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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Beckett on May 18, 2014, at 16:12:24
I deal with bipolar II and social anxiety, adhd inattentive.. The depression is worsening, and social anxiety has been bad. (It is currently untreated as is the adhd.) Anyways, my kid needs me.
Is there any treatment that would help both? I have used SSRI's and SNRI's, and if I feel less depressed, the SA is easier to work with, but it is still difficult. The thought of revisiting that type of AD treatment is discouraging. Another issue is I feel so worn out, and dealing with SA seems more than I can do. CBT has helped (at least it got me out), and I have a referral.
We all have adhd here, and the house is jumbled. When my kid isn't here, I lie down. I feel very overwhelmed.
I had some benefit from Emsam once, but don't recall how much relief from SA it provided. Trying it again would require a change of pain medication. I have peripheral neuropathy and really need it. I am afraid of suboxone which has been suggested to me. Anyone use low dose suboxone for pain?
There's a number of questions. Apologies for the same story, on and on. Thanks for reading this.
Posted by Phillipa on May 18, 2014, at 17:41:15
In reply to Treating social anxiety and depression, posted by Beckett on May 18, 2014, at 16:12:24
Did you post how much relief for SA you experienced on Ensam? Maybe the archieves? Phillipa
Posted by Phillipa on May 18, 2014, at 17:45:23
In reply to Re: Treating social anxiety and depression » Beckett, posted by Phillipa on May 18, 2014, at 17:41:15
Posted by Beckett on July 15, 2013, at 20:47:07
In reply to Re: Day 5 (6mgs) » Beckett, posted by damnthislife on July 15, 2013, at 14:10:04
Yes, though 6mg is a bit more stimulating. I went to 12 once and constantly felt faint. Maybe I did I not give it enough time. I went back to 9 and stayed there. I did not realize how much it was doing (besides making me cycle) until I went off to start tramadol for neuropathy.
Anyways, I wish you the best. Some people say Emsam is a weak AD. I found it better than any ssri/snri.
Posted by linkadge on May 18, 2014, at 19:09:09
In reply to Treating social anxiety and depression, posted by Beckett on May 18, 2014, at 16:12:24
Have you ever tried nortriptyline? It is good for pain / neuropathy and fatiuge as well as ADD / concentration.
It is a great antidepressant. It may (or may not) be great for social phobia, however.
Linkadge
Posted by Beckett on May 18, 2014, at 19:11:50
In reply to Re: Treating social anxiety and depression, posted by Phillipa on May 18, 2014, at 17:45:23
>Anyways, I wish you the best. Some people say Emsam is a weak AD. I found it better than any ssri/snri.
I forget. Did you try it as well?
Thanks for digging in the archives for me :) I completely forgot about this site's feature.
Well, it worked for depression then. I think it's worth trying, though I need to change my pain meds. You recall how med-phobic I am.
Posted by Beckett on May 18, 2014, at 19:17:21
In reply to Re: Treating social anxiety and depression, posted by linkadge on May 18, 2014, at 19:09:09
I have not tried nortriptyline. I forgot about this as a possibility. I have tried doxepin for sleep and the sides were too tough. But without trying I won't know. Thank you! The idea that one has exhausted possibility is not a good one.
Posted by Phillipa on May 18, 2014, at 20:58:33
In reply to Re: Treating social anxiety and depression » Phillipa, posted by Beckett on May 18, 2014, at 19:11:50
I also am med phobic and refuse to change a thing cause of that. I had wanted to try Emsam but the doc had said too stimulating for me. Since anxiety is the biggest problem she was probably right. Such a long time ago it seems. P
Posted by LouisianaSportsman on May 18, 2014, at 22:42:25
In reply to Treating social anxiety and depression, posted by Beckett on May 18, 2014, at 16:12:24
I have no idea what you've taken or what ever put I had fun putting together some ATOMIC BOMB combos for SA.
Social Anxiety Combo A
#30 Pexexa (paroxetine mesylate) 20mg.
#30 Viibyrd (villazodone) 40mg.
#30 Nuvigil (armodafinil) 150mg.
#30 Daytrana (methylphenidate) 15mg. (1.6mg./hr)
#120 Xanax XR (alprazolam) 0.5mg. [2mg.]
#90 Gabitril (tiagabine) 4mg. [12mg.]
#90 Buspar (buspirone) 15mg. [45mg.]
=
Social Anxiety Combo B with Nardil:
#120 Nardil (phenelzine) 15mg. [60mg.]
#30 Pamelor (nortriptyline) 75mg.
#30 Provigil (modafinil) 200mg.
#120 Dexedrine (d-amphetamine) 7.5mg. [30mg.]
#120 Klonopin (clonazepam) 0.5mg. [2mg.]
#120 Lyrica (pregabalin) 75mg. [300mg.]
#90 Neurontin (gabapentin) 600mg. [1,800mg.]=
Typical SA Combo that could work:
Viibyrd 40 mg
Luvox 50 mg
Valium 10 mg BID
Lyrica 75 mg QID
Nuvigil 50mg. TID
Kapvay 0.2 mg BID
Atenolol 50mg. BID----------------------
See if you can mix elements of all there that you like.
