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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Dima on August 7, 2009, at 1:52:10
So I'm still trying to figure out my social anxiety/depression/OCD. My SA is characterized by me not knowing what to say to hold up a conversation and not being very motivated to socialize in the first place. I think the depression might have developed as a result of the social anxiety. Or maybe the other way around.
But anyway, the only thing I've found that makes me feel great, social-wise, is adderall. Conversation topics flow and I feel pretty much no anxiety going into any social situation.
My dad has Parkinson's and so does my grandma. Seems about right since they think SA and Parkinson's might be linked. The thing is, my dad has pretty much the opposite of SA. He talks like there's no tomorrow and has no anxiety talking to anyone he doesn't know. He's on a few medications, which include levadopa. Could that be making him super social?
I bought some tyrosine and dlpa a couple days ago and I noticed some minor effects yesterday, such as appetite suppression and maybe more energy. Today, I might have experienced a little lower appetite, but nothing else. I've been taking 7 grams of the tyrosine and 1 gram of the DLPA per day on an empty stomach with B6 and 90 mg of C.
Someone told me about Nortriptyline, which is pretty effective for depression with anxiety. I'm planning on asking my family doctor about getting that prescribed, or maybe Nardil.
Any thoughts? I'm thinking about taking a levadopa pill to see what kind of effect it has on me.
Posted by morganpmiller on August 7, 2009, at 2:17:59
In reply to Am I on the right track at least?, posted by Dima on August 7, 2009, at 1:52:10
I heard some scary things about levodopa.
I may be biased but I would try Zoloft before trying Nortriptyline. May be just as effective with less side effects.
>I think the depression might have developed as a result of the social anxiety.
Depression may have always been there. Depression and anxiety go hand in hand. Often times depression will underlie the anxiety. Anxiety can also be a manifestation of anger.
I would not put all of your SA problems on brain chemistry. If you are fairly high functioning, I would keep looking into natural alternatives and maybe see a therapist. CBT and other forms of therapy like group psychodynamic therapy have been shown to help people with SA.
Posted by SLS on August 7, 2009, at 7:17:43
In reply to Re: Am I on the right track at least?, posted by morganpmiller on August 7, 2009, at 2:17:59
If Zoloft or some other SRI doesn't work, and particularly if it works only partially, you might consider adding the nortriptyline instead of making a switch.
Can you describe how you experience social anxiety?
Perhaps Nardil is the most logical choice at this point. However, sometimes social inhibition and anxiety is an integral part of the depressive disorder and not a separate disorder. In cases like this, I don't think Nardil is necessary to treat it.
I would not play with l-dopa. Most of the standard antidepressants raise dopamine in the parts of the brain that are important for mood. This is secondary to the direct actions of the drug, but is no less therapeutic.
- Scott
Posted by Dima on August 7, 2009, at 10:13:33
In reply to Re: Am I on the right track at least?, posted by SLS on August 7, 2009, at 7:17:43
> If Zoloft or some other SRI doesn't work, and particularly if it works only partially, you might consider adding the nortriptyline instead of making a switch.
>
> Can you describe how you experience social anxiety?
>
> Perhaps Nardil is the most logical choice at this point. However, sometimes social inhibition and anxiety is an integral part of the depressive disorder and not a separate disorder. In cases like this, I don't think Nardil is necessary to treat it.
>
> I would not play with l-dopa. Most of the standard antidepressants raise dopamine in the parts of the brain that are important for mood. This is secondary to the direct actions of the drug, but is no less therapeutic.
>
>
> - ScottI tried Zoloft for a month and a half with no effects other than some side effects, and brain zaps afterwards.
The social anxiety is just a fear of going into most social situations because I have nothing to say and it's hard for me to think of conversation. In one on one conversation, I'm almost never enjoying it, but rather just consider it work trying to think of what to say.
Posted by Phillipa on August 7, 2009, at 10:26:20
In reply to Re: Am I on the right track at least?, posted by Dima on August 7, 2009, at 10:13:33
I think you might benefit from therphy CBT possibly. I've always been kind of reclusive except was an extrovert at work. Off time liked being alone. For me anxiety is my number one diagnosis with Gad primary. I just force myself to try and interact with others for short periods of time. Phillipa
Posted by SLS on August 7, 2009, at 12:33:45
In reply to Re: Am I on the right track at least?, posted by Dima on August 7, 2009, at 10:13:33
> The social anxiety is just a fear of going into most social situations because I have nothing to say and it's hard for me to think of conversation. In one on one conversation, I'm almost never enjoying it, but rather just consider it work trying to think of what to say.
