Shown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by mike lynch on June 20, 2006, at 9:01:39
I just came off prozac, and at most I believe it may have had a minor impact in decreasing the social anxiety I have, but while I'm off this med and doing fine, that is when gauging the reason I took it for (depression) I am wondering if my performance socially would justify continuing meds or trying different meds, even though the depression has subsided.
When I read some stories concerning social anxiety, I feel like I am not even close to that point. The anxiety is no where near the degree where I have trouble talking on the phone, or going to the store. The primary problem I have involves personal contact. What I mean is if I'm around a group of people, whether it be at my work, school or what have you, the only time I will make the initial social contact is if it's regarding an issue that absolutely requires me to talk to someone. When it just comes to intiating casual conversation, or contributing to any conversation, I am just to reserved to make the first move, or contribute in anyway. I am fine when the person makes the conversation and I just respond, but it just seems my ability to make friends, ask questions, enquire about things, and just not seem awkward is really hindered by my absolute fear to be the first to initiate conversation. It's almost like an inferiority complex where I feel I am only justified in speaking to them only if they give me permission, which is shown by them talking to me first. If I make the first social contact I might be wasting there time, or I believe they have this "why is this loser talking to me" mindset. It's also coupled with a "I'm not worth their time" mindset.
My anxiety doesen't even cripple my thoughts, I have the thoughts I'm just to afraid to convey them in the situations I described. There'll be things I want to say or want to ask that'lll be avoided because of my fear, as I will only go about approaching someone first if an issue arises that is of high importance, other then that I just can't talk to someone casually, or ask him/her something.
This is my position, and I guess i'm looking for thoughts, similar experiences, and suggestions.
Posted by Phillipa on June 20, 2006, at 12:07:11
In reply to At what point are meds justified (social anxiety), posted by mike lynch on June 20, 2006, at 9:01:39
Have you considered theraphy? Love Phillipa
Posted by saturn on June 20, 2006, at 12:54:57
In reply to At what point are meds justified (social anxiety), posted by mike lynch on June 20, 2006, at 9:01:39
Mike,I have some similiar issues and am considering cognitive behavioral therapy (CBT).
Posted by jedi on June 20, 2006, at 14:33:10
In reply to At what point are meds justified (social anxiety), posted by mike lynch on June 20, 2006, at 9:01:39
> I just came off prozac, and at most I believe it may have had a minor impact in decreasing the social anxiety I have, but while I'm off this med and doing fine, that is when gauging the reason I took it for (depression) I am wondering if my performance socially would justify continuing meds or trying different meds, even though the depression has subsided.
...Hi Mike,
I think the problem with social anxiety is really unrecognized by a lot of medical professionals. It can have a huge effect on the quality of your life in financial and social functioning. There can be many commorbid disorders including depression, drug and alcohol abuse.I developed social anxiety as a teenager, but it was not diagnosed until my early 40s. In high school I was too shy to even date (the fear of a negative response was just to much). In college I discovered booze and pot. I self medicated my social anxiety with these substances for years. I was never an alcoholic but I was sure a problem drinker. Only by grace did I not kill myself or someone else.
I managed to find a career that I could succeed in despite the oncoing social anxiety. I would have to wipe my hand off before I could even shake someones hand. I had low level depression for many years(dysthymia). When my first major depression hit in my 40s the only thing that worked out of 35+ medication combinations was Nardil combined with clonazepam. The Nardil probably saved my life but you won't get a doctor to prescribe it for minor depression or mild social anxiety.
IMHO a low dose of clonazepam may be all that is required for mild social anxiety. Contrary to some opinions, this medication is safe without a lot of the negative effects of the antidepressants. Just my opinion, but untreated social anxiety is a lot more serious than most people realize.
Good Luck and be Well,
JediInt Clin Psychopharmacol. 2006 May;21(3):131-42.
Clonazepam in the treatment of psychiatric disorders: an update.
Link:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16528135&query_hl=15&itool=pubmed_docsum
Posted by mike lynch on June 20, 2006, at 16:35:31
In reply to Re: At what point are meds justified (social anxiety) » mike lynch, posted by jedi on June 20, 2006, at 14:33:10
When it comes to meds aside from anti-depressants such as clonzepan, does this med, or are there meds where the emotional numbing, amotivational side effects aren't present. I think the absolute best med would be one that works on dopomaine, that way you'd get the exact opposite of amotivation and emotional numbing while solving your anxiety problems.
Posted by jedi on June 21, 2006, at 0:17:36
In reply to Re: At what point are meds justified (social anxie, posted by mike lynch on June 20, 2006, at 16:35:31
> When it comes to meds aside from anti-depressants such as clonzepan, does this med, or are there meds where the emotional numbing, amotivational side effects aren't present. I think the absolute best med would be one that works on dopomaine, that way you'd get the exact opposite of amotivation and emotional numbing while solving your anxiety problems.
Hi Mike,
There is some evidence that dysregulation of the dopaminergic system can play an important role in social anxiety. I haven't used it but maybe modafinil(Provigil) along with a small dose of clonazepam(1mg) would work. Does anyone have any experience or thoughts on this?
