![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 28. This is the beginning of the thread.
Posted by NYCguy on December 22, 2006, at 15:02:54
Hi Everyone!
I’ve been lurking here a lot and I’d like to post more but my anxiety is so bad that even posting can be troublesome. My life is pretty much a shambles. Even though I take .5mg of Klonopin T.I.D. I still can barely make it out of my home as I’m so anxious around people. It is very uncomfortable and disabling. I’ve taken almost everything there is except the MAOIs. I did take Emsam for two weeks at 6mg along with Klonopin this summer. It was the closest I’ve felt to feeling “real” but while it made feel much better sometimes, other times it had me feeling more depressed. So now I think that I should either try that again (Emsam) and stick with it for a couple months at least or try something like Nardil and stick with that for a while.
The problem with Nardil is that I’m built like a Football (North American) Linebacker at 6’ 5” and 295 lbs and I’ve read that one needs to take 1mg per kg of body weight for Nardil to work… so would that mean I would have to take 135mg to see effectiveness?!?!? Is that mg/Kg thing accurate for everyone? I’ve wanted to try Nardil for a while now but I’m so scared that I’d wake up after a week and weigh 500 pounds and that it wouldn’t work anyway.
I’d love to get input from anyone on this situation. My primary problems are social anxiety and atypical depression. The big issue is the anxiety, that’s what is killing me.
Also, Merry Christmas to all Babblers out there!
Posted by jimmygold70 on December 22, 2006, at 16:59:59
In reply to Social Anxiety in the EXTREME!!! Advice Request., posted by NYCguy on December 22, 2006, at 15:02:54
Hi NYCGuy!
I had a similar story myself. It's really distressing. But don't lose hope! There is remedy!
First, I don't have much experience with Emsem and this doesn't seem a very succesful or interesting drug.
However, trying higher doses of Klonopin should do. I mean 3-4 MG a day, some take even higher doses. For me, 1.5 MG a day does very little.
Also, take some propanolol and see if it helps - it sometimes does (low doses like 10 MG 3 times a day)
Plus, add an AD for the long term. I suggest this order:
1. Paxil up to 60 MG, and 3 months (!) on that dose
2. If it fails - Effexor XR up to 225 MG, and 3 months (!) on that dose. If you tolerate higher doses with no side effects you can go much higer. Get a good PDoc though.
3. If it fails - Clomipramine, usual doses
4. If all fails, NardilIf you follow my advice, you'll probably end up with some good dose of Klonopin + option 1 or 2. And get a GOOD Pdoc.
Keep me posted.
Cheers!
J
Posted by med_empowered on December 22, 2006, at 17:09:28
In reply to Re: Social Anxiety in the EXTREME!!! Advice Reque » NYCguy, posted by jimmygold70 on December 22, 2006, at 16:59:59
I say...up the Klonopin, get into some sort of CBT therapy or similar program. EMSAM might help, but benzos have a better track record (and they're cheaper...)
social phobia may be due in part of dopamine dysfunction, so adding in Provigil or an MAOI or, if your doc will import meds and supervise you, a reversible MAOI like Manerix, might be the thing to do. Apparently, some people with SP who are stable find adding in low doses of wellbutrin or ritalin can be helpful.
Good luck.
Posted by blueberry1 on December 22, 2006, at 17:46:18
In reply to Social Anxiety in the EXTREME!!! Advice Request., posted by NYCguy on December 22, 2006, at 15:02:54
You said you've taken just about everything there is. Ok. Did you get a little bit of help from any of them? If so, maybe choose that one and just take a low dose as kind of a background thing for other stuff. But probably the real trick will be to raise the klonopin dose, or to try xanax, or diazepam. In any case, your dose is pretty low considering the severity of the symptoms.
High dose effexor, paxil, zoloft, clomipramine...sure they can work but for most people the side effect burden would be almost as bad as the condition being treated.
