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Re: Social Phobia Cocktail -- WOW!!! Aimee

Posted by Rick on September 27, 2000, at 22:41:38

In reply to Re: Social Phobia Cocktail -- WOW!!!, posted by Aimee on September 27, 2000, at 12:27:12


Aimee --

Sorry to hear that Provigil has the potential to render contraceptives ineffective. I wish I had a solid substitute recommendation for you, but I don't.

I've personally tried three stimulating meds. At one point I took selegiline with Klonopin (and pindolol), and it was very energizing, if not quite in the league of the Provigil. But it made me a bit edgy. I was taking a small dose (5 mg/day, which requires no food restrictions), but since then I've heard that as little as 2.5 mg/day, or 5 mg 2-3 times per week, can maintain the benfits after the first week. But since selegiline is a non-reversible MAOI, even small doses can have a minor, but real, potential for dangerous interaction with many prescription and non-prescription drugs (this does NOT include Klonopin, but it does include Serzone and SSRI's). So if you're not going to use an AD, low-dose selegiline might be worth trying. (Interestingly, the SSRI Celexa had an article on their website about how possible interactions -- specifically serotonin syndrome -- are rare and mild when combining low-dose selegiline with SSRI's. They said that this combo is routinely prescribed without complication to Parkinson's patients. Nonetheless, Celexa's own official monograph warns against combining any MAOI with Celexa!)

Wellbutrin is safe with Klonopin and Serzone, although the dosage should be pretty low and it should not be used if you have a history of seizures. But for me Wellbutrin was only slightly energizing, and added back a bit of anxiety. But again, it might work for you.

I have heard Effexor can be energizing for some, and sedating (especially at first) for others. And it has shown a lot of promise for Social Anxiety in a few open studies, reportedly with a unique anti-avoidance benefit -- especially for women. As for anecdotal reports, I've seen everything from "works great" to "no effect at all" for Effexor taken ALONE for Social Anxiety.
Other Babblers could probably give you more input on this one). I've never heard of a Serzone/Effexor combo, but as when combining any two serotonergic meds, there is some risk of serotonin syndrome. Nonetheless, such combos are often prescribed, with conservative doses and careful monitoring. Indeed, back when I was trying Celexa, my pdoc said that Effexor could possibly work to counter the Celexa-induced "dullness". But I've neve taken it.

BTW, I don't know the potential effects of any of these meds on contraceptives.

Hope this helps.

Rick


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poster:Rick thread:36517
URL: http://www.dr-bob.org/babble/20000926/msgs/45395.html