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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by not_so_pro_social on April 24, 2005, at 1:48:15
I'm sorry I'm posting it again, but I've added all the stuff that I have used so maybe that can help someone out in picking the right drug/med/combo :)
Hope you wont be mad :))
Here it goes:I suffer from rather "powerful" social phobia. Ok so i've been fighting with social phobia for over 5 years with little luck. Here is my story: I've tried various medications,ADs,supplements and of course drugs. Here is the list of things Ive tried:
- SSRIs were a joke. Prozac, Zoloft, Paxil - only f*cking side effects.
- Most people are helped in social phobia wiht Klonopin - I don't, it doesn't work at all. I've used up to 8mg/day to test if it could work.
-> Xanax - effective but tolerance went WAY UP VERY FAST. I've used it for 2 months - at first 1mg was enough, at the end of the 2nd month I needed 3mg and it didn't even work as good as 1mg at the beginning!
- other benzos - Valium, Medazepam, Bromazepam - practically no effect on social anxiety/phobia. (Do you think Rohypnol would be effective?)
->> Amisulpride (Solian) - 50mg/day . Worked great for 2 months, then pooped out. I've tried using it for another few months on/pff but it never worked again.
- Sulpiride 50-200mg- no effect
- Depakote - no effect
- Zyprexa up to 20 mg - no effect. gained f*cking 10 kgs of fat.
- St.John's Wort - no effect
-Reboxetine 8 mg - no effect
- Coffee - makes me pro-social for over up to an hour and then makes me extremely socially anxious.
- Pramipexole (Mirapex) - 1.5mg/day . Made me more confident, anti-depressed but didn't remove social phobia (maybe a little) plus it wasn't pro-social at all.
Ok here is the treatment which worked THE BEST for me (unfortunately I had to stop it because my GHB/Xyrem source has dried up
->>> Adderall + GHB - this was not only the best treatment for social phobia but it also made me SO PRO-SOCIAL as I have never been before in my life (even MDMA or alcohol doesn't work as good as this combo). I literally could walk to every girl and make small-talks and inteliggent conversations, which normally is impossible for me because of the anxiety. And dont think that i consider social anxiety as a problem with hanging out with girls - it is much much more complicated: fear of public speaking, fear of one-on-one conversation (even though Im not anxious when 3 ppl are involved), every thing I say I consider being, how to put it..hmm.. NOT RIGHT. tHIS combo totally removed all those symptoms. I wish GHB was more available, as it is wonderful anti-anxiety treatment (plus other benefits); too bad it was labeled 'date-rape drug' and scheduled.
Since GHB has not been available, I've been looking for some other treatment.
Lyrica (pregabalin) is not yet available in my country, but I dont think I could afford it - 600mg is effective in social phobia which probably will cost $100000. Lower doses are placebo and dont work (at least 150mg).
Nardil,Parnate - both are not available in my country, because they are irreversible MAOis - but there is possibility of importing those drugs. So here is my question - how much Parnate does one need in order to achieve social anxiety relief ? Importing Nardil is way too expensive (at least at 75-90mg dose). Oh so I've heard (read).
Moclobemide - what do you think of this reversible MAOi ?
Concerta (Ritalin XR) - is it as pro-social as amphetamines? There is no adderall in my country unfortunately and the illegal usage and "hard-to-dose thing" are 2 biggies.
What else can I try?? Dopamine agonists like Requip, Pronoran, Permax etc? Are dopamine agonists helpful in social phobia?
Tianeptine (Coaxil) 12.5mg/3x day - no effect
L-Theanine - no effect
Kava-Kava - I've used even very high doses (something up to 1g kavalactones - not kavakava)- no effect at all, even no anti-anxiety
Selegiline 5mg - no effect or even worsening of SP
Wellbutrin - didnt try but I've heard it increases anxiety
MST Continus 100mg, Heroin, Codeine - too drowsy to say that it could be helpful. I need something pro-social.->>> Tramadol - works at 400mg-600mg, but loses its effects - I can use it every 3-4 days :/. But its WONDERFUL treatment, not like morphine,codeine,heroin - Tramadol is actually VERY pro-social and anti-anxiety. Works for over 6-8 hours. Too bad I cant use it every day but oh well
And last but not least - ALCOHOL. Apart from amphetamine/G , another tremendous thing, although toxic. I use it very often in social situations, but also pray that G will come back soon :]
2 beers make me relaxed,talkative,pro-social,anti-anxiety. More (up to 5 beers or actually I prefer vodka) and I am extremely pro-social.