Most people wouldn't consider ordering a med from overseas. But if you did, amisulpride (its name overseas is Solian) at 50mg per day along with your klonopin could be amazing. In the remote chance you are interested...
Solian was tested against paxil for anxiety and depression. Both were similar in response, except that solian had the added bonus of significantly boosting psychosocial functioning, which paxil didn't. Amisulpride low dose is known for its antidepressant, antianxiety, and pro-motivation pro-interest pro-pleasure qualities. The first week or so it can have some anxiety, insomnia, agitation type side effects. After that it is very tame. The only lingering side effect really is sexual dysfunction requiring viagra for males. I tried it 10 years ago, am expecting an order to arrive soon, and it was an amazing medication for feeling perfectly comfortable in a crowd. It goes well with benzos. It is an antipsychotic at high doses (300mg - 800mg), but an antidepressant at low doses (25mg - 100mg). Since it stimulates dopamine at low doses, it does not make sense to me how it can work for social anxiety, but it just does. It is very clean affecting on 2 specific receptors in very specific parts of the brain.
Low dose zyprexa would probably help a lot. I shy away from mentioning it though, because it is very dirty...hits all kinds of receptors, changes metabolic and hormonal stuff, risk of blood sugar problems or diabetes. But for fast action, it sure can work. I've been on it for 10 years. I used to like it and now I hate it. My friend turned nasty on me. Solian is so much cleaner and more effective.
Just a thought. I only mention it because you say you've tried everything else. And I wouldn't want to mention something that has heavy side effects. Short of that, increase the klonopin dose.
Just opinions. I hope this is helpful.
Posted by NYCguy on December 22, 2006, at 18:20:55
In reply to Re: Social Anxiety in the EXTREME!!! Advice Request. » NYCguy, posted by blueberry1 on December 22, 2006, at 17:46:18
> You said you've taken just about everything there is. Ok. Did you get a little bit of help from any of them?
Yes. I got some help from a Cymbalta 60mg/ Klonopin 6mg per day/ Adderall XR 40-60mg per day combo for the better part of a year. In reality, it was only decent if I took the Adderall for four days and then slept the next two days. We thought I had ADHD, but I just couldn't sustain the Adderall for very long otherwise I would crash hard. PStims don't seem to be a very good long-term solution to depression. At least not for me anyway.
If so, maybe choose that one and just take a low dose as kind of a background thing for other stuff. But probably the real trick will be to raise the klonopin dose, or to try xanax, or diazepam. In any case, your dose is pretty low considering the severity of the symptoms.
>Do you think a different Benzo might be less depressing? I'm tapering down off the Klonopin because all it seems to do above my current dose is make me more depressed.
> High dose effexor, paxil, zoloft, clomipramine...sure they can work but for most people the side effect burden would be almost as bad as the condition being treated.
>
> Most people wouldn't consider ordering a med from overseas. But if you did, amisulpride (its name overseas is Solian) at 50mg per day along with your klonopin could be amazing. In the remote chance you are interested...
>I've tried Stablon and Ixel in the past, so that's no big deal. I also tried Geodon and Seroquel in the low dose. I don't know if low dose Solian would be the same type of approach as low dose Seroquel. Might be worth a try..
> Solian was tested against paxil for anxiety and depression. Both were similar in response, except that solian had the added bonus of significantly boosting psychosocial functioning, which paxil didn't. Amisulpride low dose is known for its antidepressant, antianxiety, and pro-motivation pro-interest pro-pleasure qualities. The first week or so it can have some anxiety, insomnia, agitation type side effects. After that it is very tame. The only lingering side effect really is sexual dysfunction requiring viagra for males. I tried it 10 years ago, am expecting an order to arrive soon, and it was an amazing medication for feeling perfectly comfortable in a crowd. It goes well with benzos. It is an antipsychotic at high doses (300mg - 800mg), but an antidepressant at low doses (25mg - 100mg). Since it stimulates dopamine at low doses, it does not make sense to me how it can work for social anxiety, but it just does. It is very clean affecting on 2 specific receptors in very specific parts of the brain.
