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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by jb on March 9, 2001, at 15:50:08
Hi. I have extreme social phobia - presenting in front of groups, speaking in front of groups, being in one-on-one meetings with senior bosses, etc. I've tried a number of drugs: Nardil, Parnate, Klonopin, Valium, Remeron, Neurontin (Gabapentin), etc. Nardil and Klonopin seem to be the best combination, by far. But, Nardil makes me gain weight and makes for complete sexual dysfunction. Klonopin causes short-term amnesia, and is kind of a dumb drug, at least for me.
(Parnate was more activating, and with limited sexual dysfunction, but gave me a very dry mouth and noticeably slurred or slowed my speech pattern. It also was not nearly as effective as Nardil. I noticed little benefit from Gabapentin, Celexa, Remeron, or Valium.)
My question:
Has anyone tried a combination which works better for them?
(1) What about Selegiline (L-Deprenyl) at high doses, where it loses its selectivity for MAO-B, and inhibits MAO-A and MAO-B?
(2) What about Modafinil, or Modafinil to combat the amnestic effects of Klonopin?
(3) Any benefit from amisulpride, pagoclone or any other meds?
(4) I understand most of the SSRI's affect 5H-T2, and, therefore, sexual function. Those that affect 5H-T1 can cause some anxyiolitic benefit. Those that affect 5HT-3 tend to induce or prevent nausea, depending on their mode of action.
Thanks, a lot for any suggestions.
JB
Posted by JahL on March 9, 2001, at 17:08:55
In reply to Better than Nardil or Klonopin for Social Phobia?, posted by jb on March 9, 2001, at 15:50:08
> Hi. I have extreme social phobia - presenting in front of groups, speaking in front of groups, being in one-on-one meetings with senior bosses, etc. I've tried a number of drugs: Nardil, Parnate, Klonopin, Valium, Remeron, Neurontin (Gabapentin), etc. Nardil and Klonopin seem to be the best combination, by far. But, Nardil makes me gain weight and makes for complete sexual dysfunction. Klonopin causes short-term amnesia, and is kind of a dumb drug, at least for me.
Hi JB.
For the past year I have treated my social phobia with low-dose (150mg/d) Sulpiride, with moderate success. Others have had success with Amisulpride (25-100mg).
However I have all but stopped the Sulpiride since starting Lamotrigine 17 days ago. My life-long s. phobia is barely detectable now & I'm still on what's considered a sub-therapeutic dose(37.5mg/d). [perhaps the dosing works differently 4 s. phobia, tho' I've never actually read about it being used for this indication]
Just some thoughts...
Jah.
Posted by JohnM on March 9, 2001, at 18:41:03
In reply to Better than Nardil or Klonopin for Social Phobia?, posted by jb on March 9, 2001, at 15:50:08
I found I suffered from "orgasmic inhibition" from Nardil. I could "perform" but it was quite difficult to climax. However that side effect went away after a year or two. A real pain. Nardil is a fantastic medicine overall though. Don't be too quick to give it up!
Posted by JohnM on March 9, 2001, at 19:10:29
In reply to Re: Lamictal? Sulpiride? » jb, posted by JahL on March 9, 2001, at 17:08:55
Just curious if that is all you take for your social phobia.
Although I have read many positive things about Lamictal, I read how it is an anti-convulsant and a treatment for bipolar. I got turned off, thinking it would dull my emotions. Does it have that effect on you at all?
I suffer from social phobia and atypical depression. John
Posted by JahL on March 9, 2001, at 19:43:49
In reply to JahL - Is that all you take -- Lamictal??, posted by JohnM on March 9, 2001, at 19:10:29
> > Just curious if that is all you take for your social phobia.
Hi John. Right now I'm just taking 37.5mg & nothing else. To be honest I think it could be all I need. With the exception of Gabapentin, I've tried every possible drug 4 social phobia. Only Sulpiride helped (& this was no better than adequate). Lamictal already provides say, 70% relief & I still have a way to go re: dosing.
> > Although I have read many positive things about Lamictal, I read how it is an anti-convulsant and a treatment for bipolar. I got turned off, thinking it would dull my emotions. Does it have that effect on you at all?
