![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by AdamCanada2 on May 7, 2009, at 1:08:16
Sometimes I feel like I am reaching the end of my rope. Today has been a day I have more seriously considered possible suicide than perhaps ever before. It's been 8 years since I been poisoned by accutane (doctor improperly gave me a dose 4 times greater than my weight would recommend) and I am stagnant.
Huge depression (the kind where I lack emotions, motivation, drive, enjoyment) and huge social anxiety. Oh before I forget my permanently damaged memory from ECT (they did it improperly) that curses me every waking day. And frequent insomnia issues any time when I feel a bit better than ''horrible''. Also my depression involves burning head pains, as if my skull is on fire any time when I am feeling worse. If anyone can give me an idea how to fix that issue or what on earth is actually truly wrong with me then please THROW ANY LONG SHOT idea towards me.
I tried Paxil, Parnate, Ativan, Clonazepam, Diazepam, Xanax, Stablon, Ritalin (loses effect), Dexedrine (same), and certain others that supposedly help for SA + Major Dep but the relief they provide is too often too minor.
Ritalin and Dex where wonderful in the beginning but these days those do too little. I became too tolerant. Parnate was too inconsistent. At times it seemed like a miracle and other occasions it was Ugh.
Any suggestions (numerous if you can, I tried over 25 meds) please because I am sick and tired of my pathetic life and sick and tired of constantly asking for help.
Please put up with me, and please help.
Posted by Phillipa on May 7, 2009, at 11:54:26
In reply to Best meds for social anxiety (plus depression)?, posted by AdamCanada2 on May 7, 2009, at 1:08:16
Adam thought you were the one the Accutane gave you horrible side effects. Didn't reliaze was from an improper doseage. Are lawsuits allowed in Canada not that this would help you feel better. Did this doctor ever do anything for you afterward. Don't feel like its putting up with you as not true. As I age I realize that is it possible there is nothing yet that helps. I don't know. I noticed didn't see any TCA's but could have missed them. Me I just stay on benzos lower doses that don't work and the same low dose of luvox and recently added bioidentical hormones no improvement which is disturbing. I'm hoping that hey how bout a mood stabalizer could help hang in there. Love Phillipa
Posted by Sigismund on May 7, 2009, at 20:50:31
In reply to Best meds for social anxiety (plus depression)?, posted by AdamCanada2 on May 7, 2009, at 1:08:16
My advice is to find a good nutritional doctor and work with him to find a way to repair the damage western pharmaceuticals have done to you, and to improve your mental state.
It's not easy, but it can be done.
It takes time and patience.
To some small extent I have succeeded in doing that.
One of the good sides to it is that it is interesting.It's not what you are asking for, I realise.
Posted by uncouth on May 7, 2009, at 21:11:19
In reply to Re: Best meds for social anxiety (plus depression)? » AdamCanada2, posted by Sigismund on May 7, 2009, at 20:50:31
i'm in the middle of a course of ECT. i'm curious as to what you mean by "they did it improperly" and how your memory has been permanently damaged. if that's the case, why aren't you on namenda or aricept to help out? are you willing to share exactly what "went wrong"?
i myself am definitely feeling the ECT memory side effects, now that i'm up to ECT number 21.
-uncouth
Posted by HyperFocus on May 7, 2009, at 21:13:22
In reply to Best meds for social anxiety (plus depression)?, posted by AdamCanada2 on May 7, 2009, at 1:08:16
How long did you stay on the Parnate and at what dosage? Sometimes improvements can be non-linear - you get blips of improvement and then worsening over the course of a few weeks, but you can only decide what the drug does for you after a moderate amount on it at a sufficient dosage. A poster called JadeKelly had to wait a while for her Parnate to kick in but it did eventually and now she's improved tremendously. She augmented her Parnate with Ritalin - how does that sound to you? Mixing a stimulant with a MAOI can be dangerous however, so you have to find the right doctor who will administer it and monitor it.
