![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by The_Resistance on March 15, 2005, at 6:59:38
High everyone
I used to post under the name TheOutsider.
I suffer from social anxiety, as you have probably guessed! And live in the UKFor years I used GHB to treat my SA.
I know others have had bad experiences with this med, but for me it was a god send.It is now no longer possible to obtain GHB over the internet, and I have tried various other forms of medication without success.
To make things simple I have compiled a list of the treatments I have tried
Klonopin - Helped, but unfortunately made me depressed and sleepy so I didn’t feel particularly sociable.
Pregabalin/Lyrica - Helped initially but then seemed to loose effect, even taking med holidays did not help to restore effectivness.
Tramadol/Ultram - Didn’t help
Effexor XL - at 225mg helped depression but not social anxiety
Clomipramine – helped a little at 150mgs
Fluoxetine – Didn’t help at all
Citalopram – Didn’t help
Diazapam – Didn’t help
Moclobemide – Didn’t help
Dexedrine – Alone this didn’t help social anxiety, did help in combination with Clomipramine, almost impossible to get prescribed in the UK
Please give me some hope.
Is Nardil likely to succeed were all these other treatments have failed? Is CBT a good idea?
Are there any other drugs that might be helpful which are going to be released in the UK at any point soon?
Posted by Bill LL on March 15, 2005, at 9:16:56
In reply to Social anxiety - Please give me hope!, posted by The_Resistance on March 15, 2005, at 6:59:38
How about Ritalin, Paxil, or inderal? I think that both inderal and Paxil are prescribed for social anxiety.
Although your doc will not prescribe dexedrine, will she prescribe Ritalin?
Another possibility might be Provigil.
I think that some people get benefits from CBT. For some reason, I don't think very highly of it. But don't go by me.
> High everyone
>
> I used to post under the name TheOutsider.
> I suffer from social anxiety, as you have probably guessed! And live in the UK
>
> For years I used GHB to treat my SA.
> I know others have had bad experiences with this med, but for me it was a god send.
>
> It is now no longer possible to obtain GHB over the internet, and I have tried various other forms of medication without success.
>
> To make things simple I have compiled a list of the treatments I have tried
>
> Klonopin - Helped, but unfortunately made me depressed and sleepy so I didn’t feel particularly sociable.
>
> Pregabalin/Lyrica - Helped initially but then seemed to loose effect, even taking med holidays did not help to restore effectivness.
>
> Tramadol/Ultram - Didn’t help
>
> Effexor XL - at 225mg helped depression but not social anxiety
>
> Clomipramine – helped a little at 150mgs
>
> Fluoxetine – Didn’t help at all
>
> Citalopram – Didn’t help
>
> Diazapam – Didn’t help
>
> Moclobemide – Didn’t help
>
> Dexedrine – Alone this didn’t help social anxiety, did help in combination with Clomipramine, almost impossible to get prescribed in the UK
>
> Please give me some hope.
> Is Nardil likely to succeed were all these other treatments have failed? Is CBT a good idea?
> Are there any other drugs that might be helpful which are going to be released in the UK at any point soon?
