thinking pathetic thoughts that are the major problems but rather something really primitive and chemical setting the psychological tone.I hope you can all find the answer.
Sabre
Posted by Michael Bell on October 1, 2004, at 16:56:40
In reply to Re: Socially fearful, posted by sabre on September 29, 2004, at 2:51:10
Sabre, I would recommend the following (you can combine some of them for good results as well):
Klonopin
Picamilon
Tianeptine
Amisulpride
Perduretas (Jury is still out on the addictiveness of it. I never had a problem)
Adrafinil
Nardil (beware the side effects)
Neurontin
Kava Kava
Gotu KolaI recommend staying away from SSRIs.
Also, I don't think Reboxetine or Selegiline are good as monotherapy medications.
Then again, if you find something that works very well for you and is safe, go with that.
Good luck!
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