Be Well,
JediNeurobiological Mechanisms of Social Anxiety Disorder
Abstract:
OBJECTIVE: The authors critically surveyed several preclinical and clinical neurobiological models of social anxiety disorder. METHOD: The authors reviewed the recent literature regarding three animal models of particular relevance to social anxiety. They then examined the recent literature concerning clinical neurobiological aspects of social anxiety disorder, including the developmental neurobiology of anxiety, the genetics of fear and social anxiety, and challenge and imaging studies. RESULTS: The available animal models are useful paradigms for understanding the features of social subordination stress, attachment behavior, and environmental rearing, but they incompletely account for the known neurobiology of human social anxiety disorder. The clinical neurobiology literature surveyed implicates specific neurotransmitter system abnormalities, most notably of the dopamine system, but largely ignores neurodevelopmental processes and the functional interactions between neurotransmitters. Both heritable factors and environmental stress factors appear to be responsible for the onset of social anxiety disorder. CONCLUSIONS: Social anxiety disorder should be conceptualized as a chronic neurodevelopmental illness that might represent a fully compensated state in adulthood. Future investigations from this perspective are discussed.
Full Article:
http://ajp.psychiatryonline.org/cgi/content/full/158/10/1558#F1Low Dopamine D2 Receptor Binding Potential in Social Phobia
Abstract:
OBJECTIVE: This study compared dopamine D2 receptor binding potential in patients with social phobia and healthy comparison subjects. METHOD: Dopamine D2 receptor binding potential was assessed in 10 unmedicated subjects with generalized social phobia and no significant lifetime psychiatric comorbidity and 10 healthy comparison subjects matched for age and sex. Binding potential was measured in the striatum by using single photon emission computerized tomography and constant infusion of the D2 receptor radiotracer [123I]iodobenzamide ([123I]IBZM). RESULTS: Mean D2 receptor binding potential was significantly lower in the subjects with social phobia than in the comparison subjects. Within the social phobia group, there was a nonsignificant correlation of binding potential with the Liebowitz Social Anxiety Scale score. CONCLUSIONS: Generalized social phobia may be associated with low binding of [123I]IBZM to D2 receptors in the striatum.
Full Report:
http://ajp.psychiatryonline.org/cgi/content/full/157/3/457?ijkey=3e69e0b77dbdf8ea9f8f30788d90052dc24833afPotential Uses of Modafinil in Psychiatric Disorders
Full Article:
http://jrnlappliedresearch.com/articles/Vol4Iss2/Bransfield-Jar-spring.pdf
Posted by zeugma on June 21, 2006, at 4:57:19
In reply to Modafinil + clonazepam for social anxiety? » mike lynch, posted by jedi on June 21, 2006, at 0:17:36
I haven't used it but maybe modafinil(Provigil) along with a small dose of clonazepam(1mg) would work. Does anyone have any experience or thoughts on this?>>
Hi.
I take 300 mg modafinil with 1 mg clonazepam, and yes, it does help the social anxiety, but it's mostly the clonazepam effect. I find modafinil to be a positively asocial med.
Ritalin worked much better in terms of socializing- it helped social anxiety, although it immeasurably worsened other forms of anxiety. Even Strattera was a less unsociable med than modafinil.
others say that Ritalin is an asocial med, so of course YMMV.
The good news is that overall anxiety is lower on modafinil than on other stim-type meds (I consider Strattera a stimulant type med). Just to show that you can't have it all, though, modafinil takes away the desire to be social.
-z
Posted by hgi698 on June 21, 2006, at 22:20:38
In reply to Re: Modafinil + clonazepam for social anxiety? » jedi, posted by zeugma on June 21, 2006, at 4:57:19
Hi i am a newbie here and i think you answered one of my first posts. I am 22 year old male who has suffered from extreme social anxiety. During high school i think i could be classified as avoidant personality disorder which is basically the most extreme sort of social anxiety there is. I totally avoided most contact with any person. It got really bad by my senior year in high school. I had extreme anxiety, i could barely talk on the phone, had no friends etc. In college I drank with people for the first time and it completely change my personality from completely shy and inhibited to an extrovert. People liked me much better when i was drunk, i was like a different person. Anyway by my second year in college i began to realized why i was shy. Before college i was afraid to show any kind of emotions, i spoke in a monotone voice and must have appeared to be very boring. I also had constant negative thoughts about my inadequacy. So alcohol showed me a door that i was just a tweak away from being a socialite. In my sophomore year i started to make changes in the way i acted around people. Like 90 percent of communication is nonverbal, so i tried to give more intonation, smile more, be more expressive. Pretending to be interesting. I looked at how successful people acted and also the way I acted on alcohol. So acting this way breaks the cycle of the negative feedback loop. People actually respond to you when you "pretend" to be more outgoing. Before I actually thought that showing no emotions would help me make friends. So eventually this "acting" becomes more natural, you gain more confidence and become more social. The next step in this process is to think back on your day, only about all the good things that happen, even if they seem small. For a person with social anxiety you tend to think that everything you say is stupid or that people are much more socially competent than you are when they really aren't. You have to realize in a social situation that there is a lot of interpretation going on. People who are very confident may interpret a remark from a person differently than a person who has social anxiety. A social phobe might think it was a put down, while the confident person would think it was just a joke. So don't think about everything wrong you did in the day, just think about all the things that went right. It sounds simple, but it does work. So anyway these are several things which i have learned. I get back to you on more things you can do. Drugs help too.
Posted by zeugma on June 22, 2006, at 18:41:32
In reply to Re: Social anxiety, posted by hgi698 on June 21, 2006, at 22:20:38
hi hgi,
I acted in plays in high school and college to get this 'pretending' thing down.
I was able (with much difficulty) to act on stage, but it carried over not at all to real life.A lot of it is related to the verbal fluency thing you mentioned in the post on glycine (which was very interesting). I have very little (verbal fluency), and it just doesn't 'feel' right to engage in social situations, except when I'm on Ritalin, which I can't tolerate otherwise (severe anorexia, mood swings). Klonopin lets me keep a job, caffeine and Provigil keep me awake.
-z
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