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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 61. This is the beginning of the thread.
Posted by Tom Twilight on October 25, 2006, at 12:34:58
I've got treatment resistant Social Anxiety :(
Its really frustrating because I've tried so many things, and nothing works long term.
I'm currently on Nardil 75mg, the "Gold Standard"
Its helping GAD, but does nothing for SA.
I worry about becoming deppendent on Benzo's and they don't do much either.
Only opiates seem to help, its strange odd
I don't know were all the social phobics have gone on babble!
Should I push the Nardil up to 90mg?
Is D-cycloserine worth trying?
Posted by dbc on October 25, 2006, at 12:48:19
In reply to Treatment Resistant Social Anxiety!, posted by Tom Twilight on October 25, 2006, at 12:34:58
I wouldnt worry about the benzos much, on the other hand i'd think about opiates alot more closesly. Long lasting benzo therapy is the only thing that helped me with SA (i was up to 5mg of klonopin daily).
I come from a substance abuse background and i used opiates excessively for a while and really wish someone could have told me what i know now. No, im not some 12 stepper or a burnout who ruined themselves with drugs but i did have to learn things the hard way.
Posted by Phillipa on October 25, 2006, at 13:18:29
In reply to Re: Treatment Resistant Social Anxiety!, posted by dbc on October 25, 2006, at 12:48:19
Long time benzo user myself but I know what you mean as they are not working well anymore. Love Phillipa
Posted by ed_uk on October 25, 2006, at 14:11:13
In reply to Treatment Resistant Social Anxiety!, posted by Tom Twilight on October 25, 2006, at 12:34:58
Hi Tom
If you can tolerate the side effects, I definitely think you should try 90mg.
Take care
Ed
Posted by Crazy Horse on October 25, 2006, at 16:16:08
In reply to Treatment Resistant Social Anxiety!, posted by Tom Twilight on October 25, 2006, at 12:34:58
> I've got treatment resistant Social Anxiety :(
>
> Its really frustrating because I've tried so many things, and nothing works long term.
>
> I'm currently on Nardil 75mg, the "Gold Standard"
>
> Its helping GAD, but does nothing for SA.
>
> I worry about becoming deppendent on Benzo's and they don't do much either.
>
> Only opiates seem to help, its strange odd
>
> I don't know were all the social phobics have gone on babble!
> Should I push the Nardil up to 90mg?
> Is D-cycloserine worth trying?Try Lyrica Tom. I also "Had" SAD, but with 300 mgs. bid of Lyrica i have become quite the extrovert..seriously, i start conversations w/strangers everyday. You must start with low dose (150 mgs. tid) and work up to 600 mgs. a day. Be patient..if you titrate too fast you will feel drunk. Best wishes Tom.
-Monte
Posted by jedi on October 26, 2006, at 1:00:55
In reply to Treatment Resistant Social Anxiety!, posted by Tom Twilight on October 25, 2006, at 12:34:58
> I've got treatment resistant Social Anxiety :(
>
> Its really frustrating because I've tried so many things, and nothing works long term.
>
> I'm currently on Nardil 75mg, the "Gold Standard"
>
> Its helping GAD, but does nothing for SA.
>
> I worry about becoming deppendent on Benzo's and they don't do much either.
>
> Only opiates seem to help, its strange odd
>
> I don't know were all the social phobics have gone on babble!
> Should I push the Nardil up to 90mg?
> Is D-cycloserine worth trying?Hi,
I have atypical depression with social and generalized anxiety. I use Nardil with clonazepam and they work fairly well for me. At high doses of Nardil I get pretty extreme carbohydrate cravings, delay in ejaculation plus insomnia. However, this is the only combination that has ever worked for me. With treatment resistant social anxiety and atypical depression sometimes you just have to endure some side effects. To me, lying in misery on the floor and not being able to leave the house is much worse than the side effects. I have been on 1mg of clonazepam for several years and for me it is a good augmentor of Nardil for social anxiety. I really don't worry about being addicted to it. I've weaned off it before and could again if forced too.Currently, I am slowly lowering my Nardil down to 45mg from 90-105mg to see if I can sustain the antidepressant effect and lessen the side effects. I've been trying to get my MD to let me try modafinil with it, but no luck so far.
Take care,
Jedi
Posted by naughtypuppy on October 26, 2006, at 8:07:11
In reply to Treatment Resistant Social Anxiety!, posted by Tom Twilight on October 25, 2006, at 12:34:58
I really don't know how you people manage to do it. I tried Nardil at 75mg for about a month and the hypotension was so bad I was blacking out several times a day. It felt like a puppet that had it's strings randomly cut, I fell down so many times. The hypotension is starting to come back a little at 60 mg and the social phobia is starting to increase. May I'm just not cut out for Nardil but everything else is useless.
