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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by tecknohed on September 19, 2007, at 14:49:35
Other than clonazepam (Klonopin, Ritrovil) or alprazolam (Xanax) I mean.
I've come to the conclusion that clonazepam is definitely adding to deppression, even at only 1.5mg/day.
I cant get alprazolam on NHS (UK) & although my doc is happy to write me a script for it I simply cant afford the cost.So has anyone found any other benzos effective for social phobia that dont cause as much depression as clonazepam? Please tell!
Posted by Quintal on September 19, 2007, at 15:58:32
In reply to Other benzos for social phobia?, posted by tecknohed on September 19, 2007, at 14:49:35
Lorazepam was my first benzo, and it worked very well. They all did at some dose, even humble Valium.
Q
Posted by Phillipa on September 19, 2007, at 17:08:58
In reply to Re: Other benzos for social phobia? » tecknohed, posted by Quintal on September 19, 2007, at 15:58:32
Valium my first worked well best was the xanax as it could be broken and only small pieces when needed for severe anxiety plus under the tongue and it works right away no waiting as valium takes some waiting. Klonopin depressed me too. Phillipa
Posted by valero on September 19, 2007, at 17:19:35
In reply to Other benzos for social phobia?, posted by tecknohed on September 19, 2007, at 14:49:35
Hi,
Are you really convinced that any benzo will help you long term? their intellect dulling effects and dependence inducing potential are high. I can't understand why they keep prescribing them for this kind of problem. Social phobia, (fear of socializing),take a socializing inducing substance.Yes I know the condition is essentially rooted in anxiety, but one could carefully experiment with small doses of disinhibitory A.D. Through the act of forced socializing, drug induced or otherwise, the coping-learning mechanism is induced. Benzo's harm the coping mechanism by providing a soft cushion/barrior to the threatening stimulus,( much in the same way as drink does) rather than a novelty seeking confrontational approach to the problem,which some dopaminergics could provide.
Amisulpride, Tianeptine, Modafinal Bupropion ( Zyban)spring to mind as disinhibitory in a positive way.
Posted by Sigismund on September 19, 2007, at 17:46:37
In reply to Re: Other benzos for social phobia?, posted by valero on September 19, 2007, at 17:19:35
Benzos can make you sufficiently befuddled that interpretation of social cues becomes difficult and anxiety is paradoxically increased, especially longterm.
Tianeptine is mildly prosocial for some who try it.
I found Adrafinil a bit of a strain.
Haven't tried bupropion, wondering if it is like diethylpropion, in which case......
Does low dose amisulpride have any negative effects? I seem to remember someone saying it was negative sexually.
Posted by Sigismund on September 19, 2007, at 19:16:33
In reply to Other benzos for social phobia?, posted by tecknohed on September 19, 2007, at 14:49:35
But having said that, Xanax is the best for me.
Posted by tecknohed on September 19, 2007, at 19:19:10
In reply to Re: Other benzos for social phobia?, posted by Sigismund on September 19, 2007, at 17:46:37
Thanks for the comments. I thought I'd get answers like these though. Seems I might be better off without a benzo. I have a short holiday 2nd week of October & I see my pdoc shortly after I return so maybe we'll discuss weaning me off the clonazepam, maybe with the aid of gabapentin (if he agrees).
I've tried both modafinal & bupropion (both whilst on Nardil) but both increased anxiety in the long run. Never tried Tianeptine or Amisulpride though, maybe I'll mention these to my doc. Tianeptine especially sounds interesting, at least from what I've just read so far. Though I'm not sure I'm ready for an AP (ie, amisulpride) yet.
I've just started mirtazepine 30mg/day so I'll know if its done any good by the time I see my doc next.
Just wish there were more 'indicated' drugs for SP (I mean ones that actually work). It would/might save a lot a trial & error!
Posted by med_empowered on September 19, 2007, at 22:29:46
In reply to Re: Other benzos for social phobia?, posted by tecknohed on September 19, 2007, at 19:19:10
i think the important thing is dosing and avoiding drugs that can induce depression (tranxene, klonopin) and maybe also skipping over drugs that are more likely to cause dosage escalation and nasty withdawals (xanax).
Ativan's good. Valium can be very good. Serax can be good and might have an mild antidepressant effects. Librium is way old school and kind of weak, but might be helpful.
Speaking of stimulating meds...some docs combine stimulating meds w/ benzos, I guess kind of like a modern-day "goofball"...one doc's website I saw recommended provigil or wellbutrin PLUS a long-term benzo (I think he was a clonazepam fan) to really fix the probs.Good luck.
Posted by Mishal on September 20, 2007, at 0:03:27
In reply to Re: Other benzos for social phobia?, posted by Sigismund on September 19, 2007, at 17:46:37
> Does low dose amisulpride have any negative effects? I seem to remember someone saying it was negative sexually.No if you can keep your dose low. I found 25mg a day to be mildly prosexual. May be it is because amisulpride helps with anticipatory anxiety.