>
> Low dose zyprexa would probably help a lot. I shy away from mentioning it though, because it is very dirty...hits all kinds of receptors, changes metabolic and hormonal stuff, risk of blood sugar problems or diabetes. But for fast action, it sure can work. I've been on it for 10 years. I used to like it and now I hate it. My friend turned nasty on me. Solian is so much cleaner and more effective.
>Does Solian cause binge eating like many of the other atypicals tend to do? Did you ever get any EPS symptoms from the Zyprexa?
> Just a thought. I only mention it because you say you've tried everything else. And I wouldn't want to mention something that has heavy side effects. Short of that, increase the klonopin dose.
>
> Just opinions. I hope this is helpful.Yes, it is very helpful! Thank you.
Posted by Quintal on December 22, 2006, at 18:26:24
In reply to Social Anxiety in the EXTREME!!! Advice Request., posted by NYCguy on December 22, 2006, at 15:02:54
I have the same problem with social anxiety. Nardil sounds like a good bet and I'm looking in to it myself. I don't think the mg/kg rule is always true. I'm 5'9 and about 180lb yet Parnate only worked for me at very high doses of 80-120mg - more than my pdoc was willing to prescribe.
If you didn't need ultra-high doses of EMSAM or other ADs then there's no reason to think you'd need more than the recommended dose of Nardil. Also, you're taking relatively small doses of Klonopin. Is it working for you - doesn't sound as if it's doing much. Have you tried raising the dose? Again, I was taking much more despite my lower body mass - about 4mg Klonopin was my usual dose though I've taken as much as 20mg/day. It seems to depend more on your individual sensitivity to each particular drug than your body mass.
Tramadol worked well for me, but doesn't seem to be a long term option - much the same for other opiates. They tend to work very well as a short term measure. I'm seriously thinking about recommending all social phobes and depressives have an opiate on standby as a pick-me-up in times of crisis though ;-)
Good luck. I'd be interested to hear what you decide and how it works for you.
Q
Posted by NYCguy on December 22, 2006, at 18:27:12
In reply to Re: Social Anxiety in the EXTREME!!! Advice Reque, posted by med_empowered on December 22, 2006, at 17:09:28
> I say...up the Klonopin, get into some sort of CBT therapy or similar program. EMSAM might help, but benzos have a better track record (and they're cheaper...)
Do you think it might be better to try a different Benzo? Klonopin really gets me depressed at a higher dose, that's why I'm reluctant to go higher.
>
> social phobia may be due in part of dopamine dysfunction, so adding in Provigil or an MAOI or, if your doc will import meds and supervise you, a reversible MAOI like Manerix, might be the thing to do. Apparently, some people with SP who are stable find adding in low doses of wellbutrin or ritalin can be helpful.
>
> Good luck.Thank you. SP seems so strange. For me Wellbutrin makes me more anxious... The PStims help for a time, then they start to cause anxiety.
Posted by Quintal on December 22, 2006, at 18:41:23
In reply to Re: Social Anxiety in the EXTREME!!! Advice Request. » NYCguy, posted by blueberry1 on December 22, 2006, at 17:46:18
>Solian was tested against paxil for anxiety and depression. Both were similar in response, except that solian had the added bonus of significantly boosting psychosocial functioning, which paxil didn't. Amisulpride low dose is known for its antidepressant, antianxiety, and pro-motivation pro-interest pro-pleasure qualities. The first week or so it can have some anxiety, insomnia, agitation type side effects. After that it is very tame. The only lingering side effect really is sexual dysfunction requiring viagra for males. I tried it 10 years ago, am expecting an order to arrive soon, and it was an amazing medication for feeling perfectly comfortable in a crowd. It goes well with benzos. It is an antipsychotic at high doses (300mg - 800mg), but an antidepressant at low doses (25mg - 100mg). Since it stimulates dopamine at low doses, it does not make sense to me how it can work for social anxiety, but it just does. It is very clean affecting on 2 specific receptors in very specific parts of the brain.