Posted by Beckett on May 19, 2014, at 2:29:09
In reply to Re: Treating social anxiety and depression, posted by LouisianaSportsman on May 18, 2014, at 22:42:25
Hi Louisiana,
Thanks for all the suggestions, and I'm glad you had some fun. May I ask if you deal with social anxiety, too? I remember your mention of BP NOS.
I plan to discuss nortriptyline with the doc this week. Lyrica is already on board. It helps with GAD type anxiety and raises the threshold against panic, but that is about it. I'll be starting CBT soon.
Posted by linkadge on May 20, 2014, at 15:06:31
In reply to Re: Treating social anxiety and depression » linkadge, posted by Beckett on May 18, 2014, at 19:17:21
Nortriptyline is definitely more tolerable than doxepin. It is much weaker of an antihistamine and less anticholinergic effects.
Linkadge
Posted by phidippus on May 21, 2014, at 15:42:12
In reply to Treating social anxiety and depression, posted by Beckett on May 18, 2014, at 16:12:24
Have you tried Mirtazapine or TCAs? They'd be a change from the SSRIs and SNRIs and may help with your SA more.
Topomax has some data suggesting it is helpful in treating social anxiety. But honestly therapy is going to be your best bet in treating your SA-find a therapist who specializes in anxiety disorders.
For peripheral neuropathy, Keppra is a good option.
Eric
Posted by Beckett on May 21, 2014, at 18:58:37
In reply to Re: Treating social anxiety and depression » Beckett, posted by phidippus on May 21, 2014, at 15:42:12
Hi Eric,
All the meds you've suggested do not do much at all for SA. I think I experience it pretty strongly. I've become agoraphobic, and between that and panic, things kinda s*ck, but at least I enjoy being home :)
I am set to do CBT, and hopefully it will help. I've done it extensively before and still had abdominal pain when in many social situations.
Today the doc shot down nortriptyline for now instead suggesting Brintellix. Hard for me to be enthusiastic about any treatment. I took a pass for now.
Thank you for the Keppra suggestion. I'll keep that in mind.
Posted by Beckett on May 21, 2014, at 19:03:05
In reply to Re: Treating social anxiety and depression » Beckett, posted by phidippus on May 21, 2014, at 15:42:12
Posted by phidippus on May 22, 2014, at 13:45:00
In reply to Re: Treating social anxiety and depression » phidippus, posted by Beckett on May 21, 2014, at 18:58:37
Why did you pass on Brintellix?
Eric
Posted by Beckett on May 23, 2014, at 14:47:54
In reply to Re: Treating social anxiety and depression » Beckett, posted by phidippus on May 22, 2014, at 13:45:00
Hi Eric,
Thanks for asking. I passed for another month. I hate the way AD's feel, and I have been on quite a few. In the past I used lexapro with CBT. I might try CBT without an AD, but think it'll go much better with one.
The doc said Brintellix has novel ways of working. I might try it, though I dither. I guess I'm med phobic. He offered 5 Xanax per month for panic which I declined as well. But I have to do something.
Posted by phidippus on May 23, 2014, at 17:00:17
In reply to Re: Treating social anxiety and depression » phidippus, posted by Beckett on May 23, 2014, at 14:47:54
I think you should try a tca, like clomipramine. Kills anxiety and and feels different than an ssri.
Eric
Posted by Christ_empowered on May 24, 2014, at 21:51:14
In reply to Re: Treating social anxiety and depression » Beckett, posted by phidippus on May 23, 2014, at 17:00:17
yes, tca...I second that e-motion.
Tofranil/Tofranil-PM might be good. Its the first one, actually. Less weight gain than Elavil. Depression, attention/cognitive issues, can be taken in one dose at night. I don't know why they made a PM (pamoate--capsule, instead of a couple tablets) form. I like it better than Cymbalta, which turned me into a zombie. Tofranil...I could still feel things.
It enhances amphetamines somehow, so watch that if you're on an upper. I was on it with Adderall and the combo was OK, I guess, but if you're already on a moderate-to-high dose amphetamine, it could get rough.
Helps my social phobia, personally.
Posted by Zyprexa on June 3, 2014, at 1:49:39
In reply to Treating social anxiety and depression, posted by Beckett on May 18, 2014, at 16:12:24
Have you tried Paxil? I hear its the only SSRI for SA. My father took it with great results. Its for depression too.
Posted by former poster on June 10, 2014, at 4:05:54
In reply to Treating social anxiety and depression, posted by Beckett on May 18, 2014, at 16:12:24
I took Cymbalta for S.A. after many years on Nardil. In my opinion it was just as effective as MAOI when combined with Vyvanse. I also tried combining it with Bupropion with some improvement but some over-stimulation. Sexual side effects along with tinnitus drove me away from Cymbalta after about 3 years.
This is the end of the thread.
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