Posted by jedi on October 26, 2006, at 10:52:47
In reply to Re: Treatment Resistant Social Anxiety!, posted by naughtypuppy on October 26, 2006, at 8:07:11
> I really don't know how you people manage to do it. I tried Nardil at 75mg for about a month and the hypotension was so bad I was blacking out several times a day. It felt like a puppet that had it's strings randomly cut, I fell down so many times. The hypotension is starting to come back a little at 60 mg and the social phobia is starting to increase. May I'm just not cut out for Nardil but everything else is useless.
Hi,
When I first started Nardil 10+ years ago I had quite a bit of orthostatic hypotension. At the time I was mixing it with trazodone, which can also cause hypotension. I have zero hypotension now, even at high dosages. Watch your drug combinations.
Take care,
Jedi
Posted by Crazy Horse on October 26, 2006, at 11:29:04
In reply to Re: Treatment Resistant Social Anxiety!, posted by naughtypuppy on October 26, 2006, at 8:07:11
> I really don't know how you people manage to do it. I tried Nardil at 75mg for about a month and the hypotension was so bad I was blacking out several times a day. It felt like a puppet that had it's strings randomly cut, I fell down so many times. The hypotension is starting to come back a little at 60 mg and the social phobia is starting to increase. May I'm just not cut out for Nardil but everything else is useless.
Let's face it ALL MAOI's have mega side effects. I have never heard of or met one person who was on Nardil or Parnate (Two of the most effective MAOI's which are both power house AD's) that didn't have very troubling side effects, i.e. insomnia, fatigue, weight gain, hypotension, dizziness, night jerks, ears ringing, and many more. They are so effective for depression, anxiety, social anxiety, but who can live with the side effects. I tried but couldn't!
-Monte
Posted by Tom Twilight on October 26, 2006, at 11:56:59
In reply to Re: Treatment Resistant Social Anxiety! » naughtypuppy, posted by Crazy Horse on October 26, 2006, at 11:29:04
I find Nardil quite tolerable now
Side effects were horrible to begin with.
Now even hypotensions faded.
It just doesn't work for SA, grrrrrrrrrr
Posted by Crazy Horse on October 26, 2006, at 12:21:32
In reply to Re: Treatment Resistant Social Anxiety!, posted by Tom Twilight on October 26, 2006, at 11:56:59
> I find Nardil quite tolerable now
>
> Side effects were horrible to begin with.
>
> Now even hypotensions faded.
>
> It just doesn't work for SA, grrrrrrrrrrRead my above post Tom..please. Have you ever tried Lyrica?
-Monte
Posted by Tom Twilight on October 26, 2006, at 15:55:19
In reply to Re: Treatment Resistant Social Anxiety! » Tom Twilight, posted by Crazy Horse on October 26, 2006, at 12:21:32
Hey Crazy H
I'm sorry to ignore your post!
I had high hopes for Lyrica
Lyrica worked OK for the first few days, then it pooped out.
Bizarly it now makes my anxiety worse!
Unlike Benzo's tollerance sets in very quickly.
Posted by bigcat on October 26, 2006, at 19:39:48
In reply to Re: Treatment Resistant Social Anxiety! » naughtypuppy, posted by jedi on October 26, 2006, at 10:52:47
Hi,
> When I first started Nardil 10+ years ago I had quite a bit of orthostatic hypotension. At the time I was mixing it with trazodone, which can also cause hypotension. I have zero hypotension now, even at high dosages. Watch your drug combinations.
> Take care,
> JediHey Jedi,
Sorry to butt it, but I'm currently taking 90mg of Nardil, with no major side effects except insomnia. For a while now I've been taking Seroquel with it for z's, but I don't dream and am wondering if I may be missing out on REM sleep. I remember having vivid dreams and restful nights when I tried Trazodone a while back, and was considering trying that with the Nardil. Did you have a hypotensive crisis? Are these two meds contraindicated? How did you find the combination otherwise? I'd appreciate a word on this if you have a moment. I don't experience any hypotension on Nardil alone.many thanks,
-matt-
Posted by jedi on October 26, 2006, at 20:20:56
In reply to Re: Treatment Resistant Social Anxiety! » jedi, posted by bigcat on October 26, 2006, at 19:39:48
> Hey Jedi,
> Sorry to butt it, but I'm currently taking 90mg of Nardil, with no major side effects except insomnia. For a while now I've been taking Seroquel with it for z's, but I don't dream and am wondering if I may be missing out on REM sleep. I remember having vivid dreams and restful nights when I tried Trazodone a while back, and was considering trying that with the Nardil. Did you have a hypotensive crisis? Are these two meds contraindicated? How did you find the combination otherwise? I'd appreciate a word on this if you have a moment. I don't experience any hypotension on Nardil alone.