Don't be put off by the term anti-convulsant-it means little in the context of treating depression. There is a school of thought that argues atypical depression might be a subtype of Bipolar, & social phobia is often co-morbid with this disorder.I, & others, have found Lamotrigine to be rather activating & good 4 cognitive function. It is purported to have potent AD properties; I doubt *very* much it would dull either yr mind or emotions. (4 details of its benefits see BIPOLAR EXPERT thread).
To be honest I never expected Lamotrigine to help so with the s. phobia (taking primarily 4 depression) but there you go...
Jah.
> > I suffer from social phobia and atypical depression. John
Posted by jb on March 10, 2001, at 1:50:03
In reply to Re: Better than Nardil or Klonopin for Social Phobia?, posted by JohnM on March 9, 2001, at 18:41:03
Hi, JahL. Is your social phobia severe? I know mine is. If Lamictal at such a low dose is giving you 70% improvement with no side effects, sounds likes it's worth a try. By the way, can you tell me if you find it more effective than Nardil or Klonopin, or both, combined?
Thanks, much!
JB
Posted by JahL on March 10, 2001, at 12:29:03
In reply to Thanks, JahL. Is your social phobia severe?, posted by jb on March 10, 2001, at 1:50:03
> > Hi, JahL. Is your social phobia severe?
I think the severity of my s. phobia is related to the severity of my depression. Unmedicated, my depression is as bad as it gets right now so I suspect the s. phobia wld be pretty incapacitating, but it's hard to tell since the Sulpiride's kept it under control for the past year.
> > I know mine is. If Lamictal at such a low dose is giving you 70% improvement with no side effects, sounds likes it's worth a try.
Gabapentin might be another anti-convulsant worth considering.
> > By the way, can you tell me if you find it more effective than Nardil or Klonopin, or both, combined?
Neither did *anything*, tho' Klonopin helps w/sleep.
Do you have a good pdoc? Social phobia is a notoriously obstinate condition to treat.
J.
Posted by jb on March 12, 2001, at 19:40:48
In reply to Re: Thanks, JahL. Is your social phobia severe? » jb, posted by JahL on March 10, 2001, at 12:29:03
Hi, Jahl. Yes, I have a good psychdoc. Unfortunately, everytime a find something that works, I'm not happy with the side effects. I'm happy that I found this guy, though. I had been going to the University of Michigan Anxiety Disorders's Program - top notch psychopharmacologists and very up to date on the latest treatment. Also, they weren't what you'd consider conservative, at all. Unfortunately, they quit taking my HMO, but did give me a good referral of a private psychopharmacologist, which is the psychdoc I'm now seeing.
So, I'll be meeting with him in a week to see if we can come up with a multiple drug cocktail. I'd like to include Selegiline to correct sexual dysfunction, and then Modafinil to correct for the slight decrease in alertness due to my Klonopin benzodiazepine.
Thanks, again.
John
Posted by kregpark@yahoo.com on September 9, 2001, at 15:05:08
In reply to Re: Thanks, Is your social phobia severe? Jahl, posted by jb on March 12, 2001, at 19:40:48
Hi jb,
Glad someone asked about lamotrigine. One of
the few meds I haven't tried. I'm pretty new here.
I like the Nardil Klonopin combo too, though I
go both at moderate dose now. I'd be
curious to see what your regimen is now.
Mine is working good. I took Nardil 60 +
Klonopin 4.5 for last 2 years until
changing to Nardil 60 + K 2.5 + provigil 50-100
6 months ago.I finally made a website (I like to stay off
web normally)It is http://www.socialfear.com/
Hope to hear from you.
BTW I have (untreated) 'very severe' SP and
probably dysthmia (secondary perhaps).Now things mostly under control, very little
side effects except wakefulness I'm working on
now.
> Hi, Jahl. Yes, I have a good psychdoc. Unfortunately, everytime a find something that works, I'm not happy with the side effects. I'm happy that I found this guy, though. I had been going to the University of Michigan Anxiety Disorders's Program - top notch psychopharmacologists and very up to date on the latest treatment. Also, they weren't what you'd consider conservative, at all. Unfortunately, they quit taking my HMO, but did give me a good referral of a private psychopharmacologist, which is the psychdoc I'm now seeing.
>
> So, I'll be meeting with him in a week to see if we can come up with a multiple drug cocktail. I'd like to include Selegiline to correct sexual dysfunction, and then Modafinil to correct for the slight decrease in alertness due to my Klonopin benzodiazepine.
>
> Thanks, again.
>
> John
This is the end of the thread.
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