Have you tried augmenting an AD with and AP? Augmenting with Abilify is all the rage now. The writer of this article: http://www.nytimes.com/2009/05/10/magazine/10Depression-t.html?_r=1&hp got a response with Abilify added to an AD after being severely depressed for many years. There are several APs that can be tried - Abilify, Zyprexa, Geodon, Riserdal, sulpiride, in combination with Prozac or Effexor or a TCA. Low dose sulpiride (50-200mg) has been reported to work for people with SP and improves dysthemia greatly. I tend to believe that the nature of SP and its concomitant disorders means that SSRIs or SNRIs or TCAs by themselves will not be effective.
Have you considered a mood stabilizer like Lamictal? Sometimes SP can develop as a result of bipolar II. You might be bipolar and not know it (I most likely am.) Read this: http://www.psycheducation.org/depression/02_diagnosis.html as well as other stuff on that site and see if it strikes a chord with you. You may need to take an AD augmented with Lamictal.
Social phobia is almost always accompanied by atypical depression, which is why it is so hard to treat. I know you're suffering but hang in there. There are too many drugs and drug treatment strategies out there to give up. I have had SP and atypical depression a long time as well and I know how bad it can get. You are not alone in this.
Oh yeah, currently I take 150mg amitriptyline, 150mg imipramine, and 200mg sulpiride. As for how I'm doing on this - well this week I started on an 'upshift' where I feel like I'm getting better.
But I don't know if it will last. But I still have hope.
Posted by jedi on May 8, 2009, at 2:34:28
In reply to Best meds for social anxiety (plus depression)?, posted by AdamCanada2 on May 7, 2009, at 1:08:16
Adam,
I think you have already seen my opinion on this. For social anxiety with atypical depression the only combo that worked for me was Nardil + clonazepam. I believe Nardil is the gold standard for treating atypical depression. When combined with clonazepam(they both affect GABA), it is also unbeatable for social anxiety. I believe that Nardil should be 2nd tier for treatment of atypical depression. Not the last resort, which is the role that it often plays.Is your depression atypical?
"The DSM-IV-TR, a widely used manual for diagnosing mental disorders, defines Atypical Depression as a subtype of depression or dysthymia, characterized by Atypical Features:
A. Mood reactivity (i.e., mood brightens in response to actual or potential positive events)
B. At least two of the following:
1. Significant weight gain or increase in appetite ("comfort eating")
2. Hypersomnia (sleeping too much, as opposed to the insomnia present in melancholic depression)
3. Leaden paralysis (i.e., heavy, leaden feelings in arms or legs)
4. Long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment
C. Criteria are not met for Melancholic Depression or Catatonic Depression during the same episode. " Source: Wikipedia
Best of Luck,
Jedi
Posted by Michael Bell on May 8, 2009, at 20:58:06
In reply to Best meds for social anxiety (plus depression)?, posted by AdamCanada2 on May 7, 2009, at 1:08:16
What exactly is your social anxiety like? Is it more physiological in nature, meaning sweating, racing hearbeat, tremors when in social situations? Or is it more of the social paranoid type, meaning the feeling like others are always evaluating you in a negative way? I may have some advice for meds based on the info you give me.
Posted by whitmore on May 9, 2009, at 17:10:07
In reply to Re: Best meds for social anxiety (plus depression)?, posted by Michael Bell on May 8, 2009, at 20:58:06
Don't want to hijack the poster's thread--but I have the paranoid type of social anxiety and have never seen anyone make the distinction between that type and the physical manifestation of nervousness type, which I don't have. I actually appear cool in social settings, but find them very awkward, so avoid them. I have also tried various kinds of meds. over many years with varying degrees of success. SSRI's seem to work the best eventually, though I'm scared of them long term. Am curious about what you'd recommend for this sub-type.
Posted by Michael Bell on May 9, 2009, at 22:00:01
In reply to Re: Best meds for social anxiety (plus depression)? » Michael Bell, posted by whitmore on May 9, 2009, at 17:10:07
I used to have both types: the extreme physiological social anxiety, where I would go into a near panic when anticipating a social event, and also the paranoid type.
a) best med for physiological social anxiety - nardil and klonopin. Somewhere along the line that extremely debilitating social anxiety was diffused. I suspect that it was from the nardil and possibly also a short stint on d-cycloserine. however, none of these meds were good for social paranoia.
b) great combo for social paranoia - low dose risperdal plus lexapro. The two augment each other quite nicely.