>I would second Solian. It worked very well for me when I happened to stumble across an old packet a few months ago. I was able to walk down the street in the middle of the day without any anxiety for the first time in years. I grew wary of recommending it here though because I tended to get objections from people who suffered serious sexual dysfunction from it long term, blueberry1 included ;-)
I've never taken it longer than two months but I don't recall sexual dysfunction being a problem for me in that time. The sexual dysfunction seems to be caused by elevated prolactin levels and I believe we were looking into ways of lowering/preventing it. I think someone posted that pre-treatment with Depakote could suppress amisulpride induced prolactin elevation. Someone else had used bromocriptine for this purpose but I don't recall the outcome.
Q
Posted by NYCguy on December 22, 2006, at 18:44:38
In reply to Re: Social Anxiety in the EXTREME!!! Advice Reque » NYCguy, posted by jimmygold70 on December 22, 2006, at 16:59:59
> Hi NYCGuy!
>
> I had a similar story myself. It's really distressing. But don't lose hope! There is remedy!
>
> First, I don't have much experience with Emsem and this doesn't seem a very succesful or interesting drug.
>Hello jimmygold70,
I guess the Emsam seems worth trying again because it was so awesome to feel "connected" to the world or "real" and genuinely non-depressed/anxious for a few of the days I took it. It was so different than the SSRI/SNRI and/or Klonopin response, which is kind of a numbed out/spaced out feeling. It was also different from the "fake feeling good" response I get from Stimulants like Ritalin or Adderall.
> However, trying higher doses of Klonopin should do. I mean 3-4 MG a day, some take even higher doses. For me, 1.5 MG a day does very little.
>I find that the more Klonopin I take the more depressed I feel. I should have indicated in the original post that I was taking 6mg per day for a time. I've tapered down since then. The anxiety has increased... but I feel less "disconnected" than I did. I really don't have the right words to describe it. And a bit less depressed as well. Perhaps a different Benzo would be better.
> Also, take some propanolol and see if it helps - it sometimes does (low doses like 10 MG 3 times a day)
That's an interesting idea. I've never tried a Beta-Blocker before. Thanks!
>
> Plus, add an AD for the long term. I suggest this order:
> 1. Paxil up to 60 MG, and 3 months (!) on that dose
> 2. If it fails - Effexor XR up to 225 MG, and 3 months (!) on that dose. If you tolerate higher doses with no side effects you can go much higer. Get a good PDoc though.
> 3. If it fails - Clomipramine, usual doses
> 4. If all fails, Nardil
>
> If you follow my advice, you'll probably end up with some good dose of Klonopin + option 1 or 2. And get a GOOD Pdoc.
>
> Keep me posted.
>
> Cheers!
> JThanks, Happy Holidays!
Posted by NYCguy on December 22, 2006, at 19:05:12
In reply to Re: Social Anxiety in the EXTREME!!! Advice Request. » NYCguy, posted by Quintal on December 22, 2006, at 18:26:24
> I have the same problem with social anxiety. Nardil sounds like a good bet and I'm looking in to it myself. I don't think the mg/kg rule is always true. I'm 5'9 and about 180lb yet Parnate only worked for me at very high doses of 80-120mg - more than my pdoc was willing to prescribe.
S.A.D. makes me sad. lol. I guess I will only find out if I try it(Nardil). Or try Emsam for longer at a higher dose.
>
> If you didn't need ultra-high doses of EMSAM or other ADs then there's no reason to think you'd need more than the recommended dose of Nardil. Also, you're taking relatively small doses of Klonopin. Is it working for you - doesn't sound as if it's doing much. Have you tried raising the dose? Again, I was taking much more despite my lower body mass - about 4mg Klonopin was my usual dose though I've taken as much as 20mg/day. It seems to depend more on your individual sensitivity to each particular drug than your body mass.
