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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 Aadika on December 28, 2002, at 0:54:08
I haven't seen mention of this disorder on the forum, so I thought I'd ask if anyone else has been DX'd with this disorder? Or any social phobics who believe that AvPD may be a more suitable diagnosis for them? Just wondering, thanks in advance for any replies. :-)
~ Aadika
Posted by chad_3 on December 28, 2002, at 12:09:40
In reply to Avoidant personality disorder, anyone?, posted by Aadika on December 28, 2002, at 0:54:08
Hi Aadika -
I was diagnosed with Social Phobia (untreated is severe) - and it responds pretty well to several medications and combinations.
Your Dr. diagnosed an unusual one - Avoidant Peronality Disorder - because the new line of thinking is that Avoidant Personality Disorder is actually the same as severe Social Phobia - and has been shown to respond well to the MAOI "Nardil" in studies - very well in fact.
If you are willing to - I recommend checking out my website - it is very good. In particular for your case - I suggest Nardil. There are some drug interactions you will have to be aware of so you need to talk to your Dr. about Nardil but for your diagnosis Nardil is proven to be highly efficacious.
In fact, since APD responds to med treatment - often dramatically - the term "personality disorder" was kind of fading out - because by definition a "personality disorder" is not treatable - but APD clearly IS tretable with medication - often resulting is dramatic and outstanding improvements - the MAOI's in particular Nardil are the preferred first line choice in these cases.
Chad
http://www.socialfear.com/
> I haven't seen mention of this disorder on the forum, so I thought I'd ask if anyone else has been DX'd with this disorder? Or any social phobics who believe that AvPD may be a more suitable diagnosis for them? Just wondering, thanks in advance for any replies. :-)
>
> ~ Aadika
Posted by Aadika on December 28, 2002, at 12:23:08
In reply to Re: Avoidant pers = treatable severe social phobia, posted by chad_3 on December 28, 2002, at 12:09:40
Hi there, actually I have checked out your site in the past and it was a great help... though I have tried Nardil recently (up to 135mg) with no effect whatsoever. At the moment I take Provigil and Klonopin which help substantially, but I really would like to one day be able to discontinue the Klonopin. As of this moment, I'm considering Riluzole, Sabril, Lamictal, Parnate, or high-dose Depakote as an add-on. I've tried basically everything else available-- all SSRIs, Effexor, Remeron, Serzone, Wellbutrin, most tricyclics, Nardil, all currently available stimulants, neuroleptics, anticonvulsants, lithium, Equanil, several barbiturates, most benzodiazepines, and, of course, many forms of therapy with an extensive list of different therapists. I know I could achieve complete relief of my symptoms once again if I went up to 10mg Klonopin, but I'd like to save that as a last resort.
~ Aadika
Posted by comftnumb on December 28, 2002, at 15:20:16
In reply to Re: Avoidant pers = treatable severe social phobia, posted by chad_3 on December 28, 2002, at 12:09:40
I think I agree with you, APD may just be a very bad case of social phobia. I know that my first psychiatrist diagnosed me with APD but gave me Zoloft so he must have thought it was treatable with meds. My current pdoc diagnoses me with schizophrenia and severe social phobia. He says I have avoidant and narcissistic traits, and that avoidant and narcissistic PD are like two sides of the same coin: they both originate from bad self-esteem.
Posted by utopizen on December 29, 2002, at 8:17:24
In reply to Re: Avoidant pers = treatable severe social phobia » chad_3, posted by comftnumb on December 28, 2002, at 15:20:16
>
me with schizophrenia and severe social phobia.
>wow- how does one get missed over schizo? Wouldn't someone know if they had that?
anyway, so Aadika, how did your doctor come to deciding on Equanil? I am aware it's still sold, it's just that even on this site, which is like a conglomerate of all us hard-to-treat types, I couldn't find anyone on Equanil over a year's time. It really is a 50's trend that got a bad rep for abuse and habit forming potential. I'm curious, how did you feel on it? sleepy? relaxed?
And also, speaking of taboo drugs, how were the barbs? Seriously, it's like so taboo to even mention those these days it appears... from what I read, in the 70's Seconal was given like Ambien is today for sleep. How did your doctor get comfortable enough to prescribe them?
Posted by comftnumb on December 29, 2002, at 14:21:51
In reply to Re: Avoidant pers = treatable severe social phobia, posted by utopizen on December 29, 2002, at 8:17:24
> >
> me with schizophrenia and severe social phobia.
> >
>
Usually the only way to find out you have schizophrenia is to have a psychotic episode first. I had a 6week psychotic episode that came about 6months after I was first diagnosed with APD. No one, including myself, ever suspected I had schizophrenia.
Posted by utopizen on December 29, 2002, at 17:28:13
In reply to Re: Avoidant pers = treatable severe social phobia, posted by comftnumb on December 29, 2002, at 14:21:51
> > >
> > me with schizophrenia and severe social phobia.
> > >
When I was younger I use to fear of going insane one day. It seemed everyone who did go insane did it in college. Like one day, I would just flip.
Posted by comftnumb on December 29, 2002, at 21:14:34
In reply to Re: Avoidant pers = treatable severe social phobia, posted by utopizen on December 29, 2002, at 17:28:13
I never feared getting schizophrenia and it doesn't run in my family. But I had a predisposition to it and got it, possibly from doing too much marijuana. So if you want to minimize your chances stay away from the reefer.
Posted by Aadika on December 30, 2002, at 1:42:56
In reply to Re: Avoidant pers = treatable severe social phobia, posted by utopizen on December 29, 2002, at 8:17:24
Well, re: the Equanil (btw, I actually took the brand Meprospan, which is extended-release), according to my pdoc it actually seems to be making a small comeback (though God only knows why). It was the most recent drug tried on me after the barbs failed, even though Klonopin has ALWAYS worked for me. Perhaps ol' Doc Desai just had an itch to experiment that day? He did say he'd never prescribed meprobamate before.
