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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by tecknohed on September 23, 2007, at 12:51:20
OK. Nardil worked wonders for my SP (social Phobia) for a good while but in the end became just too problematic for me and lost most of its efficacy anyway. Its been the ONLY med which has REALY helped my SP. Amphetamines helped but the downsides are FAR too costly (I used to abuse/self medicate with them, and suffer the consequences!), & my pdoc would never agree anyway. Caffein has often helped (depending on what meds I'm taking at the time), at least for a short while but I very quickly build tolerance (after just a few days), ending up more fatigued than socially stimulated. All this tells me that adding a dopamine-increasing med to my current regime might help.
Since being off Nardil I've continued to take 1.5mg/day clonazepam which does help somewhat but it makes me depressed, or at least adds to it. I've tried adding Buspar but had a few problems, the worst being interference with my diabetes (caused many hypoglyceamic episodes, as if acting like or enhancing insulin). I've tried buspirone (whilst on Nardil) which made me irritable & more anxious so I'm not keen on trying it again. I'm now taking mirtazapine 30mg/day (been 5 days now) for the depression which hasn't properly kicked in yet, though I am getting 'some' periods of relief & its particularly helping my usual lethergy & somnolence (banished them in fact!). But even if & when it does kick in I 'know' I'm still gonna be too socially anxious to function properly.
So I ask, what other dopaminergic meds can I try adding? How can I get that 'Nardilness' back (GABA + serotonin + dopamine + noradrenalin [I need a noradrenergic med to get out of bed in the mornings]) Is a low dose AP my only option left, and if so which ones could I try? I know I could try another MAOI but I really want to avoid that route again if at all possible (ending Nardil has been HARD - not sure I could handle another MAOI poop-out or withdrawal).
I'm in a very deep hole at the moment, not sure how to get out of it. Got no friends. Never go out. Find it hard to even 'be' with my partner (& vice-versa). Cant even enjoy the things which usually bring me some sense of pleasure or a break from it all (I'm a keen fisherman, mad on it in fact but have recently found even that boring). All I do is dwell on that one short time Nardil made me feel human again. That med has betrayed me, at least thats how it feels. Man its not fair!
(I dont wish to alarm any Nardil users - it only poops out for some)
Sorry to 'babble' on.
Posted by Phillipa on September 23, 2007, at 12:56:21
In reply to Dopaminergic suggestions for SP?, posted by tecknohed on September 23, 2007, at 12:51:20
Is it the med or just the disease? I ask myself that a lot. Phillipa
Posted by Jimmyboy on September 23, 2007, at 13:06:05
In reply to Re: Dopaminergic suggestions for SP? » tecknohed, posted by Phillipa on September 23, 2007, at 12:56:21
One way to boost dopamine without much side effects is to take a small dose 5-10 mg of selegiline . That usually does the trick, but its not going to have the same effect as Nardil b/c it messes with a bunch of other chemicals, like you said.
Good luck on your search, hope you find some relief soon
JB
Posted by tecknohed on September 23, 2007, at 13:22:36
In reply to Dopaminergic suggestions for SP?, posted by tecknohed on September 23, 2007, at 12:51:20
>....I've tried buspirone (whilst on Nardil) which made me irritable & more anxious so I'm not keen on trying it again.
Sorry, I meant to say I tried BUPROPION (whilst on Nardil). I always get those two mixed up. D'oh!
Posted by back4abit on September 23, 2007, at 13:28:25
In reply to Re: Dopaminergic suggestions for SP? *correction*, posted by tecknohed on September 23, 2007, at 13:22:36
> >....I've tried buspirone (whilst on Nardil) which made me irritable & more anxious so I'm not keen on trying it again.
>
> Sorry, I meant to say I tried BUPROPION (whilst on Nardil). I always get those two mixed up. D'oh!Before emsam,and touted much better than deprenyl caps,much better,is liquid deprenyl as the poster above suggested.
It is doses in 1 mg increments,and at these doses the formulation of the liquid is quite potent,very nice but mild stimulant anti depressant and social enhancer,best to keep a benzo handy if over stimulated.