For the paranoia, I also very strongly recommend acceptance-commitment therapy in combination with the meds. It is a great adjunct.
P.S. Bear in mind the paranoia I had was strictly social in nature - was not paranoid about anything else.
Posted by whitmore on May 10, 2009, at 20:31:45
In reply to Re: Best meds for social anxiety (plus depression)?, posted by Michael Bell on May 9, 2009, at 22:00:01
Thanks for taking the trouble to respond, Michael.
Posted by AdamCanada2 on May 12, 2009, at 12:09:16
In reply to Re: Best meds for social anxiety (plus depression), posted by uncouth on May 7, 2009, at 21:11:19
they stuck the things in the wrong places. those idiot doctors. not only did they think accutane depression was impossible (it's a known fact these days) but they couldn't even do ECT properly. but i was so desperate so hopeless that i felt i had to try it.
SECOND biggest MISTAKE OF MY LIFE. I don't remember exactly how they did it but i think it was too low. i forget the details.
and i am in so much pain right now that i am fantasizing about any DAMN afterlife that might possibly await.
> i'm in the middle of a course of ECT. i'm curious as to what you mean by "they did it improperly" and how your memory has been permanently damaged. if that's the case, why aren't you on namenda or aricept to help out? are you willing to share exactly what "went wrong"?
>
> i myself am definitely feeling the ECT memory side effects, now that i'm up to ECT number 21.
>
> -uncouth
Posted by AdamCanada2 on May 12, 2009, at 12:22:28
In reply to Re: Best meds for social anxiety (plus depression)? » AdamCanada2, posted by HyperFocus on May 7, 2009, at 21:13:22
thanks for suggestions andn the reminder of abilify. that is one i always wanted to try but not available here in canada. so i will have to order and my doc long time ago said it;'s fine if i did. so time to break the piggy bank and use up the rest of the cash i have left for this month from my measily government cheques.
> How long did you stay on the Parnate and at what dosage? Sometimes improvements can be non-linear - you get blips of improvement and then worsening over the course of a few weeks, but you can only decide what the drug does for you after a moderate amount on it at a sufficient dosage. A poster called JadeKelly had to wait a while for her Parnate to kick in but it did eventually and now she's improved tremendously. She augmented her Parnate with Ritalin - how does that sound to you? Mixing a stimulant with a MAOI can be dangerous however, so you have to find the right doctor who will administer it and monitor it.
>
> Have you tried augmenting an AD with and AP? Augmenting with Abilify is all the rage now. The writer of this article: http://www.nytimes.com/2009/05/10/magazine/10Depression-t.html?_r=1&hp got a response with Abilify added to an AD after being severely depressed for many years. There are several APs that can be tried - Abilify, Zyprexa, Geodon, Riserdal, sulpiride, in combination with Prozac or Effexor or a TCA. Low dose sulpiride (50-200mg) has been reported to work for people with SP and improves dysthemia greatly. I tend to believe that the nature of SP and its concomitant disorders means that SSRIs or SNRIs or TCAs by themselves will not be effective.
>
> Have you considered a mood stabilizer like Lamictal? Sometimes SP can develop as a result of bipolar II. You might be bipolar and not know it (I most likely am.) Read this: http://www.psycheducation.org/depression/02_diagnosis.html as well as other stuff on that site and see if it strikes a chord with you. You may need to take an AD augmented with Lamictal.
>
> Social phobia is almost always accompanied by atypical depression, which is why it is so hard to treat. I know you're suffering but hang in there. There are too many drugs and drug treatment strategies out there to give up. I have had SP and atypical depression a long time as well and I know how bad it can get. You are not alone in this.