>I've been up as high as 6mg Klonopin per day before. The more I take, the more depressed and less productive I seem to be. I'm not sure why. I should have mentioned that initialy, sorry. Did you notice anything different when you went as high as 20 mg? Did you ever reach a state where the anxiety was mostly gone?
> Tramadol worked well for me, but doesn't seem to be a long term option - much the same for other opiates. They tend to work very well as a short term measure. I'm seriously thinking about recommending all social phobes and depressives have an opiate on standby as a pick-me-up in times of crisis though ;-)
>Not a bad idea. I find that Vicodin really helps me chill out. Of course like any anxious person I'm far too afraid of getting hooked on something like that to use it more than once every few months. Oh, the irony.
About the Solian, I didn't know about the elevated Prolactin. My HPA is already messed up in the direction of elevated Prolactin/Cortisol anyway, so I use Cialis a lot as it is. Maybe Bromo on its own would bring down anxiety by virtue of bringing down my Prolactin levels...
I guess I always worry about stuff like TD with Atypicals. It's just more worrying, I know. =)
> Good luck. I'd be interested to hear what you decide and how it works for you.
>
> QThanks a bunch, I really appreciate it.
Posted by med_empowered on December 22, 2006, at 19:28:47
In reply to Re: Social Anxiety in the EXTREME!!! Advice Request., posted by NYCguy on December 22, 2006, at 19:05:12
if Klonopin makes you depressed, you may want something else. There's ativan, and there's also the new xanax xr (normal xanax is also an option, but it has a short half life). I liked tramadol myself. I don't know if its a short- or long-term solution: I imagine that would depend on how well you respond to it and what other options you have available.
Posted by NYCguy on December 22, 2006, at 19:32:54
In reply to Re: Social Anxiety in the EXTREME!!! Advice Request. » NYCguy, posted by Quintal on December 22, 2006, at 18:26:24
>
> Tramadol worked well for me, but doesn't seem to be a long term option - much the same for other opiates. They tend to work very well as a short term measure. I'm seriously thinking about recommending all social phobes and depressives have an opiate on standby as a pick-me-up in times of crisis though ;-)
>Quintal, I should have mentioned this before but the reason it's so easy for me to converse (on a chatboard!!! Insane as it is, it's often too hard for me to even post on a chatboard on the internet, that's how worried I am about how I think others might respond. :-( Grrrr!!! ) today is that today I took a Vicodin. My once every sixty day dose. It works so much better than anything else, but what does that really say or solve? I mean, who wouldn't be less anxious and less depressed and more themselves when taking an opioid?
It seems dumb to ask, but has anyone else felt this effect? Is there some kind of med that mimics the effect without becoming a tolerance issue? Does everyone feel better and less inhibited when taking something like a small dose of Vicodin?
BTW, what was your experience with the Tramadol and why was it not a long-term solution?
Thanks,
NYCGuy
Posted by NYCguy on December 22, 2006, at 19:52:31
In reply to Re: Social Anxiety in the EXTREME!!! Advice Reque, posted by med_empowered on December 22, 2006, at 19:28:47
> if Klonopin makes you depressed, you may want something else. There's ativan, and there's also the new xanax xr (normal xanax is also an option, but it has a short half life). I liked tramadol myself. I don't know if its a short- or long-term solution: I imagine that would depend on how well you respond to it and what other options you have available.
>
>Is Tramadol something where one would build up a tolerance and then it would stop working? How do the effects compare to something like Hydrocodone (Vicodin)? Some list anxiety as a S/E of Vicodin but to me that's very strange! It delivers a peace of mind to me that is otherwise very hard to come by. It's just too bad I can only take it a few times a year. The last thing I need to do is compound my problems with an addiction to somthing like that.
When I think about it... the best, least anxious, least depressed times In my life were all spent in the hospital recovering from major surgury. Everything was "okay" for once and I'm sure it was the pain-killers.
