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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Englishman006! on April 17, 2018, at 5:57:38
Hi everyone, I am struggling once again with social anxiety. It was under control for 13 years until I had a stroke. This has left my right arm paralysed and the muscles at the back of my right leg aren't strong. I also couldn't talk but my speech has come back. At the time the Drs took me off all my meds for 7 wks except for prozac. Now I've gone back on my old cocktail and it's not working. I was on: prozac, lamictal, dexamphetamine, memantine, 50mg amisulpride. Now my ADD and anxiety are under control but my social anxiety is back. I had 3 weeks where I recovered by adding dextromethorphan (two caps full) before i relapsed, then i doubled the lamictal to 400mg and had a further 5 weeks and now i've relapsed again. Any ideas?
Posted by SLS on April 17, 2018, at 8:02:56
In reply to Social anxiety relapse brought on by stroke!, posted by Englishman006! on April 17, 2018, at 5:57:38
> Hi everyone, I am struggling once again with social anxiety. It was under control for 13 years until I had a stroke. This has left my right arm paralysed and the muscles at the back of my right leg aren't strong. I also couldn't talk but my speech has come back. At the time the Drs took me off all my meds for 7 wks except for prozac. Now I've gone back on my old cocktail and it's not working. I was on: prozac, lamictal, dexamphetamine, memantine, 50mg amisulpride. Now my ADD and anxiety are under control but my social anxiety is back. I had 3 weeks where I recovered by adding dextromethorphan (two caps full) before i relapsed, then i doubled the lamictal to 400mg and had a further 5 weeks and now i've relapsed again. Any ideas?
It looks like you might profit from a reduction in glutamate / NMDA as indicated by the improvements produced by Lamictal and dextromethorphan.
Perhaps you would profit from taking guanfacine and/or memantine. Guanfacine is currently being looked at for Social Anxiety Disorder. Memantine has been described as reducing social anxiety anecdotally, and is now being studied also.
Would psychotherapy or CBT be of any help?
- Scott
Posted by bleauberry on April 17, 2018, at 8:39:35
In reply to Social anxiety relapse brought on by stroke!, posted by Englishman006! on April 17, 2018, at 5:57:38
I would just say that the stroke by itself is an indication that other lifestyle changes are in order. Beyond meds. Beyond treatment. Specific diet changes can prevent strokes and improve the course post-stroke.
'Managing disease' is not the same thing as 'restoring wellness'.
I have no idea of your lifestyle. But it may be worth considering getting back to basics, if not already there, and doing everything possible to restore the fullest health potential you possibly can. Meds alone cannot do that.
By basics I am referring to a wide spectrum of lifestyle tactics that includes gluten-free, non-genetically-modified, low sugar, low carbs, high protein, high fats, colorful meals, fish oil, professional multivitamin with words in it like 'methyl' and 'picolinate' and 'p5p', walking or exercise. Etc. etc.
For managing the social anxiety I think maybe it makes sense to go straight toward things that calm the nervous system directly - such as the benzodiazepines. I realize it is maybe not politically correct to be taking stimulants and benzos at the same time. Nobody ever got better being politically correct.
I would also suggest taking a look at Zyprexa since it has such a wonderful synergy with Prozac. I'm not a fan of lamictal. Amisulpride at 25mg might be better for you than 50mg. If not, then maybe go the other direction to 100mg.
The stroke changed the game. It is not the same game-board as pre-stroke. Things changed. Things got damaged. It's a different game now. I don't think it is realistic to expect the same meds from the old game to work in the new game.
It's tough. I hope you get some relief!
Posted by Phillipa on April 17, 2018, at 9:19:52
In reply to Social anxiety relapse brought on by stroke!, posted by Englishman006! on April 17, 2018, at 5:57:38
I'm so sorry about the stroke and residual damage. How long ago was it? I'm sure you are being seen by a cardiologist and have different medications from this doctor. How frightening. Are you in rehab? Also a support group for other stroke patients. Don't know if you are overweight or age . Work with your doctors . Phillipa
Posted by Englishman006! on April 17, 2018, at 22:23:04
In reply to Re: Social anxiety relapse brought on by stroke!, posted by SLS on April 17, 2018, at 8:02:56
I already take 20mg of memantine a day, do you think raising the dose to 30mg might help?