>
> Oh yeah, currently I take 150mg amitriptyline, 150mg imipramine, and 200mg sulpiride. As for how I'm doing on this - well this week I started on an 'upshift' where I feel like I'm getting better.
> But I don't know if it will last. But I still have hope.
Posted by AdamCanada2 on May 12, 2009, at 12:24:12
In reply to Re: Best meds for social anxiety (plus depression)?, posted by Michael Bell on May 8, 2009, at 20:58:06
> What exactly is your social anxiety like? Is it more physiological in nature, meaning sweating, racing hearbeat, tremors when in social situations? Or is it more of the social paranoid type, meaning the feeling like others are always evaluating you in a negative way? I may have some advice for meds based on the info you give me.
paranoid type. self-conciousness. self-awareness. ppl evaluating me. fears of what people think of me or what i say. talking to people.
Posted by Michael Bell on May 12, 2009, at 21:31:30
In reply to Re: Best meds for social anxiety (plus depression)? » Michael Bell, posted by AdamCanada2 on May 12, 2009, at 12:24:12
I suggest risperdal + ssri + Acceptance Commitment Therapy. Best combo i've ever tried for social paranoia
> > What exactly is your social anxiety like? Is it more physiological in nature, meaning sweating, racing hearbeat, tremors when in social situations? Or is it more of the social paranoid type, meaning the feeling like others are always evaluating you in a negative way? I may have some advice for meds based on the info you give me.
>
> paranoid type. self-conciousness. self-awareness. ppl evaluating me. fears of what people think of me or what i say. talking to people.
Posted by Questionmark on May 13, 2009, at 20:20:38
In reply to Best meds for social anxiety (plus depression)?, posted by AdamCanada2 on May 7, 2009, at 1:08:16
Adam. (I have not read any of the other posts in the thread so forgive me if i say anything already covered.)
I cannot-- morally, philosophically, or rationally-- tell anyone not to take his or her own life. I hope you do not, and i hope you do not ever have to. But it is one of the most complex and ambiguously difficult philosophical questions. (In fact i believe someone has a quote)... Okay i looked it up...
From Albert Camus:
"There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy. All the rest -- whether or not the world has three dimensions, whether the mind has nine or twelve categories -- comes afterward. These are games; one must first answer."Wow that's more brilliant than i remember.
Anyway... (i'm sorry)... as i was saying, i cannot tell anyone, definitively, not to take his or her own life. However, i will tell you this:
Do NOT. even seriously consider. ending your life. before you try Nardil. I may only be alive right now as a result of Nardil. And you seem like a good candidate for it. It may not help your memory difficulties at all and may possibly even somewhat exacerbate them (though i doubt any more than Paxil or benzos would), but for me it seems better to have a slightly worse memory than to be paralyzed with despair.
Also, PLEASE do not choose not to try Nardil because you had a trial with Parnate. They are VASTLY different drugs. (I actually was more depressed on Parnate than off, yet miracle is a miracle antidepressant for me). One of the many misconceptions about MAOIs that have unjustly damaged their reputation so much is that of them being more or less similar in their effects. Nothing is further from the truth. Strangely, they do not talk about tricyclics or APs this way, for example. And SSRIs *are* all similar in their effects.
Trust me. Try Nardil, give it enough time at a high enough and not-too-high (which could make the side effects worse than they need to be or even intolerable) dose, and then prepare to feel the amazing relief of having the darkness and pain being pulled away.
Also it may be difficult finding a dr who will prescribe it to you but you will be able to find one if you search around.(My suggestion for ideal trial)...
Start or work up to 45mg/day; stay on for at least one month.
If Depression or Anxiety still lingers too strongly, increase to 60mg for at least one month.
If not sufficient, increase in increments of 15mg per at least one month. (For some 45mg is ideal; others might not gain relief until as high as 90mg.)
Also, i believe it is definitely preferable to split doses to at least three times a day; and maybe 4 at the higher doses.Finally, it is important when you do find relief to remember to work "at it"-- on your life, your self, etc.-- all the while, preferably with therapy. It may be easier than you think to fall into contented stagnation with this kind of a powerful depression-blocker.