Posted by tecknohed on September 23, 2007, at 13:32:24
In reply to Re: Dopaminergic suggestions for SP? » tecknohed, posted by Phillipa on September 23, 2007, at 12:56:21
> Is it the med or just the disease? I ask myself that a lot. Phillipa
I assume you're refering to placebo effect?
Well, at least in Nardil's case it HAD to be the med - I didn't ever expect it to work then after 3 weeks BANG! Was no placebo. Nardil was definitely doing the biz.
Posted by tecknohed on September 23, 2007, at 13:37:27
In reply to Re: Dopaminergic suggestions for SP?, posted by Jimmyboy on September 23, 2007, at 13:06:05
> One way to boost dopamine without much side effects is to take a small dose 5-10 mg of selegiline . That usually does the trick, but its not going to have the same effect as Nardil b/c it messes with a bunch of other chemicals, like you said.
>
> Good luck on your search, hope you find some relief soon
>
> JBOf course! Never though of that one. Should be fine with my other meds too, as long as I keep the dose low. I'll ask my doc what he thinks. Thanx!
Posted by mav27 on September 23, 2007, at 17:13:27
In reply to Dopaminergic suggestions for SP?, posted by tecknohed on September 23, 2007, at 12:51:20
50mg of amisulpride helps with dopamine, it's an anti-psychotic though however it didn't feel like one when i took it (felt more like ritalin or something in my opinion)
I've had some succes with dothiapen+ seroquel at night, side effects were annoying though.Effexor+melleril also worked but took a few months.
I've only been treated for SP and depression to a lesser extent.
Posted by cactus on September 26, 2007, at 15:45:32
In reply to Dopaminergic suggestions for SP?, posted by tecknohed on September 23, 2007, at 12:51:20
What about a Dopamine Agonist like ropinirole or mirapex. I had great results from requip for SP and would recommend it. It also works well in conjunction with ssri's and counteracts quite a few side effects from ssri's especially sexual side effects etc...
Posted by tecknohed on September 26, 2007, at 18:03:55
In reply to Re: Dopaminergic suggestions for SP? » tecknohed, posted by cactus on September 26, 2007, at 15:45:32
> What about a Dopamine Agonist like ropinirole or mirapex. I had great results from requip for SP and would recommend it. It also works well in conjunction with ssri's and counteracts quite a few side effects from ssri's especially sexual side effects etc...
Thanx so much! I'll bring these up with my doctor too. Not sure about mirapex though. Says here "pramipexole is a depressant": http://en.wikipedia.org/wiki/Pramipexole
(end of third paragraph under sub-heading 'Mechenism of Action')
Anyone use it? How does it make you feel?
Posted by psychobot5000 on September 29, 2007, at 13:31:55
In reply to Re: Dopaminergic suggestions for SP? » cactus, posted by tecknohed on September 26, 2007, at 18:03:55
> Not sure about mirapex though. Says here "pramipexole is a depressant": http://en.wikipedia.org/wiki/Pramipexole
> (end of third paragraph under sub-heading 'Mechenism of Action')
> Anyone use it? How does it make you feel?Not sure what they mean by the term 'depressant' here...possibly just that it makes you drowsy (something like 50% of patients in the studies seem to complain of symptoms of drowsiness while on pramipexole). However, it has been show pretty well to have antidepressant capabilities in a few studies (try a google search of 'pramipexole' and 'antidepressant' if you're curious), so I wouldn't worry too much about that line in wikipedia.
I think many people do find the side-effects daunting, though. Probably the main reason it isn't used widely as an AD, if I understand correctly.
Posted by cactus on September 29, 2007, at 15:49:15
In reply to Re: pramipex » tecknohed, posted by psychobot5000 on September 29, 2007, at 13:31:55
I found the side effects less than most ssri's except for zoloft and luvox. Ropinirole(requip/repreve) did make me drowsy sometimes so I took it at night. Make sure you tirate up VERY SLOWLY or you will get quite sick, the nausea is pretty bad with ropinirole once to get up to around 1mg and it takes a couple of days to go away. After that is all good. Just follow the instructions to the letter and don't chomp down a 2mg pill straight away or else you'll pay for it puking your gut's out. Good luck
Posted by tecknohed on September 29, 2007, at 16:32:22
In reply to Re:ropinirole (requip/repreve), posted by cactus on September 29, 2007, at 15:49:15
> I found the side effects less than most ssri's except for zoloft and luvox. Ropinirole(requip/repreve) did make me drowsy sometimes so I took it at night. Make sure you tirate up VERY SLOWLY or you will get quite sick, the nausea is pretty bad with ropinirole once to get up to around 1mg and it takes a couple of days to go away. After that is all good. Just follow the instructions to the letter and don't chomp down a 2mg pill straight away or else you'll pay for it puking your gut's out. Good luck
After reading your above post it suddenly occured to me that I may well have taken this drug before.