Posted by Englishman006! on April 19, 2018, at 4:22:10
In reply to Re: Social anxiety relapse brought on by stroke! » Englishman006!, posted by Phillipa on April 17, 2018, at 9:19:52
It was 2.5 years ago! I do take medication for it and I have joined a walking group. Thank you for your concern.
Posted by Englishman006! on April 19, 2018, at 4:27:32
In reply to Re: Social anxiety relapse brought on by stroke!, posted by bleauberry on April 17, 2018, at 8:39:35
Thank you Bleauberry for your words of wisdom which I have taken onboard.
Posted by Englishman006! on April 19, 2018, at 4:32:59
In reply to Re: Social anxiety relapse brought on by stroke!, posted by Englishman006! on April 19, 2018, at 4:27:32
Anything for background anxiety?
Posted by SLS on April 19, 2018, at 9:55:52
In reply to Re: Social anxiety relapse brought on by stroke! » SLS, posted by Englishman006! on April 17, 2018, at 22:23:04
> I already take 20mg of memantine a day, do you think raising the dose to 30mg might help?
I once took memantine (Namenda) 20 mg/day for a few weeks. I regret not going higher. If you find yourself feeling drunk or somehow uncomfortable at a higher dosageAcetly-l-carnitine May Be Effective in Treatment-Resistant Depression, you can always return to 20 mg/day. Just know that the initial cognitive effects may pass quickly.
Some researchers believe that paroxetine (Paxil) is the best SSRI for anxiety disorders. It would be interesting to add buspirone (Buspar) to an antidepressant to treat residual depression or anxiety,
What are your thoughts?
- Scott
Posted by bleauberry on April 19, 2018, at 13:14:25
In reply to Re: Social anxiety relapse brought on by stroke!, posted by Englishman006! on April 19, 2018, at 4:27:32
It's a really tough fight. We gotta help each other. Too much unnecessary suffering in the world.
> Thank you Bleauberry for your words of wisdom which I have taken onboard.
Posted by Englishman006! on April 19, 2018, at 20:42:45
In reply to Re: Social anxiety relapse brought on by stroke!, posted by SLS on April 19, 2018, at 9:55:52
> > I already take 20mg of memantine a day, do you think raising the dose to 30mg might help?
>
> I once took memantine (Namenda) 20 mg/day for a few weeks. I regret not going higher. If you find yourself feeling drunk or somehow uncomfortable at a higher dosageAcetly-l-carnitine May Be Effective in Treatment-Resistant Depression, you can always return to 20 mg/day. Just know that the initial cognitive effects may pass quickly.
>
> Some researchers believe that paroxetine (Paxil) is the best SSRI for anxiety disorders. It would be interesting to add buspirone (Buspar) to an antidepressant to treat residual depression or anxiety,
>
> What are your thoughts?
>
>
> - ScottI might try Buspirone, thanks for tips.
Posted by SLS on April 19, 2018, at 22:12:17
In reply to Re: Social anxiety relapse brought on by stroke!, posted by Englishman006! on April 19, 2018, at 20:42:45
Oops. Sorry for the inadvertent paste from the clipboard.
> > > I already take 20mg of memantine a day, do you think raising the dose to 30mg might help?
Corrected:
> > I once took memantine (Namenda) 20 mg/day for a few weeks. I regret not going higher. If you find yourself feeling drunk or somehow uncomfortable at a higher dosage, you can always return to 20 mg/day. Just know that the initial cognitive effects may pass quickly.
> > Some researchers believe that paroxetine (Paxil) is the best SSRI for anxiety disorders. It would be interesting to add buspirone (Buspar) to an antidepressant to treat residual depression or anxiety,
> >
> > What are your thoughts?> I might try Buspirone, thanks for tips.
- Scott
Posted by Hugh on April 21, 2018, at 13:22:10
In reply to Social anxiety relapse brought on by stroke!, posted by Englishman006! on April 17, 2018, at 5:57:38
> This has left my right arm paralysed and the muscles at the back of my right leg aren't strong.
Are you still doing physical therapy? What's your prognosis?
This is the end of the thread.
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