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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by becksFLA on March 6, 2009, at 9:47:47
For a long time I have been treated for severe social anxiety with benzos. After trying them all, Klonopin seems to work the best. However, still only puts me at about 70 percent. (If that!) I was doing some reading, and the more I think about it, it's not so much that I'm incredibly anxious, no panic attacks, etc...but I simply APPEAR anxious because the muscles in my face honestly feel tight and I am unable to appear relaxed in social situations. That's why I would consider asking my doc about this...however I'd rather not get into it with him if it's something that's never been done. I'm just not sure. I'd take a muscle relaxer with no benzo and I think it would do the trick, based on how I currently feel.
Thanks.
Posted by myco on March 6, 2009, at 10:05:59
In reply to Treat Social Anxiety w/ Muscle Relaxers instead?, posted by becksFLA on March 6, 2009, at 9:47:47
Hey,
Social anxiety is alot more than just GABA receptors which is why klon will only help to a certain extent. The muscle relaxer idea could be a good option, I would probably combine it though with the benzo. I've found Orphenadrine (Norflex as we call it in Canada) is a pretty good muscle relaxant but you dont want to take it everyday as it would become uncomfy after prolonged use. Muscle tension in the face is interesting...have you considered, I know it sounds silly, facial massage in combo with klon? or just massage in general with the benzo? Tolerence is an issue with muscle relaxants as well as benzo. You may be better taking an AD that is good for anxiety...for instance nardil (a maoi) that has the "function" of a benzo "built in", so to speak...it hits GABA receptors nicely making the med a good choice for many with anxiety...myself included. You could minimize or quit klon if you took nardil.
> For a long time I have been treated for severe social anxiety with benzos. After trying them all, Klonopin seems to work the best. However, still only puts me at about 70 percent. (If that!) I was doing some reading, and the more I think about it, it's not so much that I'm incredibly anxious, no panic attacks, etc...but I simply APPEAR anxious because the muscles in my face honestly feel tight and I am unable to appear relaxed in social situations. That's why I would consider asking my doc about this...however I'd rather not get into it with him if it's something that's never been done. I'm just not sure. I'd take a muscle relaxer with no benzo and I think it would do the trick, based on how I currently feel.
>
> Thanks.
Posted by becksFLA on March 6, 2009, at 10:28:43
In reply to Re: Treat Social Anxiety w/ Muscle Relaxers instead? » becksFLA, posted by myco on March 6, 2009, at 10:05:59
I've just never wanted to go as "far" as an MAOI, I've heard so many stories about those drugs...I'd like to consider this first. And AD's do nothing, I've been on every single one of those also.....
Posted by Phillipa on March 6, 2009, at 11:09:00
In reply to Re: Treat Social Anxiety w/ Muscle Relaxers instead?, posted by becksFLA on March 6, 2009, at 10:28:43
Becks I constantely purse my lips tightly and pick cuticles which I feel is anxiety. I'd once asked about a muscle relaxer and that was after surgery and all that was suggested was valium which already on. Did you have one in mind? Sounds like a good idea. Phillipa
Posted by myco on March 6, 2009, at 11:13:28
In reply to Re: Treat Social Anxiety w/ Muscle Relaxers instead?, posted by becksFLA on March 6, 2009, at 10:28:43
I think I had something similar to what you describe here about the face...how does this compare:
in public situations I would always be insecure about smiling and showing much facial emotion that the muscles in my face would "fix" themselves to the point of almost twitching or looking odd to people. Some good natured people I know would try to make me smile by playing on this...thinking i'm holding back but it's really an insecurity or adaptation I had to reduce the anxiety of this insecurity of smiling in public. This was more pronounced around those I didnt know during times when my brain and body would feel heightened anxiety. You can deal with some of this through behaviour therapy because alot of it is a learned pattern but there is a biological aspect to it that links back to anxiety...when your body is tensing up so much to cause you pain and distress, like mine was, behaviour changes can only help so far...klon was good for this but the maoi gives a nice sustained calm of this tension that really makes adaptation to public surroundings much more easy. Norflex did this for me aswell but different...the relief of the physical pain it provided felt like a load of my shoulders, so to speak, producing more of a wellness feeling to it that allowed me to relax a bit better but was in no way a long term solution. A great addon though for other treatment options for sure but alone?...youre mileage will vary.myco
> I've just never wanted to go as "far" as an MAOI, I've heard so many stories about those drugs...I'd like to consider this first. And AD's do nothing, I've been on every single one of those also.....
Posted by becksFLA on March 6, 2009, at 11:19:11
In reply to Re: Treat Social Anxiety w/ Muscle Relaxers instead? » becksFLA, posted by myco on March 6, 2009, at 11:13:28
Interesting stuff...is Norflex considered a Muscle Relaxer? I looked it up, it seems less potent. And yes, that sounds like me. Even if deep down I "know" I should not be anxious and am perfectly in a calm situation, I still feel the forced smiling and am constantly worried about how to make the smile look as natural as possible, resulting in a vicious cycle.