It was during a double-blind research study I took part in about dopamines role in social anxiety (disorder).
On 2 seperate occasions (2 weeks appart) I had to ingest a drug and then carry out certain anxiety provoking tasks. One of the drugs was a dopamine agonist, the other an antagonist. On each occasion I didn't really notice much difference between the effects of the two drugs, not much of any effect in fact (they were small doses, so I was told). But thinking back I remember that one of them made me feel extremely nauseous, I even vomited a little! After about 1-2hours the nausea had gone. What strikes me was that I wasn't particularly bothered or embarrassed by the 'commotion' (I worried the doc, who actually put me on a saline drip, believing it was a blood pressure reaction!). Normally, this sort of situation would make most social phobics rattle in thier boots! Instead I found the whole incident rather ammusing. In my books this would count as some kind of anxiolytic effect. Perhapse it was indeed ropinirole?I never was told the outcome/conclusion of the study. I must ask my pdoc about this when I see him next, after all it was 'his team' who carried out the study! I'll post what I find out.
Posted by tecknohed on September 29, 2007, at 16:38:21
In reply to Re:ropinirole (requip/repreve), posted by cactus on September 29, 2007, at 15:49:15
By the way, why were you taking ropinirole? Was it a trial med for social anxiety/phobia? Why did you stop? Was it effective at all? (I assume you have stopped taking it as you talk in past tense)
Posted by tecknohed on September 29, 2007, at 16:49:16
In reply to Re:ropinirole (requip/repreve), posted by cactus on September 29, 2007, at 15:49:15
Sorry, just realised you already answered 3 of my questions in your 1st post! (I must check these things!!!) Still, I'm curious as to why you decided to stop.
Posted by cactus on September 29, 2007, at 18:48:11
In reply to Re:ropinirole (requip/repreve) » cactus, posted by tecknohed on September 29, 2007, at 16:49:16
I basically stopped because my pdoc switched me to clonazepam for anxiety and panic because the valium wasn't working anymore(not that it isn't an excellent drug). My sleep study specialist was the one who put me one the ropinirole and I just couldn't afford it. It's not indicated on the pharmaceutical benefits scheme here in Australia for Restless Leg Syndrome so I just couldn't afford it because I didn't have parkinson's disease. It's supposed to be added to the scheme in november. Once I figured out clonazepam and ropinirole both work for RLS I just stopped taking requip due to expense. This doesn't happen very often in Australia, it's actually very rare to have to pay $180 AUD for 28 2mg pills which last for a month. I might consider going back on it when it comes onto the PBS.
I wasn't bothered by the vomiting either but I had an unexpected date arrive the night I had raised my dose. I opened the door, said hello then had to run to the toilet to puke my guts out. Thank god I live in a long skinny house, they didn't hear a thing. ROFL!!!!!!!!!!
Posted by Iansf on September 30, 2007, at 0:48:41
In reply to Re:ropinirole (requip/repreve) » tecknohed, posted by cactus on September 29, 2007, at 18:48:11
> it's actually very rare to have to pay $180 AUD for 28 2mg pills which last for a month.
I checked Costco in the US, and they sell 30 x 4mg pills for $73 US. So by splitting pills in half, a person could get two months' worth for $36.50 if he or she were taking 2mg a day. That seems doable for many people without insurance.
Posted by cactus on September 30, 2007, at 1:58:29
In reply to Re:ropinirole (requip/repreve), posted by Iansf on September 30, 2007, at 0:48:41
But does that mean they have to be diagnosed with parkinson's disease?
This is the end of the thread.
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