Meanwhile, I am trading a mood stabilizer (Neurontin) for Xanax. Do you think Neurontin is better than Xanax for long term use? Or Am I substituting an addiction with another addiction?
Posted by med_empowered on September 20, 2007, at 0:35:44
In reply to Re: Other benzos for social phobia? » Sigismund, posted by Mishal on September 20, 2007, at 0:03:27
look, parke-davis had to pay 100s of millions of $$$ b/c they promoted it off-label. You can google it; the settlement was pretty recent, it was big news, and yet..shrinks still, apparently, haven't altered their prescribing practices to match up with, you know...*evidence*.
Its a terrible mood stabilizer. In the few trials that *weren't* funded by the manufacturers, it not only didn't out-perform placebo, it did *worse* than placebo. Worse as in more mood issues, and, I believe, more suicides.
Its not an anxiolytic, either. Apparently docs associate "mind-numbing" with "anxiolytic;" this may explain the use of Gabitril, Depakote, and atypical neuroleptics as anxiolytics. With that sort of logic, we should all be prescribed anxiolytic hammers with which to bash our own heads. Such an approach would be efficient, cheap, and non-addictive.Anyway, sorry to rant, but its ridiculous that your doc is pushing Neurontin as if its actually useful. If you have epilepsy that's only partly controlled by other meds, and that's the reason for your anxiety, then maybe Neurontin could help--its really only good as an adjuvant anti-convulsant in some forms of epilepsy. that's it, at least in terms of solid, data-supported indications.
Posted by med_empowered on September 20, 2007, at 3:35:45
In reply to neurontin is fish oil, posted by med_empowered on September 20, 2007, at 0:35:44
nm
Posted by Mishal on September 20, 2007, at 4:51:25
In reply to neurontin is fish oil, posted by med_empowered on September 20, 2007, at 0:35:44
If neurontin is not a good mood stabilizer,What do you suggest? Keppara? Lamictal?
Posted by tecknohed on September 20, 2007, at 4:54:57
In reply to neurontin is fish oil, posted by med_empowered on September 20, 2007, at 0:35:44
>Anyway, sorry to rant, but its ridiculous that your doc is pushing Neurontin as if its actually useful. If you have epilepsy that's only partly controlled by other meds, and that's the reason for your anxiety, then maybe Neurontin could help--its really only good as an adjuvant anti-convulsant in some forms of epilepsy. that's it, at least in terms of solid, data-supported indications.
But do you think using Neurontin to help taper/wean off from a benzo is possibly another valid & helpfull usage of the drug? I've read such accounts more than once on this board (though anecdotal of course), including a very recent post. Know of ANY studies done on this?
Posted by Jamal Spelling on September 20, 2007, at 5:40:26
In reply to wow. I meant 'snake oil', posted by med_empowered on September 20, 2007, at 3:35:45
Posted by Phillipa on September 20, 2007, at 18:49:21
In reply to you have options, posted by med_empowered on September 19, 2007, at 22:29:46
Hi Med. Seriously when I went off xanax I did switch onto valium from 2mg divided to l5mg of valium and never had any withdrawal and the xanax lifted my mood til for some reason it started to make me tired. Any idea why as the same is happening with the valium now just cut down from 20 to l5mg. Body chemistry change or thyroid again. I also found klonopin very depressing and felt suicidal and wasn't. One dose of the xanax .5 it went away. Phillipa ps also stopped the klonopin at that time had called the pdoc and that's what he said to do.
Posted by back4abit on September 20, 2007, at 20:53:57
In reply to neurontin is fish oil, posted by med_empowered on September 20, 2007, at 0:35:44
> look, parke-davis had to pay 100s of millions of $$$ b/c they promoted it off-label. You can google it; the settlement was pretty recent, it was big news, and yet..shrinks still, apparently, haven't altered their prescribing practices to match up with, you know...*evidence*.
> Its a terrible mood stabilizer. In the few trials that *weren't* funded by the manufacturers, it not only didn't out-perform placebo, it did *worse* than placebo. Worse as in more mood issues, and, I believe, more suicides.
> Its not an anxiolytic, either. Apparently docs associate "mind-numbing" with "anxiolytic;" this may explain the use of Gabitril, Depakote, and atypical neuroleptics as anxiolytics. With that sort of logic, we should all be prescribed anxiolytic hammers with which to bash our own heads. Such an approach would be efficient, cheap, and non-addictive.
>
> Anyway, sorry to rant, but its ridiculous that your doc is pushing Neurontin as if its actually useful. If you have epilepsy that's only partly controlled by other meds, and that's the reason for your anxiety, then maybe Neurontin could help--its really only good as an adjuvant anti-convulsant in some forms of epilepsy. that's it, at least in terms of solid, data-supported indications.