>
Posted by med_empowered on March 15, 2005, at 10:22:18
In reply to Re: Social anxiety - Please give me hope!, posted by Bill LL on March 15, 2005, at 9:16:56
hey! There really IS hope for social anxiety, trust me. As emotional problems go, social anxiety is highly treatable, so rest assured that you can more than likely be helped. Klonopin is, of course, the emerging gold-standard for social anxiety...if it makes you sleepy, that generally means you haven't yet adjusted...try taking it as a sleeping pill FIRST, and then gradually moving it into daytime use. Worked for me, anyway. Inderal (propranolol) is a great ADD-ON med...with benzos, in particular, it seems to work nicely. Anyway, what I think may be necessary for you is to focus less on INDIVIDUAL meds and more on a POLYPHARMACY regimine. Hate to say it, but sometimes social anxiety needs more than 1 med (I've been there, don't worry). If a TCA worked for you in the past, you may want to try that again...sometimes SSRIs just don't have what it takes for some people. It is hard sometimes to get stimulants RX'd, especially in combo with TCAs (they have a synergistic "thing" whereby they tend to boost the effects of one another...good idea for severe depression, but carries additional risks of heart problems, etc.). I personally wouldn't do an MAOI at this point, b/c they're soooo hard to mix with other meds...even though it CAN be done safely, a lot of docs religiously avoid doing so b/c of obvious liability issues. ECT...not my bag. I've had relatives who've had it; it seems to work, then stop working, then you're back to meds or maintenance ECT. Unless you're suicidal..I'd personally avoid it. Anyway, here's the mix that I found worked for my anxiety, which was BAD: 1)mood-stabilizer (Trileptal, in my case) +2) anti-depressant (I respond best to TCAs or new TCA-ish drugs, like duolexitene) 3) benzo(s) (Klonopin, with the occasional Ativan booster) 4) sleeping pill (as needed...Ambien or Neurontin worked best) 5) stimulant (Adderall is best...I don't think they have Adderall in the UK, but dexedrine should work well, too) 6) Propranolol (dosing is kinda tricky: you need it high enough to work, low enough so you don't get too many side-effects). And..that's it. Lots of drugs, I know, but now I just take Trileptal, Adderall, and an occasional benzo for anxiety and/or sleep...it seems like treating really bad anxiety effectively for a while makes it less severe over the long-run. Anyway, good luck!
Posted by The_Resistance on March 15, 2005, at 12:35:27
In reply to Re: Social anxiety - Please give me hope!, posted by med_empowered on March 15, 2005, at 10:22:18
Thanks guys for your supportive messages
Unfortunatly I live in the UK which imposes specific problems.
For one thing its all but impossible to get stimulants prescribed in the UK.
Secondly Polifarmacy is fround upon in the UK and is generaly only used for hospital inpatients.
Thirdly I have yet to find a doctor who takes social anxiety very seriously.
I am really considering going to the US, but I don't know how to go about it.
Posted by med_empowered on March 15, 2005, at 12:49:26
In reply to Re: Social anxiety - Probably have to travel to US, posted by The_Resistance on March 15, 2005, at 12:35:27
hey! I didn't realize the polypharmaceutical approach is so frowned upon in the UK. I mean, I can see why a doctor would choose to avoid it in most cases- costs, side-effects, drug-drug interactions, so on-- but it seems unwise to abandon it when dealing with cases that have as yet proven resistant to treatment. Anyway, if you opt to come to the US for treatment, I'd really suggest you first establish a relationship with a UK shrink who is willing to work with whatever the US doctor does and carry it through in their own practice. Or, better yet, try to find a doc in the UK who specializes in psychopharmacology/anxiety disorders...my guess would be that you might be able to find friendlier docs that way, as well. Good luck!
Posted by ed_uk on March 15, 2005, at 13:05:56
In reply to Re: Social anxiety - Probably have to travel to US, posted by The_Resistance on March 15, 2005, at 12:35:27
Hi!
>Secondly Polifarmacy is fround upon in the UK and is generaly only used for hospital inpatients.
You're not kidding. The pharmacist almost had a seizure when I was on two ADs at once and THIS WAS IN A PSYCH HOSPITAL. She said she'd never come across anyone on two ADs before! My doc prescribed a combo of lofepramine and citalopram, but only after I'd brought in loads of data on drug interactions. He was scared but he did it, he'd never had a patient on more than one AD at once, and THIS WAS A CONSULTANT PSYCHIATRIST.
>For one thing its all but impossible to get stimulants prescribed in the UK.
True, unless you're a highly irritating little child running wild in the classroom and swearing at the teachers. None of the classical stims are approved for use in adults here. Apparantly, in the UK, you can't have ADD unless you're wildly hyperactive. Also, only in the UK does ADD dissapear overnight when you hit puberty.
Best of luck,
Ed.
Posted by Phillipa on March 15, 2005, at 17:53:25
In reply to Re: Social anxiety - Probably have to travel to US » The_Resistance, posted by ed_uk on March 15, 2005, at 13:05:56
You know, when I've been in the hospital the pharmacy always has a fit that a pdoc would rx two benzos at once. Fondly, Phillipa
Posted by smith562 on March 15, 2005, at 18:33:45
In reply to Re: Social anxiety - Please give me hope!, posted by med_empowered on March 15, 2005, at 10:22:18
Dear Med Empowered,
I have severe anxiety and panic with atypical depression. Nardil worked well, but 30 lbs weight gain-insomnia-sexual dysfunction-memory disturbance made me try something new. Doing okay on zoloft-lithium augmentation 450mg-klonopin-wellbutrin.