I don't think i need to write more about alcohol social effects, everyone knows how it worksMDMA - I won't comment it because everyone knows it is social lubricant like alcohol or G. And DEFINITELY not something being used long term/daily
Question popped into my mind: how effective are barbiturates in social anxiety? Or 5-HTP, Enada NADH, Ativan, Topamax, Luvox, Modafinil ?
As a final note I need to mention that I've been drinking to control my social phobia, since no other available treatment comes close to relieving my symptoms unfortunately (since GHB is nowhere near) ;(( That's why Im looking for some medicine to help me out with my condition and so I could stop poisoning my body with alcohol.
Ok I'm done rambling Thanks in advance to anyone who can give advice, recommendation or has similar problem and tried various substances and they worked.
Posted by sdb on April 24, 2005, at 3:11:32
In reply to Social phobia/anxiety and drugs/meds [long], posted by not_so_pro_social on April 24, 2005, at 1:48:15
have you taken xanax xr or regular xanax?
have you taken lorazepam?
have you taken niacinamide?
did you use clonidine as supplement?
Posted by sdb on April 24, 2005, at 3:18:57
In reply to Social phobia/anxiety and drugs/meds [long], posted by not_so_pro_social on April 24, 2005, at 1:48:15
Hi!
I could buy the pregabalin but i dont think its worth a try. Yes alcohol probably one of the most effective drugs you can take in your disorder. I have myself not found any agent working as well as ethanol. But i would stop drinking a lot permanently because its poisening your body and your liver will cross the point and irreversible damaged.
kind regards
Posted by not_so_pro_social on April 24, 2005, at 3:26:54
In reply to Re: Social phobia/anxiety and drugs/meds [long], posted by sdb on April 24, 2005, at 3:11:32
> have you taken xanax xr or regular xanax?
Yes I wrote that Ive taken Xanax. I didnt take XR version since it is expensive and from what ive read isnt as good.
> have you taken lorazepam?
No. Its on my list things to try ;-)> have you taken niacinamide?
Yes. No success.
> did you use clonidine as supplement?
Nope. Gotta google this one because i havent heard about it. Thanks for interest :)
Posted by sdb on April 24, 2005, at 4:04:52
In reply to Re: Social phobia/anxiety and drugs/meds [long] » sdb, posted by not_so_pro_social on April 24, 2005, at 3:26:54
How much (mg) was your dosage of niacinamide? did it poop out?
Posted by not_so_pro_social on April 24, 2005, at 4:14:32
In reply to Re: Social phobia/anxiety and drugs/meds [long], posted by sdb on April 24, 2005, at 4:04:52
> How much (mg) was your dosage of niacinamide? did it poop out?
Various doses, up to 3g from what I remember. It never worked even a little bit. Why would you think that niacinamide helps SP/SA?
Posted by sdb on April 24, 2005, at 4:22:14
In reply to Re: Social phobia/anxiety and drugs/meds [long] » sdb, posted by not_so_pro_social on April 24, 2005, at 4:14:32
look at this thread:
http://www.dr-bob.org/babble/alter/20050414/msgs/485434.html
and at this interesting (!) experience:
Posted by sdb on April 24, 2005, at 4:41:50
In reply to Social phobia/anxiety and drugs/meds [long], posted by not_so_pro_social on April 24, 2005, at 1:48:15
If you are interested in clonidine there are many interesting articles concerning panic, locus coeruleus and so on. One of the article:
http://www.cpa-apc.org/Publications/Archives/CJP/2004/february/lettersPanic.asp
Posted by not_so_pro_social on April 24, 2005, at 4:48:36
In reply to Re: Social phobia/anxiety and drugs/meds [long], posted by sdb on April 24, 2005, at 4:22:14
> look at this thread:
>
> http://www.dr-bob.org/babble/alter/20050414/msgs/485434.html
>
> and at this interesting (!) experience:
>
> http://www.dr-bob.org/babble/20030505/msgs/226283.htmlInteresting. Too bad it didnt work for me. :-(
Posted by ixus on April 24, 2005, at 8:57:00
In reply to Social phobia/anxiety and drugs/meds [long], posted by not_so_pro_social on April 24, 2005, at 1:48:15
> Nardil,Parnate - both are not available in my
> country, because they are irreversible MAOis - > but there is possibility of importing those
> drugs. So here is my question - how much
> Parnate does one need in order to achieve
> social anxiety relief ? Importing Nardil is way > too expensive (at least at 75-90mg dose). Oh so > I've heard (read).If you are patient enough (and lucky ;-) ), you can have Nardil or Parnate imported and refund by public health care.