>
>Yess they had issues because they drove this med so hard.HOWEVER gabapentin is a drug that does affect levels of gaba in the brain,and gaba is a issue in many social and tons of disorders.
I use gabapentin along side my benzo,i find it to be a mild drug,combo friendly as i take it with a maoi,and little interaction.
And although it is a milder drug best not effective in monotherapy,i am personaly offended by the calling of it in terms of "snake oil".
Its pharmocology is real,and its far from snake oil.
Posted by cloudnine on September 21, 2007, at 8:06:18
In reply to Re: Other benzos for social phobia?, posted by tecknohed on September 19, 2007, at 19:19:10
Posted by rina on September 21, 2007, at 19:20:44
In reply to neurontin is fish oil, posted by med_empowered on September 20, 2007, at 0:35:44
The thing I don't like about this situation is the "jump on the ban wagon" theory. Now that the big man in charge has been caught with his pants down regarding the promoting of this drug, everyone, even those that is has/is working for wants to bash it. Well I say shame on you!
Neurontin, marketed by the international pharmaceutical giant, Pfizer, has been one of the most notorious examples of illegal and fraudulent marketing in the pharmaceutical industry. Yes, this is true, we know that but so are others that havn't come out yet and bet your bottom dollar, they will.
Neurontin was approved by the FDA (Federal Drug Administration) for epileptic seizures, to be used in addition to other drugs. Pfizer’s Warner-Lambert division aggressively promoted it for the treatment of many other conditions, including:
Bipolar disorder
Pain syndromes, peripheral neuropathy, and diabetic neuropathy
Treatment of epilepsy alone (as monotherapy)
Reflex sympathetic dystrophy (RSD)
Attention deficit disorder (ADD)
Restless leg syndrome (RLS)
Trigeminal neuralgia
Post-hepatic neuralgia (PHN)
Essential tremor periodic limb movement
Migraine
Drug and alcohol withdrawal seizures
After federal prosecution, Warner-Lambert agreed in 2004 to pay $430 million for its illegal and fraudulent promotions of Neurontin. This was only a miniscule portion of the profits the company collected from its illegal promotion of its blockbuster drug.
Warner-Lambert then faced several civil lawsuits filed on behalf of people who suffered adverse side effects to Neurontin but to simply say all of a sudden it's a snake oil? C'mon we'll let's think about that for a quick moment. Given Dr. Richard Kunin's 1989 analysis it appears that the Chinese snake oil made from Chinese water snakes is very high in EPA.
The substance was known to be a pain reliever, and the Chinese snake oil products contain up to 4% of it. So,I guess from a purely pharmacochemical perspective, it is likely that the genuine Chinese snake oil is not fraudulent, at least for its intended purpose after all so for all those neurontin takers, if it ain't broke, don't fix it. Just one babblers opinion.
Posted by rina on September 22, 2007, at 13:27:58
In reply to Other benzos for social phobia?, posted by tecknohed on September 19, 2007, at 14:49:35
Beta-blockers, such as propanolol, are often used to treat heart conditions but have also been found to be helpful in certain anxiety disorders, particularly in social phobia. That might be one to consider.
Posted by cactus on September 23, 2007, at 2:04:04
In reply to Re: Other benzos for social phobia? » tecknohed, posted by rina on September 22, 2007, at 13:27:58
valium
Posted by tecknohed on September 23, 2007, at 10:10:32
In reply to Re: Other benzos for social phobia? » tecknohed, posted by rina on September 22, 2007, at 13:27:58
> Beta-blockers, such as propanolol, are often used to treat heart conditions but have also been found to be helpful in certain anxiety disorders, particularly in social phobia. That might be one to consider.
Tried propanolol but found it useless. Normally isn't very effective for 'Generalized' social phobia. Better, apparently, for more specific situations. But thanks anyway!
Posted by Existentialist on September 24, 2007, at 0:58:39
In reply to Re: Other benzos for social phobia? » rina, posted by tecknohed on September 23, 2007, at 10:10:32
I find kratom tea to work better than a benzo for having to go out in 'social reality'. Honestly I find benzos leave me feeling vunverable because my tight *ssed defensive mechanism is brought down a few notches. Kratom has this numbing aspect that saves me altogether from feeling like a trapped-in-my-head introvert.
Posted by tecknohed on September 24, 2007, at 5:06:54
In reply to Re: Other benzos for social phobia?, posted by Existentialist on September 24, 2007, at 0:58:39
> I find kratom tea to work better than a benzo for having to go out in 'social reality'. Honestly I find benzos leave me feeling vunverable because my tight *ssed defensive mechanism is brought down a few notches. Kratom has this numbing aspect that saves me altogether from feeling like a trapped-in-my-head introvert.
Wow! From what I've read from google searches so far it sounds almost too good to be true!
One question though, if used daily do you build tolerance to it?
This is the end of the thread.
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