![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by jhj on August 7, 2007, at 3:56:34
HiI am from India.I have social anxiety disorder,GAD,dysthymia,IBS and avoidant personality disorder.I am 29 years old and i have social phobia right from my childhood.I have tried Paroxetine,Fluoxetine,Escitalopram,Imipramine,clomipramine,clonazepam,alprazolam,diazepam,chlordiazepoxide,clobazm,venlafaxine,mirtazepine,bupropion,amisulpride,modafinil,tiagabine,lamotrigine,pregabalin,buspirone,gabapentin,propranolol.Currently I am on Venlafaxine,bupropion,modafinil,gabapentin and clobazm.None of the above drugs gave me even one percent benefit in all those years notwithstanding the side effects.Now I am frustrated because i do not know whether i have any options.None of the doctors is prepared to give any Monoamine Oxedise inhibitors.Can you tell me what options are left with me now? Thanks
Posted by Racer on August 7, 2007, at 13:22:17
In reply to what are the options?, posted by jhj on August 7, 2007, at 3:56:34
Of course you have options! There are always options, although not always optimal choices.
The first that comes to my mind is psychotherapy, since all the diagnoses you've listed respond well to therapy. But, this is the medications board, so let's discuss drug options.
First of all, I'll suggest using spaces between your commas and the following words, because it makes for much easier reading and copying.
As for the meds you've taken, it looks as though it's pretty well mixed between the older and newer drugs. You've tried a bit of TCAs, SSRIs, benzos, and some novel antidepressants. That's good, since it gives you a pretty good idea of what effects the different classes have on your symptoms. The problem is, we'd need to know more about your reactions to them, how long you were on them, what combinations you've been on, etc, to get a very good idea of what might help next. For instance, if the paroxetine was helpful, but left you too lethargic, sertraline might be a good choice to try. Also, an atypical antipsychotic might be wonderful -- but if you had the rage reaction to mirtazepine, that might not be the best choice. Does that make sense?
So, can you tell us more? How long were you on each medication, approximately? What were your responses? What specific symptoms are you looking for help with? How did each of the medications you've tried so far work on those specific symptoms? And have you tried any combinations? Which ones, and for how long? If you can give more information, I'm sure you'll get a lot of good advice and information here. There are a few people here who know an awful lot about these drugs. And a few of us who've taken most of them...
Good luck.
Posted by jhj on August 8, 2007, at 1:56:57
In reply to Re: what are the options?, posted by Racer on August 7, 2007, at 13:22:17
Thanks for your help.I have tried CBT too for 10-12 sessions.I have tried following combinations in all these years. Starting for the firstParoxetine+buspirone 3 months
Imipramine+alprazolam+fluoxetine 3 months
Paroxetine+clonazepam+prpranolol 3 months
Escitalopram+clonazepam 3 months
tiagabine+clomipramine+clonazepam 6 months
Venlafaxine+bupropion+mirtazepine+
lamotrigine+chlordiazepoxide 2 yearsVenlafaxine+bupropion+clobazam+ 6 months
lamotrigineVenlafaxine+bupropion+clobazam+ 6 months
pregabalin+amisulprideCurrently on,Venlafaxine+bupropion+
clobazam+gabapentin+modafinil for the last 6 months.I am currently experiencing severe stomach pain and drowziness as side effects.None of the above combinations improved my symptoms by even 1 percent. I would be happy right now even if there is improvement in any problems social anxiety(which is the most horrible and oldest problem), general anxiety or depression by modest 25%. I do not mind serious side effects too if that happens.
I am sorry if you find my gramer or spellings incorrect because i am from india and we use english as only our third choice language.
Posted by Racer on August 8, 2007, at 3:42:45
In reply to Re: what are the options?, posted by jhj on August 8, 2007, at 1:56:57
>
> I am sorry if you find my gramer or spellings incorrect because i am from india and we use english as only our third choice language.
>No, it's not spelling or grammar, so much as having spaces between words -- it just makes it much easier for old eyes such as mine to read. The easier it is to read, the more chance you'll get responses. :-)
Hm... You say you get no relief whatsoever from any symptom with all the meds you've taken? If so, it doesn't make a lot of sense to continue taking them. Are you sure you're not getting *something* from them? Some sort of relief?It sounds as though the anxiety is giving you the most trouble? In that case, I'd recommend talking to your doctor about ruling out any physical causes for it. Chances are, it really is psychological, but it's always best to rule out physical problems before you give up.
After that, assuming it is entirely psychological, and your doctor really and truly won't try an MAOI, I guess it's time to start looking at the meds you've already tried, and see if there's something that can be resued in there. What I see, is that you're currently taking a bunch of meds which can INCREASE anxiety. That doesn't seem like such a great idea, and I'd suggest starting by discontinuing the buproprion, and possibly the modafinil. The gabapentin and modafinil work against one another -- the gabapentin increases GABA, while modafinil decreases it -- so I'd ask your doctor about that, too: whether it makes sense to be taking both at once. It might make sense, but it's worth asking about.
Another thought I have is about dosages: have you had a trial at an adequate dose of each medication? My guess is no, since you seem to have been on a lot of them for a very short time. Also, it looks as though you've been started on multiple drugs at the same time, which can also be a problem. It might be worth discussing with your doctor tapering off most of what you're currently taking, and then adding things back one at a time.
It doesn't look as though you've given any of the SSRIs an adequate trial. They're often quite good for anxiety as well.
Last, aside from MAOIs, there's another class of medication you have not yet tried: atypical anti-psychotics. They can be great for anxiety, as well as augmenting antidepressants. It's worth trying.
I hope that helps.
Posted by jhj on August 8, 2007, at 7:16:34
In reply to Re: what are the options? » jhj, posted by Racer on August 8, 2007, at 3:42:45
I have had my complete physical check up done many times and any physical problem has already been rule out.I know modafinil and gabapentin work against each other but before that i had pregabalin for around 6 months with out modafinil and there is not much difference between pregabalin and gabapentin. The situation was same at that time too.I have tried escitalopram for around 1.5 years and another SSRI paroxetine for at least three years in all.I had nightmares at 50 mg paroxetine.It is in my opinion the worst drug along with imipramine in terms of side effect.I have social phobia right from the childhood when i was physically good.I have had amisulpride for more then six months.If i am not mistaken it is atypical antipsychotics. I have not taken any drug for less then three months which i think adequate time to at least some effect.I have definitely got something from most of the drugs and that is "side effects". By adding modafinil or bupropion i do not think my anxiety has worsened.Paroxetine is the drug i have taken the most and in my opinion SSRI do not work either for dysthymia,social anxiety or GAD at all. In earlier part of my treatment,i was only on couple of drugs with mild dosage.It is only in last three or four years five or six drugs have been simultaneously used. And from what i have got from internet most of these drugs have been tried at almost highest level of their tolerable limit.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.