And finally, don't forget what you have learned through your depression, when it mostly evaporates.Oh, and one other thing. I sort of convinced myself that Nardil will be the answer for you, particularly in light of your two main "diagnoses". I do strongly believe it will help you. If, however, it is not enough, or not right for you, i still urge you to keep looking and fighting. New and novel drugs and other treatments will continue to be developed (albeit more slowly than we would all prefer, but still), and, unfortunately and in some ways fortunately, we will all get to die someday. And none of us may ever get to live again.
That does not solve the question/problem absolutely, but i think there is really something to that, if you know what i mean.Good luck to you.
Sincerely.
> Sometimes I feel like I am reaching the end of my rope. Today has been a day I have more seriously considered possible suicide than perhaps ever before. It's been 8 years since I been poisoned by accutane (doctor improperly gave me a dose 4 times greater than my weight would recommend) and I am stagnant.
>
> Huge depression (the kind where I lack emotions, motivation, drive, enjoyment) and huge social anxiety. Oh before I forget my permanently damaged memory from ECT (they did it improperly) that curses me every waking day. And frequent insomnia issues any time when I feel a bit better than ''horrible''. Also my depression involves burning head pains, as if my skull is on fire any time when I am feeling worse. If anyone can give me an idea how to fix that issue or what on earth is actually truly wrong with me then please THROW ANY LONG SHOT idea towards me.
>
> I tried Paxil, Parnate, Ativan, Clonazepam, Diazepam, Xanax, Stablon, Ritalin (loses effect), Dexedrine (same), and certain others that supposedly help for SA + Major Dep but the relief they provide is too often too minor.
>
> Ritalin and Dex where wonderful in the beginning but these days those do too little. I became too tolerant. Parnate was too inconsistent. At times it seemed like a miracle and other occasions it was Ugh.
>
> Any suggestions (numerous if you can, I tried over 25 meds) please because I am sick and tired of my pathetic life and sick and tired of constantly asking for help.
>
> Please put up with me, and please help.
Posted by kayak on June 18, 2009, at 19:19:56
In reply to Re: Best meds for social anxiety (plus depression)? » AdamCanada2, posted by Questionmark on May 13, 2009, at 20:20:38
Please, please know there are those (me among them!!!) who CARE for and about you. My heart is with you. I am feeling similarly and it is a comfort to know that I am not "crazy" but rather that I am not alone, because you are feeling this way, too. (Misery loves company? SICK, and I do not mean that at all.) I am almost 47 years old and am unemployed, ending my 3rd marriage with nothing (and I mean nothing, including support) and I pray that you read these posts and draw comfort and strength from them!!!!! I wish you could get in touch with me personally so I could LISTEN to you and HEAR you and support you. Please try 5-HTP (or is it HTP-5??) by Nature's Bounty or Natrol or other, 100 mg twice a day. I am about to try it myself after horrors with Paxil, Trazadone and of late, Wellbutrin. Please try this over the counter supplement. I am about to myself! Let's check in afterword. It is supposed to relieve anxiety same day!!!!
GOD BLESS YOU!!!!!!!!!!!!!!
Posted by morganpmiller on June 21, 2009, at 0:16:03
In reply to Re: Best meds for social anxiety (plus depression)?, posted by kayak on June 18, 2009, at 19:19:56
I had a bad reaction to 5htp. I know everyone is different. I think 5htp is more powerful than people realize. It's worth a shot though.
I would also suggest piracetam as it has helped put people and a better mood and can help with memory. there is a study that shows piracetam helped people overcome memory deficits from ECT
Posted by morganpmiller on June 21, 2009, at 0:20:29
In reply to Abilify » HyperFocus, posted by AdamCanada2 on May 12, 2009, at 12:22:28
On second thought, after reading through your posts, stay away from 5htp and piracetam for now. Take care of your anxiety/paranoia first. I agree with a previous post that therapy may be one of the best things you could do for yourself. And, of course a medication or 2 that does not give you any major issues.
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.