Parnate is very helpful in SP but it may aggravate GAD symptoms. If GAD, tiredness is not a problem for you, Parnate may work just fine, since you had good experiences with stimulants (how did you get them, they are not either available in your country).
I don't have any experience with Nardil yet.
/ixus
Posted by smith562 on April 24, 2005, at 16:47:14
In reply to Social phobia/anxiety and drugs/meds [long], posted by not_so_pro_social on April 24, 2005, at 1:48:15
Hey Notsoprosocial,
Most individual with severe social phobia need a "coctail" of meds for moderate relief. For me (and many individuals and expert pdoc also state), the best combination is nardil 60 + klonopin .5 and intermitent coffee throughout the day. Your core should be an antidepressant ... the best being MAOI or less potent an SSRIs. Add on a benzo to the ad. You can augment that with Neurontin, stimulant, lamictal, caffeine, etc. (0ffically an MAOI and other meds may cause hypertensive crisis or serotonin syndrome ... but many experts will still use them).
Hope this helps
Smith
www.socialfear.com
Posted by zeugma on April 24, 2005, at 17:43:59
In reply to Re: Social phobia » not_so_pro_social, posted by smith562 on April 24, 2005, at 16:47:14
> Hey Notsoprosocial,
>
> Most individual with severe social phobia need a "coctail" of meds for moderate relief. For me (and many individuals and expert pdoc also state), the best combination is nardil 60 + klonopin .5 and intermitent coffee throughout the day. Your core should be an antidepressant ... the best being MAOI or less potent an SSRIs. Add on a benzo to the ad. You can augment that with Neurontin, stimulant, lamictal, caffeine, etc. (0ffically an MAOI and other meds may cause hypertensive crisis or serotonin syndrome ... but many experts will still use them).
>
> Hope this helps
>
> Smith
>
> www.socialfear.com>>I get "moderate relief" from my social phobia from my meds: 1 mg clonazepam and 100 mg nortriptyline, and probably the 30 mg buspirone helps but without clonazepam the TCA and buspirone are useless, so probably it's the clonazepam that's doing the work. Provigil is not good for social phobia, neither was Ritalin. I have other diagnoses than SP, so most of the meds are oriented towards those. I wonder how many people with social phobia desire to be "pro-social" anyway. I find social interaction taxing, even if it doesn't trigger severe anxiety, and I seem to need a lot of time 'decompressing' from social interactions. I wonder if this is a manifestation of social phobia or is caused by something else.
-z
Posted by Phillipa on April 24, 2005, at 18:13:56
In reply to Re: Social phobia » smith562, posted by zeugma on April 24, 2005, at 17:43:59
You know that's a good question. When I have said that I functioned and could work while drinking after work[I had rules nothing before 8pm], I always came home from work and had to lie down and deepbreath for a while as I found the social interracting so exhausting. And I neve felt guilty for not socializing when I worked. Even when I was young I never had close friends that I went out with or hung around with. I preferred to be alone or with my husband. Fondly, Phillipa
Posted by Declan on April 25, 2005, at 1:42:36
In reply to Re: Social phobia » zeugma, posted by Phillipa on April 24, 2005, at 18:13:56
Yeah, I could never understand why I would find social interaction so exhausting. Some ego boundary thing, or some problem accepting seperateness, and the only substances which ever helped were illegal (cocaine) or of course alcahol. Someone associated with the development of GHB spoke of depression and sociability as being opposites, which sounded right. I would have liked to have tried it. I suppose Nardil's the thing to try
Declan
Posted by woolav on April 26, 2005, at 9:31:29
In reply to Re: Social phobia, posted by Declan on April 25, 2005, at 1:42:36
klonopin has been the only thing that works for my social phobia. without it i would be agoraphobic i think...have you tried that??