Could you tell me more about Trileptal? Do you thing it would be better then lithium (mildly depressiongenic)? Thank you!
Smith
> hey! There really IS hope for social anxiety, trust me. As emotional problems go, social anxiety is highly treatable, so rest assured that you can more than likely be helped. Klonopin is, of course, the emerging gold-standard for social anxiety...if it makes you sleepy, that generally means you haven't yet adjusted...try taking it as a sleeping pill FIRST, and then gradually moving it into daytime use. Worked for me, anyway. Inderal (propranolol) is a great ADD-ON med...with benzos, in particular, it seems to work nicely. Anyway, what I think may be necessary for you is to focus less on INDIVIDUAL meds and more on a POLYPHARMACY regimine. Hate to say it, but sometimes social anxiety needs more than 1 med (I've been there, don't worry). If a TCA worked for you in the past, you may want to try that again...sometimes SSRIs just don't have what it takes for some people. It is hard sometimes to get stimulants RX'd, especially in combo with TCAs (they have a synergistic "thing" whereby they tend to boost the effects of one another...good idea for severe depression, but carries additional risks of heart problems, etc.). I personally wouldn't do an MAOI at this point, b/c they're soooo hard to mix with other meds...even though it CAN be done safely, a lot of docs religiously avoid doing so b/c of obvious liability issues. ECT...not my bag. I've had relatives who've had it; it seems to work, then stop working, then you're back to meds or maintenance ECT. Unless you're suicidal..I'd personally avoid it. Anyway, here's the mix that I found worked for my anxiety, which was BAD: 1)mood-stabilizer (Trileptal, in my case) +2) anti-depressant (I respond best to TCAs or new TCA-ish drugs, like duolexitene) 3) benzo(s) (Klonopin, with the occasional Ativan booster) 4) sleeping pill (as needed...Ambien or Neurontin worked best) 5) stimulant (Adderall is best...I don't think they have Adderall in the UK, but dexedrine should work well, too) 6) Propranolol (dosing is kinda tricky: you need it high enough to work, low enough so you don't get too many side-effects). And..that's it. Lots of drugs, I know, but now I just take Trileptal, Adderall, and an occasional benzo for anxiety and/or sleep...it seems like treating really bad anxiety effectively for a while makes it less severe over the long-run. Anyway, good luck!
Posted by med_empowered on March 15, 2005, at 21:56:22
In reply to Re: Please tell me more about Trileptal! » med_empowered, posted by smith562 on March 15, 2005, at 18:33:45
hey! I personally prefer Trileptal to other mood-stabilizers because: a) no blood-tests b)better side-effect profile c) it seems to play well with other drugs and d) it works well (for me, at least). Anyway, Trileptal is basically Tegretol, the old-school anti-convulsant, with an added oxygen molecule. The added oxygen apparently makes all the difference; unlike Tegretol, Trileptal doesn't require blood work and seems to do well with other meds. But...it is a new drug, so there are problems with cost and lack of data. For some reason the Trileptal people are marketing it ONLY as an anti-convulsant, and they're not doing mood-stabilizer research (same thing the Tegretol people did). So, since so much of the funding for drug research flows from the drug manufacturers (sad, isn't it?), the evidence for Trileptal's efficacy is mostly based on clinical practice. That said...for me, anyway, the Trileptal first helped calm the "raw edge" of hypomania (anxiety, insomnia, etc.). Then, after a while, I had less hostility and mood-swings, and I eventually found myself with less anxiety and depression. Be careful, though; like Lithium, Trileptal can "flatten out" your emotions if the dose is too high. Anyway, I can't predict how you personally will respond to Trileptal vs Lithium, but I found it helpful. There is MUCH more data for Lithium than for Trileptal, but Trileptal still seems to be gaining popularity, and I personally prefer it over, say, Depakote.