>
> many thanks,
> -matt-
>
>
Hi Matt,
My orthostatic hypotension while on Nardil and trazodone was not very major. Usually I just had to be careful when rising to avoid getting dizzy. Trazodone is quite commonly used as a sleep aid for Nardil users. For me, it gave me just a little too much of a drugged out feeling. I have used Seroquel also, but this was during my trial on Parnate. Some people really like Traz, others don't.
Good Luck,
Jedi
Posted by christophrejmc on October 27, 2006, at 4:07:45
In reply to Re: Treatment Resistant Social Anxiety! » naughtypuppy, posted by Crazy Horse on October 26, 2006, at 11:29:04
I had zero side-effects on Nardil except for orthostatic hypotension (which was very mild and quite tolerable). Parnate made me really sleepy during the day and caused some insomnia, but no other adverse effects. SSRIs and tricyclics, on the other hand, gave me all kinds of nasty side-effects.
> Let's face it ALL MAOI's have mega side effects. I have never heard of or met one person who was on Nardil or Parnate (Two of the most effective MAOI's which are both power house AD's) that didn't have very troubling side effects, i.e. insomnia, fatigue, weight gain, hypotension, dizziness, night jerks, ears ringing, and many more. They are so effective for depression, anxiety, social anxiety, but who can live with the side effects. I tried but couldn't!
>
> -Monte
Posted by christophrejmc on October 27, 2006, at 4:16:54
In reply to Treatment Resistant Social Anxiety!, posted by Tom Twilight on October 25, 2006, at 12:34:58
Posted by christophrejmc on October 27, 2006, at 4:17:35
In reply to Treatment Resistant Social Anxiety!, posted by Tom Twilight on October 25, 2006, at 12:34:58
I'm in the same situation--nothing seems to work. If you're doing okay on 75mg, you should consider increasing the dose--many people have needed much higher doses to get results.
I'm also quite interested in D-cycloserine but I know that my doctor wouldn't even consider prescribing it.
The only thing that seems to help for me is Ambien, which seems to cause a complete personality change. But it also leads to a lot of embarrassing behavior.
Posted by naughtypuppy on October 27, 2006, at 5:46:14
In reply to Re: Treatment Resistant Social Anxiety! » Tom Twilight, posted by christophrejmc on October 27, 2006, at 4:17:35
> I'm in the same situation--nothing seems to work. If you're doing okay on 75mg, you should consider increasing the dose--many people have needed much higher doses to get results.
>
> I'm also quite interested in D-cycloserine but I know that my doctor wouldn't even consider prescribing it.
>
> The only thing that seems to help for me is Ambien, which seems to cause a complete personality change. But it also leads to a lot of embarrassing behavior.Speaking of embarassing behavior, Nardil gives me such bad gas that I don't even want to be in public sometimes. I smell like I just won the world egg and beer eating contest. How's that for a social anxiety situation. Anybody else have this problem. Plus it's probably the foulest tasting med ever devised.
Posted by naughtypuppy on October 27, 2006, at 5:50:20
In reply to Re: Treatment Resistant Social Anxiety! » naughtypuppy, posted by jedi on October 26, 2006, at 10:52:47
> > I really don't know how you people manage to do it. I tried Nardil at 75mg for about a month and the hypotension was so bad I was blacking out several times a day. It felt like a puppet that had it's strings randomly cut, I fell down so many times. The hypotension is starting to come back a little at 60 mg and the social phobia is starting to increase. May I'm just not cut out for Nardil but everything else is useless.
>
> Hi,
> When I first started Nardil 10+ years ago I had quite a bit of orthostatic hypotension. At the time I was mixing it with trazodone, which can also cause hypotension. I have zero hypotension now, even at high dosages. Watch your drug combinations.
> Take care,
> Jedi
>
>
>I know what you mean with the trazodone. It makes the hypotension much worse for me, plus I get really spaced out until mid afternoon. I am currently taking 1000mg Valproate as well, but I don't think that should be a problem.
Posted by naughtypuppy on October 27, 2006, at 5:54:31
In reply to Re: Treatment Resistant Social Anxiety! » naughtypuppy, posted by Crazy Horse on October 26, 2006, at 11:29:04
> > I really don't know how you people manage to do it. I tried Nardil at 75mg for about a month and the hypotension was so bad I was blacking out several times a day. It felt like a puppet that had it's strings randomly cut, I fell down so many times. The hypotension is starting to come back a little at 60 mg and the social phobia is starting to increase. May I'm just not cut out for Nardil but everything else is useless.
>
> Let's face it ALL MAOI's have mega side effects. I have never heard of or met one person who was on Nardil or Parnate (Two of the most effective MAOI's which are both power house AD's) that didn't have very troubling side effects, i.e. insomnia, fatigue, weight gain, hypotension, dizziness, night jerks, ears ringing, and many more. They are so effective for depression, anxiety, social anxiety, but who can live with the side effects. I tried but couldn't!