It is a bit sad now that I think about it. Out of all the Prozac, Paxil, Zoloft, Lexapro, Cymbalta, Ixel, Wellbutrin, Vivactil, Gerodon, Seroquel, Ritalin, Adderall, Dexedrine, Selegiline, Klonopin, Androgel and whetever else I've taken to try to function... simple pain-killers work the best?!?? Am I just really strange in my wiring? Is this at all a common experience?
I just want to thank all you guys/gals in advance because I never would have put any of this together without your insights. Not that realizing this connection really solves, but it feels like a big clue. It's strange.
Posted by blueberry1 on December 22, 2006, at 20:58:12
In reply to Re: Social Anxiety in the EXTREME!!! Advice Request., posted by NYCguy on December 22, 2006, at 18:20:55
> Do you think a different Benzo might be less depressing? I'm tapering down off the Klonopin because all it seems to do above my current dose is make me more depressed.Probably yes. Just like the antidepressants are different and unique from each other, the benzos are too. The best bet for anti-anxiety without inducing depression, and maybe even helping depression, is xanax.
> I've tried Stablon and Ixel in the past, so that's no big deal. I also tried Geodon and Seroquel in the low dose. I don't know if low dose Solian would be the same type of approach as low dose Seroquel. Might be worth a try..Low dose solian is very different than seroquel or geodon. The latter two hit a variety of receptors in various parts of the brain, and act as antagonists at both pre and post synaptic receptors. Solian low dose only hits dopamine D2 and D3 receptors in the mesolimbic part of the brain, and it only hits the pre-synaptic ones, causing a release of more dopamine.
qualities.>
> Does Solian cause binge eating like many of the other atypicals tend to do? Did you ever get any EPS symptoms from the Zyprexa?Any dose of solian rarely causes binge eating or weight gain in clinical studies. I lost weight on it. I think the binge eating comes from blocking serotonin and histimine receptors, which solian doesn't do. And yes, I did get EPS from zyprexa. Though the dose was low, 5mg, I guess it was the time, 8 years, that did it. Plus it was with prozac, and prozac is turning out to be guilty in that respect also.
Posted by Quintal on December 22, 2006, at 21:21:18
In reply to Re: Social Anxiety in the EXTREME!!! Advice Request., posted by NYCguy on December 22, 2006, at 19:05:12
>It is a bit sad now that I think about it. Out of all the Prozac, Paxil, Zoloft, Lexapro, Cymbalta, Ixel, Wellbutrin, Vivactil, Gerodon, Seroquel, Ritalin, Adderall, Dexedrine, Selegiline, Klonopin, Androgel and whetever else I've taken to try to function... simple pain-killers work the best?!?? Am I just really strange in my wiring? Is this at all a common experience?
Yes, it's common for people to feel better when taking an opiate whatever their problems. Just take a look at my own treatment history (!): http://www.dr-bob.org/babble/20061217/msgs/715
>I've been up as high as 6mg Klonopin per day before. The more I take, the more depressed and less productive I seem to be. I'm not sure why. I should have mentioned that initially, sorry. Did you notice anything different when you went as high as 20 mg? Did you ever reach a state where the anxiety was mostly gone?
It's common for people to become depressed on Klonopin, though it just seemed to make me generally more emotionally labile. I had blackouts and respiratory depression when I was taking 20mg - it was only for a short while and I was also taking up to 800mg tramadol with it. Yes, I certainly reached a place where my anxiety was gone completely. It was ecstasy - I felt completely comfortable in my own skin, everything was right with the world etc., but I'm lucky to still be here when I think about it. I reckon I came close to respiratory failure and choking on my saliva a few times.
I eventually built up tolerance to tramadol until even 800mg was doing nothing for me - this was over a few months of taking tramadol four times a day. There are tolerance reduction/limitation strategies such as Lamictal that may be worth looking in to.