Posted by myco on March 6, 2009, at 11:32:25
In reply to Re: Treat Social Anxiety w/ Muscle Relaxers instead?, posted by becksFLA on March 6, 2009, at 11:19:11
Hey,
Depends how you define potency...you see "real" muscle relaxer are benzo-types like valium...that's certainly one option you could consider. Valium or restoril will give you a nice muscle relaxant feel but being benzo...you know the issues with prolonged use. There are tons of muscle relaxant out there though, most through rx unfortunately. But if you have a good open minded dr then thats ok. I used alot of methylcarbomol (i.e. robaxacet and the like) in the past and found it a good muscle relaxant that was dose dopendent but suffered, again, from tolerance over time. But a good blast of 3-4 extra strength tabs couple times a day every 2 or 3 days was brilliant for relieving enough pain to make me "at ease", which would bring out some limited AD effect for sure. People under so much pain for ages finally get a lil relief then wow they smile a lil and ease up in mood to some extent. The reason I like Norflex (one of my occassional favs even now) is the strength and duration. It feels diff than robaxacet...it will make your whole body, every muscle, go "jelly like" lol kind of in enough of a dose. And in Canada it's over the counter so easy to get. Lasts a good 5-7 or so hours (less than the package says - studies back this up actually) but you can also get a slow release form of it that, to me, feels more like 10-15h. Watch tolerence again though...this particular one will make you feel sh*tty if you use it more than about 4 or 5 days in a row...cycle it with robax or something else. Of course if you can get rx relaxant then you may be better off...I do alot of OTC's due to ease of access and norflex is the best OTC relaxant (dose wise comparison) in Canada...it may be rx in the USA though. Try a few though, it will only add positives if used correctly...but do cycle so you get more out of them. Prob don't wanna ditch the klon or at least not yet.
myco
atypical depression, gad, sad
75mg nardil
> Interesting stuff...is Norflex considered a Muscle Relaxer? I looked it up, it seems less potent. And yes, that sounds like me. Even if deep down I "know" I should not be anxious and am perfectly in a calm situation, I still feel the forced smiling and am constantly worried about how to make the smile look as natural as possible, resulting in a vicious cycle.
Posted by Meltingpot on March 6, 2009, at 13:15:57
In reply to Treat Social Anxiety w/ Muscle Relaxers instead?, posted by becksFLA on March 6, 2009, at 9:47:47
Hi Becks,
I get loads of facial tension too (especially in the jaw) and I've often wondered if muscle relaxants would help. I haven't tried one but it has ocurred to me.
Denise
Posted by HyperFocus on March 8, 2009, at 11:08:56
In reply to Treat Social Anxiety w/ Muscle Relaxers instead?, posted by becksFLA on March 6, 2009, at 9:47:47
In addition to meds you might benefit from CBT. I have SA as well and this hyper-awareness of facial expressions - smiling and blushing and so on - is a secondary symptom of anxiety. We think that people are scrutinizing our facial expressions which causes us to become more nervous and so develops the cycle. In the tape CBT series I listen to (http://www.social-anxiety-network.com/audioseries.html,) I learn to
enforce the reality that people are not focusing on us exclusively and our facial expressions are under everybody else's scrutiny. It's not something that we don't already know and having knowledge of it does it doesn't really change your subconscious thoughts and feelings. The goal is to consciously embed this rational idea in the brain until it replaces the subconscious anxiety and gives a more realistic appraisal of the situation. Ultimately you want to get to a state-of-mind where you're not really concerned with what your face is doing. This isn't easy and usually requires meds in conjunction.
Posted by myco on March 8, 2009, at 11:17:22
In reply to Re: Treat Social Anxiety w/ Muscle Relaxers instead?, posted by HyperFocus on March 8, 2009, at 11:08:56
Hyperfocus,
How is the CBT working out for the facial expression issue? I have/had that bad...nardil kicks alot of its butt though...but not totally. It seemed my face would just revert to this pose naturally (the angry man look when i'm not overly angry or anxious inside) but was extreme at times of public encounters. CBT seems like an excellent addon to nardil..one i'm pretty much ready to begin.
> In addition to meds you might benefit from CBT. I have SA as well and this hyper-awareness of facial expressions - smiling and blushing and so on - is a secondary symptom of anxiety. We think that people are scrutinizing our facial expressions which causes us to become more nervous and so develops the cycle. In the tape CBT series I listen to (http://www.social-anxiety-network.com/audioseries.html,) I learn to
> enforce the reality that people are not focusing on us exclusively and our facial expressions are under everybody else's scrutiny. It's not something that we don't already know and having knowledge of it does it doesn't really change your subconscious thoughts and feelings. The goal is to consciously embed this rational idea in the brain until it replaces the subconscious anxiety and gives a more realistic appraisal of the situation. Ultimately you want to get to a state-of-mind where you're not really concerned with what your face is doing. This isn't easy and usually requires meds in conjunction.
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