Posted by Chairman_MAO on April 26, 2005, at 12:10:31
In reply to Social phobia/anxiety and drugs/meds [long], posted by not_so_pro_social on April 24, 2005, at 1:48:15
I am a tranylcypromine success story for lifelong social phobia and treatment-resistant dysthymia/double depression. At 24 years of age, last August, after over three years of trying every medication in the book--and a lifetime of baseline high anxiety, low self esteem, social phobia, and generalized hopelessness and inability to maintain a long-term interest in nearly anything--I clamored and clamored until I had the good fortune of moving to the New Brunswick, NJ area. Here, even the public clinic has top-notch psychiatrists because of their affiliation with the state medical university.
Even though the doctor I saw was barely out of residency, she consulted with her supervisor and prescribed me Parnate out of compassion. Man, what an ultimately ineffable difference! I could walk around, head up high, generally happy about what was going on. It's the classic SP remission story: being able to look people--esp attractive members of the opposite sex--in the eye, etc. My self-image began to accomodate for the fact that other people liked me and/or found me attractive and fun to be around.
It wasn't long, however, that I found that the Parnate didn't provide constant relief throughtout the day. The MAOI effect was always there, but the dopaminergic punch faded a few hours after the last dose. The insomnia was also horrible, and I had to take Cialis to get it up. Parnate is also quite expenisve at the minimum effective dose for me (60-80mg/day). I took things into my own hands, read about high-dose tranylcypromine, and brought the dose up gradually all the way to 200mg/day. WOW!
I purchase tranylcypromine powder through a chemical broker in order to afford this (no insurance).I am fully convinced that the reason so many people do not have success with Parnate is that their dose is too low. In my opinion, anyone not completely satisfied with their response to Parnate should shoot for a target dose of AT LEAST 90mg, preferably 120-200mg/day.
Moreover, the side effects lessened somewhat instead of increased the higher I went. Very strange. I only had to take Cialis sometimes. The insomnia lessened somewhat, but remained. I thought I had the best pharmacological solution available. I was wrong.You see, I also have a history of moderate-to-severe drug addiction (controlled substances of all kinds) which began due to a failed quest to self-medicate my unlivable mental condition coupled with too many doctors that only knew how to script SSRIs. Even though I was on the Parnate, that remained. So did my procrastination and "reward deficiency syndrome". Don't get the wrong idea: I was hardly ever depressed, and it never stopped working for social phobia. It aggrivated my predisposition toward anxiety late at night when it wore off, but some seroquel before bed took care of that.
But things were still not good. I was still getting high to cope, and the stress of school was overwhelming. I began to isolate, etc. And you probably have no idea how weird it feels to feel hopeless, frustrated, and cornered by life while also feeling somewaht upbeat and sociable due to taking such an effective medication.
To make a long story short, I sought out treatment with Suboxone (sublignual buprenorphine) to deal with drug cravings and to prevent my getting high on opiates (my "drug of choice" when I try to maintain functionality despite the demons in my head). The ironic thing is that I never really wanted to get high in the first place; I was just buying the dope--and taking all associated risks--just to be able to shut the "demons" up so I could function.
I told this to an extremely compassionate addictionologist that works at another clinic around here, and he put me on Suboxone. It's been one moth since I started it, and I'm happy to say I am done with the medication thing. I feel great. My cravings for drugs have been lessened by--conservatively--75%.. Not only that, but it's slightly sedative effect is just enough to counteract any overstimulation from the Parnate. Buprenorphine is also so effective for depression and anxiety in and of itself that I have been able to cut the tranylcypromine back to 120mg/day, looking for a further reduction back to around 60-80mg/day; I simply don't think I need that much punch from tranylcypromine anymore now that I have the bupe on board. Furthermore, buprenorphine actually corrects my "reward deficiency"--the core problem that lead to all of my academic failures--such that I now enjoy even the previously insurmountable yet simple task of cleaning up my room, which used to always be a mess.
I cannot stress it enough: I had no idea it was possible to live this way. I had no idea such a state of normalcy was something I'd ever experience. I thought it was reserved for "them", and that I was destined to exist on the fringe of society, forever a dilettante, unable to actualize his vast array of talents because of mental illness. I pray daily that God allow me to continue to have access to this medication, because without my meds, I would likely be in a virtual gutter in 10-20 years. I am not being hyperbolic at all in saying that, either. With it, I will now most liekly be able to finish my undergrad degree, go to grad school, and have a rewarding life.
At any rate, the point of my post is this: If anyone thinks they've tried every combination of psych meds for depression/social phobia, if you haven't tried buprenorphine + tranylcypromine, you are doing yourself a grand disservice. I only wish it were easier and cheaper to get so that more people could benefit from it.