Buprenorphine is gaining a good reputation as an effective therapy for treatment resistant depression. It is said to have lower abuse potential than other opiates and is used in some parts of the world to 'treat' opiate dependence during detox. There's more info here if you're interested: http://en.wikipedia.org/wiki/Buprenorphine. There are a few people posting here who take it, or are being prescribed other opiates for TRD.
Kratom is another option that I find very nice as an occasional treat: http://www.thekratomking.com/, http://www.iamshaman.com/eshop/10Browse.asp?Category=Kratom. It's said to be like taking a 'speedball' - heroin and cocaine, and from my own experince that isn't too great an exaggeration when I've taken a large dose of quality material. Some people are using it to help 'treat' hydrocodone withdrawals because they don't want to become addicted to state-issued methadone.
>About the Solian, I didn't know about the elevated Prolactin. My HPA is already messed up in the direction of elevated Prolactin/Cortisol anyway, so I use Cialis a lot as it is. Maybe Bromo on its own would bring down anxiety by virtue of bringing down my Prolactin levels...
That's possible, but dopamine agonists are usually stimulating and can cause anxiety. There are other DA agonists that also lower prolactin levels such as cabergoline, mirapex, pergolide etc.Q
Posted by rosa63 on December 23, 2006, at 3:12:40
In reply to Re: Social Anxiety in the EXTREME!!! Advice Request. » NYCguy, posted by blueberry1 on December 22, 2006, at 17:46:18
> Amisulpride low dose is known for its antidepressant, antianxiety, and pro-motivation pro-interest pro-pleasure qualities.
How can I go about getting Amisulpride in the states? This sounds like a miracle med!!!
Posted by jimmygold70 on December 23, 2006, at 4:41:36
In reply to Re: Social Anxiety in the EXTREME!!! Advice Reque » jimmygold70, posted by NYCguy on December 22, 2006, at 18:44:38
You may also play with the propranolol dose a bit, but don't take more thaN 120 MG a day - you're not likely to tolerate it and you'll be really hypotensive and the like.
I have seen such reactions to Klonopin (not me, but others). Xanax may be the answer.
As you feel numbed on SSRIs and SNRIs there you may try Remeron. And if this fails - a tricyclic drug might do. People react in so different ways to particular drugs and particular groups.
J
Posted by med_empowered on December 23, 2006, at 16:54:47
In reply to Re: Social Anxiety in the EXTREME!!! Advice Reque » NYCguy, posted by jimmygold70 on December 23, 2006, at 4:41:36
opiates are making a comeback for mood disorders. I think now that docs admit that SRIs suck and old antidepressant also suck, there's finally some willingness to branch out and see what the options are.
If you can find a doc who does treatment-resistant depression or has a good rep, you might be able to get an RX. for bupe, the doc has to be licensed--I think if you google buprenorphine you'll find the bupe. website, which has a searchable directory of licensed docs. My guess would be that a lot of them, especially the shrinks, are RXing the stuff off-label for mood disorders.
Posted by Tom Twilight on December 24, 2006, at 5:21:19
In reply to opiates for anxiety, depression, posted by med_empowered on December 23, 2006, at 16:54:47
Social Anxiety is horrible!
I live in the UK-Docs here wont even prescribe Benzo's :(
Regarding Amisulpride
It works great for some people, but for others (like me) it does nothing!
I understand that people who it works for want others to have the same good experience, but theres no garrantee it will work.
Having said all that even Nardil doesn't do a lot for me, so perhapse I'm unlucky.
Posted by djmmm on December 24, 2006, at 8:54:23
In reply to Tramadol, Opioids and Social Anxiety... » med_empowered, posted by NYCguy on December 22, 2006, at 19:52:31
> > if Klonopin makes you depressed, you may want something else. There's ativan, and there's also the new xanax xr (normal xanax is also an option, but it has a short half life). I liked tramadol myself. I don't know if its a short- or long-term solution: I imagine that would depend on how well you respond to it and what other options you have available.