That's an excellent description. In my opinion, that's depression rather than an anxiety disorder. You probably have a relatively inactive mind and would rather just be alone in a safe place where you can just sit and vegetate. If you were not depressed and your mind were more active, you would have more things to say and more likely to interact with people. I will say, however, that there is now a psychological component to the fears you have developed. Even if you were to respond to a biological treatment, you will still have a mess to clean up. It is difficult to know, but you might have had psychological issues earlier in life that produced the content of your fears. Not only that, this content may have produced enough stress to trigger the depressive disorder. Whatever is the explanation, you will now have some work to do to help work past the depressive thoughts and social awkwardness.
This is, of course, all guesswork on my part. The bottom line is that I don't think you need to treat your social discomfort as if it were a separate comorbid disorder. I believe things will improve once the depression remits.
- Scott
Posted by floatingbridge on August 7, 2009, at 13:55:04
In reply to Am I on the right track at least?, posted by Dima on August 7, 2009, at 1:52:10
Dima,
I would advise against the l-dopa pill. There are other dopamine agonists you could try (I don't know them all). SA and Parkinson's are different animals. Your discomfort must be fairly strong if you are thinking of nardil. Have you been treated for SA before? I know the chicken and egg nature of depression and SA....it's quite a puzzle that I'm still working on. CBT helped some--in fact, it I think it's essential for SA, but I still need meds. Has adderall stopped working? What is your current regime?
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Posted by Phillipa on August 7, 2009, at 20:37:25
In reply to Re: Am I on the right track at least? » Dima, posted by Phillipa on August 7, 2009, at 10:26:20
I know my husband isn't depressed he's much happier being alone in the house. That's his personality hates to go out. Did you once like to go out and do things? Phillipa
Posted by Sigismund on August 8, 2009, at 15:38:16
In reply to Re: Am I on the right track at least?, posted by Dima on August 7, 2009, at 10:13:33
>The social anxiety is just a fear of going into most social situations because I have nothing to say and it's hard for me to think of conversation. In one on one conversation, I'm almost never enjoying it, but rather just consider it work trying to think of what to say.
I suppose you see other people who look as if they are enjoying the social world? It's not surprising that you should find it frightening. You didn't say you found it frightening, but I think that all these people are distinctly scary. It would, of course, be nicer if it was not felt to be so. The popular culture, the idea of normal, everyone will try to bring you to a consensus reality from which point there is no alternative but to see yourself as abnormal and in need of treatment. But saying that doesn't make it any less awful.
In "Awakenings", Oliver Sacks talks about L-dopa. I wouldn't take too much.
Posted by Sigismund on August 8, 2009, at 15:41:40
In reply to Re: Am I on the right track at least?, posted by Sigismund on August 8, 2009, at 15:38:16
Talking about Oliver Sacks....when he was 25 or so he said that his idea of a good time was to take around 100mg methamphetamine and hang out in a library all weekend.
I wonder if he was allowed to stay there all night? He said he didn't sleep for several days.
Posted by Dima on August 9, 2009, at 14:14:27
In reply to Re: Am I on the right track at least?, posted by Sigismund on August 8, 2009, at 15:41:40
Hypothyroid or adrenal fatigue, possibly?
Posted by Dima on August 10, 2009, at 17:43:47
In reply to Re: Am I on the right track at least?, posted by Dima on August 9, 2009, at 14:14:27
I went to the doctor today. She didn't like the idea of MAOI's at all. She prescribed 100mg Zoloft and 25mg Nortriptyline, which she plans on raising. She ordered a full thyroid test and a cortisol test. I'm going in to the lab tomorrow morning to do that.
Posted by Phillipa on August 10, 2009, at 20:44:56
In reply to Re: Am I on the right track at least?, posted by Dima on August 10, 2009, at 17:43:47
Dima that's great. Good luck let us know what the labs show. Phillipa
Posted by Alexanderfromdenmark on August 10, 2009, at 21:14:32
In reply to Re: Am I on the right track at least?, posted by Dima on August 9, 2009, at 14:14:27
> Hypothyroid or adrenal fatigue, possibly?
It's worth looking into. It's hard to get diagnosed and treated properly though unless your TSH is wide of out of range and conventional doctors don't recognise Adrenal fatigue.
Posted by floatingbridge on August 10, 2009, at 21:19:47
In reply to Re: Am I on the right track at least?, posted by Dima on August 10, 2009, at 17:43:47
Hi Dima,
Let us know how your labs go! And your new treatment.
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