Posted by Phillipa on March 15, 2005, at 22:03:31
In reply to Trileptal, posted by med_empowered on March 15, 2005, at 21:56:22
I took a low dose of it. The pdoc at the time said it was for mood and sleep. I only took l50mg but had no side effects, and I think it made me sleepier at bedtime. Fondly, Phillipa
Posted by krybrahaha78 on March 16, 2005, at 0:51:16
In reply to Re: Social anxiety - Please give me hope!, posted by Bill LL on March 15, 2005, at 9:16:56
Have you ever tried Luvox? Awesome med for anxiety in my opinion
> How about Ritalin, Paxil, or inderal? I think that both inderal and Paxil are prescribed for social anxiety.
>
> Although your doc will not prescribe dexedrine, will she prescribe Ritalin?
>
> Another possibility might be Provigil.
>
> I think that some people get benefits from CBT. For some reason, I don't think very highly of it. But don't go by me.
>
> > High everyone
> >
> > I used to post under the name TheOutsider.
> > I suffer from social anxiety, as you have probably guessed! And live in the UK
> >
> > For years I used GHB to treat my SA.
> > I know others have had bad experiences with this med, but for me it was a god send.
> >
> > It is now no longer possible to obtain GHB over the internet, and I have tried various other forms of medication without success.
> >
> > To make things simple I have compiled a list of the treatments I have tried
> >
> > Klonopin - Helped, but unfortunately made me depressed and sleepy so I didn’t feel particularly sociable.
> >
> > Pregabalin/Lyrica - Helped initially but then seemed to loose effect, even taking med holidays did not help to restore effectivness.
> >
> > Tramadol/Ultram - Didn’t help
> >
> > Effexor XL - at 225mg helped depression but not social anxiety
> >
> > Clomipramine – helped a little at 150mgs
> >
> > Fluoxetine – Didn’t help at all
> >
> > Citalopram – Didn’t help
> >
> > Diazapam – Didn’t help
> >
> > Moclobemide – Didn’t help
> >
> > Dexedrine – Alone this didn’t help social anxiety, did help in combination with Clomipramine, almost impossible to get prescribed in the UK
> >
> > Please give me some hope.
> > Is Nardil likely to succeed were all these other treatments have failed? Is CBT a good idea?
> > Are there any other drugs that might be helpful which are going to be released in the UK at any point soon?
> >
>
>
Posted by Maximus on March 16, 2005, at 9:32:26
In reply to Re: Social anxiety - Probably have to travel to US » The_Resistance, posted by ed_uk on March 15, 2005, at 13:05:56
> You're not kidding. The pharmacist almost had a seizure when I was on two ADs at once and THIS WAS IN A PSYCH HOSPITAL.
Hi Ed,
I'm not sure if you have been sarcastic or not. But in the affirmative, with all due respect, it appears that UK still lives in the Bronze Age. It's weird. Isn't?
Posted by ed_uk on March 16, 2005, at 9:52:19
In reply to Re: Social anxiety - Probably have to travel to US » ed_uk, posted by Maximus on March 16, 2005, at 9:32:26
Hi Maximus!
>I'm not sure if you have been sarcastic or not. But in the affirmative, with all due respect, it appears that UK still lives in the Bronze Age. It's weird. Isn't?
No, I wasn't being sarcastic! I hope things are better in Quebec :-) Our pdocs live in the SSRI age, where SSRIs and Effexor are prescribed almost exclusively.
Ed.
Posted by The_Resistance on March 16, 2005, at 12:13:56
In reply to Re: Social anxiety - Probably have to travel to US » Maximus, posted by ed_uk on March 16, 2005, at 9:52:19
I'm glad I got people talking, and I apreciate all the support.
Is there anyone who actually has any experience of going to the US though?
There was someone on this board who has traveld from the UK to the US, but I don't remeber his posting name.
Posted by tygereyes on March 17, 2005, at 9:38:08
In reply to Trileptal, posted by med_empowered on March 15, 2005, at 21:56:22
Yes, you SHOULD get blood tests with Trileptal. It can cause a condition known as "hyponatremia" - dangerously low sodium levels. If left untreated, it is fatal.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.