How it made me feel? Honestly, I prefer Soma (the muscle relaxant) over Equanil for its anxiolytic properties. Equanil seems (to me) to act more as a hypnotic-- I would continually start to nod off on that stuff, as if I'd taken one too many Vicodin. And Soma is, of course, metabolized into meprobamate in your system, so I imagine the combined effects of carisoprodol and meprobamate are highly synergistic. This is absolutely a drug worth looking into for relief from severe anxiety, as it is not scheduled by the FDA. And this is of course provided that your doctor would be open-minded enough to consider such a radical treatment. After all, it IS a muscle-relaxant with sometimes euphoric, almost opioid-like effects (I've read articles wherein abusers refer to the combination of two Soma and five Vicodin HP to equal the heroin high, without the rush... this is a combination I've tried in the past [along with a few other things; Xanax, alcohol, pot, mushrooms, just to name a few lol] and if that's what heroin feels like, keep me away from heroin! lol). And finally, Equanil (just like the barbs) fell out of usage primarily because of its high toxicity, which would negate the possibility of taking more than about 4-10 Soma (1400-2000mg) at a time, depending on body weight, or approximately 3g of Equanil at a time, limiting your dosage range. But fortunately I, even with my absolutely unbelievable tolerance to all things sedative/hypnotic, found that I was able to maintain a dose of 700mg Soma q.i.d. for several months with no loss of effect. I do admit, however, that I know little of the long-term effects of taking this medication... if you decide to consider it for anxiolysis, you may want to read up on that. But as for Equanil, I personally wouldn't waste my time. Oh, and by the way, my dose of Meprospan was 2400mg b.i.d.
The barbiturates never felt much different from Equanil to me... with the possible exception of Solfoton (phenobarbital), which was the only long-acting barb I tried. I was ultimately allotted NINE-HUNDRED 65mg tabs per month, with instructions to take up to 1950mg each day, preferrably in evenly-spaced doses... he recommended 975mg twice a day. Now, I know this seems DANGEROUSLY close to the LD50 for humans (after all, the Heaven's Gate cult simply used, I believe, 2500mg phenobarbital + a glass of wine to execute their mass suicide). The only reason I was prescribed such a high amount of this drug (not to mention other anxiolytics... though I'm not sure pheno falls under the pharmaceutical classification of anxiolytics any more than ethanol does... most of the long-acting barbs are hypnotics/anticonvulsants, first and foremost) was because I consented to spend some time in the hospital under the care of both my GP and my psychiatrist for the purpose of using hourly doses of Nembutal (pentobarbital) 200mg to determine my level of sedative tolerance. Basically, once I started showing clear signs of intoxication (nystagmus would be the first indication, followed by drowsiness or what they call "simple-sleep"), they would determine the total amount of Nembutal I had received, convert that into its phenobarbital equivalent, and then lower the dose slightly (seeing as how anxiolysis, not sedation, was the aim). Well, I ended up going back several times to repeat this process... Nembutal only has a duration of around six hours, and after six hours, with 1000mg in my system, I still wasn't affected by the drug in any way. So we rescheduled for the following week. This time they gave me what they called "loading doses"... 200mg every 15 minutes for two hours (this time via IV), then resuming the previous dosing schedule of 200mg / hour. Once again, after six hours and 2800mg, I had achieved NO level of sedation. So we rescheduled......... The next week, they decided to give up on Nembutal, as it would have been quite the financial shame for THEM had they overdosed me. So they started me on Valium, 90mg/hour. Not long after the fourth dose I began showing signs of mild sedation. They monitored me for a while, made sure my vitals remained stable, etc. The total dose was 360mg, which equals out to roughly 1100mg phenobarbital, so we lowered this to ~1000 and that was my prescribed b.i.d. dose.
Now, back to the barbs vs. Equanil vs. benzos issue... as I mentioned, phenobarbital had a slightly different effect as compared to Equanil-- primarily in that it was LESS sedating (...?) and actually more ENERGIZING (...?????). But even still, the hangover headache between doses (this stuff is VERY unreliable regarding its absorbtion rate, at least in my experience) and the mild visual disturbances (occasional tracers and flanging for the most part) rendered it less than ideal for anxiety. Other than those undesirable S/FX... all in all not too bad-- two doses last 24 hours, and it's highly underrated for anxiolysis, IMHO, and always has been-- even in the glory days of the barbs, phenobarbital was an anticonvulsant first (still its most common use today, especially in pediatrics) and a temporary sleep-aid second.
Seconal was nothing but a pain in the ass for me... 3600mg/day in four divided doses throughout the day, but the largest oral form of the drug is a 100mg tablet or capsule. 36 pills a day? Don't think so. It worked fairly well, but swallowing all those pills brought on nausea to rival the kill-me-now kind of nausea I tend to experience on high-potency opioids. My pdoc added Marinol, 5mg along with each dose of Seconal, which helped considerably. Unfortunately, I very soon thereafter began developing a tolerance, said 'no way' to the thought of taking more pills than I already was, and gave Amytal a shot. Long story short, Amytal was just a repeat of Seconal... only fewer pills to take.
Once again, I can't really answer your question re: what possessed my pdoc to give the barbs a trial... wish I could. It's not like I asked for them; I would've asked him to represcribe me the Klonopin, but he seemed so hyped-up about trying the barbiturates...... I guess I just didn't want to disappoint him. LOL
~ Aadika
This is the end of the thread.
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