> >
> >
>
> Is Tramadol something where one would build up a tolerance and then it would stop working? How do the effects compare to something like Hydrocodone (Vicodin)? Some list anxiety as a S/E of Vicodin but to me that's very strange! It delivers a peace of mind to me that is otherwise very hard to come by. It's just too bad I can only take it a few times a year. The last thing I need to do is compound my problems with an addiction to somthing like that.
>
> When I think about it... the best, least anxious, least depressed times In my life were all spent in the hospital recovering from major surgury. Everything was "okay" for once and I'm sure it was the pain-killers.
>
> It is a bit sad now that I think about it. Out of all the Prozac, Paxil, Zoloft, Lexapro, Cymbalta, Ixel, Wellbutrin, Vivactil, Gerodon, Seroquel, Ritalin, Adderall, Dexedrine, Selegiline, Klonopin, Androgel and whetever else I've taken to try to function... simple pain-killers work the best?!?? Am I just really strange in my wiring? Is this at all a common experience?
>
> I just want to thank all you guys/gals in advance because I never would have put any of this together without your insights. Not that realizing this connection really solves, but it feels like a big clue. It's strange.
>
>FWIW, I believe Tramadol is effective for Social Phobia because it is primarily a serotonin and norepinephrine re-uptake inhibitor. It's activity at the opioid receptor is several thousand times less than something like morphine. I don't even think Tramadol is considered a "controlled" drug by the DEA
Posted by blueberry1 on December 24, 2006, at 15:59:00
In reply to Re: Tramadol, Opioids and Social Anxiety..., posted by djmmm on December 24, 2006, at 8:54:23
I've heard great things about tramadol for social anxiety and depression. A couple people here didn't like the way it made them feel. But for the most part people really seem to like it. They say it works in 2 to 6 hours instead of 2 to 6 weeks. I have some but have not tried it.
Posted by Tom Twilight on December 24, 2006, at 16:04:41
In reply to Re: Tramadol, Opioids and Social Anxiety..., posted by blueberry1 on December 24, 2006, at 15:59:00
Again a lot of people get good results with Tramadol for SA-suprise suprise it didn't help me!
To put things in perspective other Opiates do help, even Kratom helps, so some things do work for me!
Posted by Quintal on December 24, 2006, at 16:12:01
In reply to Re: Tramadol, Opioids and Social Anxiety..., posted by djmmm on December 24, 2006, at 8:54:23
>FWIW, I believe Tramadol is effective for Social Phobia because it is primarily a serotonin and norepinephrine re-uptake inhibitor. It's activity at the opioid receptor is several thousand times less than something like morphine. I don't even think Tramadol is considered a "controlled" drug by the DEA
SNRIs like Effexor were not effective for me yet tramadol was. The effects of SNRIs usually take weeks or months to appear, but tramadol usually works within hours so it seems there's a different mechanism at work there. It does have a distinct opiate feel for me.
Q
Posted by Declan on December 25, 2006, at 15:43:52
In reply to Re: Tramadol, Opioids and Social Anxiety... » djmmm, posted by Quintal on December 24, 2006, at 16:12:01
It was like being trapped in a poem by Sylvia Plath and TS Eliot, blank and senseless, with no idea of what to do, no idea of what I wanted, no idea of me. Opiates helped that dramatically. The great simplifier and comforter. All of a sudden I knew what to do next.
Posted by ed_uk on December 31, 2006, at 13:56:05
In reply to Opioids and Social Anxiety..., posted by Declan on December 25, 2006, at 15:43:52
That was very poetic Dec. I like it.
Hmm, I just found a rather unusual Spanish poem. It starts........
La luna se puede tomar a cucharadas
o como una cápsula cada dos horas.
Es buena como hipnótico y sedante
y también alivia
a los que se han intoxicado de filosofía.
The translation........You can take the moon by the spoonful or in capsules every two hours.
It's useful as a hypnotic and sedative and besides it relieves those who have had too much philosophy.I think it's just what you need Dec :)
Ed
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