IMHO, buprenorphine alone is safer and far more effective than any antidepressant out there besides perhaps the MAOIs. 80% of the ADs and other psych drugs on the market are utterly useless for populations such as those that make up a large portion of people on this board: the "treatment-resistant".
P.S. Even though I now feel sublimely "OK" and often elated just to be alive, I still can cry and get frustrated when appropriate. When I was taking SSRI-poisons, I had no ability to cry. It's quite ironic that the meds I take now--including the opiate, which would make me a virtual pariah if the average person knew why I took it (ie, not for physical pain)--which are so effective at raising my mood, still allow me to feel down whenever it's appropriate.
If you have any questions/comments, please let me know. I don't post here much anymore because I just don't have the time, but if my experiences could help anyone achieve full remission like I have, it's worth my spending a little time here.
Posted by Wee Willy on April 26, 2005, at 13:01:30
In reply to Re: Social phobia/anxiety and drugs/meds [long], posted by Chairman_MAO on April 26, 2005, at 12:10:31
My condition and lack of success to so many treatments except Parnate and once on Librium is similar to yours it seems. I did try bupe by itself without success. For many years I have been treated with Parnate for three months each spring, allthough the onset of effectiveness is slower and peak effectiveness is lower. Years ago on my first trial of Parnate after three months its effectiveness quit. We uped the dose, topping out at about 100 mg and then added Lithium, but the possitive response never returned. I think i will look into adding bupe. I have posted a few times here and elsewhere about my suspicion that what is the underlying cause of my condition. I believe I do not produce enough Inhibin B and without a proper level my cognitive function is greatly reduced. It appears it will be many more years until this theory will be verified and proper treatment comes forth. Until then I need to find a treatment to get by with. Your thoughts or anyone elses would be appreciated. Thanks and best wishes.
Posted by sdb on April 26, 2005, at 13:03:56
In reply to Re: Social phobia/anxiety and drugs/meds [long], posted by Chairman_MAO on April 26, 2005, at 12:10:31
Hi Chairman_MAO!
Your story resembles to mine. Your symptoms are similar (social phobia/bp). I have first taken different SRRIS with no result ecxept asexuality.
Then I have taken clonazepam with definite results, but sideeffects are hardly to tolerate. I would be interested in your treatment with tranylcypromine. I have already tried moclobemide but i suppose its the placebo under the mao's. Could you send me the url/adress from your chemical broker at [xxx] ? -I would like to leave the street of sorrow.Kind regards
sdb
Posted by sdb on April 26, 2005, at 13:28:10
In reply to Re: Social phobia/anxiety and drugs/meds [long], posted by sdb on April 26, 2005, at 13:03:56
Hi!
Whats your current treatment now exactly (drugs/dosages/how many daily/when intake/chemical brokers/diet). Could you precise that trough [xxx] ?
By the way, in my country is only one MAO (moclobemide)available.
Thanks a lot
sdb
Posted by willyee on April 26, 2005, at 22:45:42
In reply to Social phobia/anxiety and drugs/meds [long], posted by not_so_pro_social on April 24, 2005, at 1:48:15
I take parnate and i miss the day when a sinle tab 2-3 x a day worked fine alone,the brightness in your mind,it was great.
Years later taking parnate alone isnt even a option now,as i would just worsen my anxiety,it stil is however my fondtaion on which i augment,or attempt to.
Ive augmented everything,right now i fond some relief in besides a normal standerd dose,i can take half of a parnate,small pieace of klonopin,small pieace of lopressor,small amount of l-theanine cap under the tongue.As for l-theanine alone its horrable,but adding small very small amounts of a cap can sometimes edge of a ansy mood.
Lopressor is a beta blocker i stumbled upon,and it works GREAT with parnate.
Other favorite augments inculde GHB,and or pure caffiene for when parnate makes u fatigue.ONE thing id like to mention about nardil,it sounds like parnate just better,but remember a few things first there is as far as i know still a big issue where tons of long term users found a re fourmatlion of the med so severe they went off,they formed a group and are fighting to get the old one back,so getting nardil now,if its the new formula,might possably be cheating yourself of a good med since many many say the new one cant touch the old,i am in this spot.
Also unfortunatly you cant say well if parnate works,then nardil is the same only enhanced so it must work,one might work and the other not at all,dont be discouraged.As for me,if anyone has found any good parnate augments please,please share lol.
This is the end of the thread.
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