>
> -Monte
Usually I will put up with quite a bit when it comes to side efects, but this dosen't seem to be all that effective. Of course life circumstanses are extreamly intense at the moment and no pill will alleviate that.
Posted by tgo on November 1, 2006, at 0:43:43
In reply to Re: Treatment Resistant Social Anxiety! » Crazy Horse, posted by naughtypuppy on October 27, 2006, at 5:54:31
I tried cycloserine. Worked great the first time I took it, then nothin after that. It only lasted for 2-3 hours anyway. Don't waste your money. It doesn't work!
Posted by tgo on November 1, 2006, at 0:45:33
In reply to Treatment Resistant Social Anxiety!, posted by Tom Twilight on October 25, 2006, at 12:34:58
I would really be interested in finding out if anyone has had any luck for SA without weight gain. I'm about to give up hope of ever leading a normal life. Already put on 50 lbs with paxil, which I haven't been able to lose.
Posted by Cairo on November 1, 2006, at 13:35:46
In reply to Treatment Resistant Social Anxiety!, posted by Tom Twilight on October 25, 2006, at 12:34:58
Have you ever tried exposure therapy for your social anxiety? Cognitive behavioral therapy worked only so-so with my teen daughter who has SA, but working with a therapist who made her go out to stores, the mall, answer the phone, call people up, go to a restaurant and speak up when she didn't like something, made a big difference for her. We need to constantly reinforce, but she's improved alot. CGT gave the knowledge of what to do, but she had to go out and DO it for it to work.
I attended a SA conference last year and the keynote speaker emphasized exposure therapy. When he asked the psychologists in the room who did exposure therapy with their SA patients, only two raised their hands.
She's on Zoloft 75mg plus 6.25mg Seroquel. Zoloft works far better for her SA than Lexapro did, and Seroquel is a good adjunct for SA for her.
Good luck.
Cairo
> I've got treatment resistant Social Anxiety :(
>
> Its really frustrating because I've tried so many things, and nothing works long term.
>
> I'm currently on Nardil 75mg, the "Gold Standard"
>
> Its helping GAD, but does nothing for SA.
>
> I worry about becoming deppendent on Benzo's and they don't do much either.
>
> Only opiates seem to help, its strange odd
>
> I don't know were all the social phobics have gone on babble!
> Should I push the Nardil up to 90mg?
> Is D-cycloserine worth trying?
Posted by tgo on November 3, 2006, at 11:25:00
In reply to Re: Treatment Resistant Social Anxiety!, posted by Cairo on November 1, 2006, at 13:35:46
> Have you ever tried exposure therapy for your social anxiety? Cognitive behavioral therapy worked only so-so with my teen daughter who has SA, but working with a therapist who made her go out to stores, the mall, answer the phone, call people up, go to a restaurant and speak up when she didn't like something, made a big difference for her. We need to constantly reinforce, but she's improved alot. CGT gave the knowledge of what to do, but she had to go out and DO it for it to work.
>
> I attended a SA conference last year and the keynote speaker emphasized exposure therapy. When he asked the psychologists in the room who did exposure therapy with their SA patients, only two raised their hands.
>
> She's on Zoloft 75mg plus 6.25mg Seroquel. Zoloft works far better for her SA than Lexapro did, and Seroquel is a good adjunct for SA for her.
>Has she had any weight gain on the zoloft and seroquel?
Posted by kingcolon on November 7, 2006, at 11:49:55
In reply to Treatment Resistant Social Anxiety!, posted by Tom Twilight on October 25, 2006, at 12:34:58
I also have TR SA; Nardil worked for 6 months. I've also got TRD and am augmenting Cymbalta and Lamictal with Requip for its dopamine agonism. I've found the latter makes me more assertive. But here's a wild card--my sleep was poor and I wake with lots of anxiety and I have not responded to Seroquel or trazodone, and have a history of substance abuse many years ago, so my doc and I decided to try low dose baclofen. It's an old drug used for muscle spasms, but is mildly sedating and anxiolytic, and is now being intensely studied in alcohol, cocaine and opiate addiction prevention of relapse. It is not addictive, although you have to taper it slowly to avoid a discontinuation syndrome. It resembles phenibut and GHB in that it stimulates GABA B receptors. I've used GHB in the past and found it helped my social anxiety better than anything (phenibut makes me ill). Since starting baclofen, 20 mg for sleep, I find I am less anxious and get back to sleep better, and that the effect carries over into the day, with less general anxiety and improved social anxiety. I wonder if more research should be done on use of this agent in anxiety disorders, and SA in particular.
Anybody used baclofen?
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