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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Michael Bell on June 21, 2009, at 23:28:22
Has anyone else noticed that:
a) medications that have norepinephrine reuptake inhibition as one of their mechanisms of action, such as reboxetine, and tramadol, increase emotional instability, increase the feeling that others are judging you/staring at you, etc., and increase sensitivity to perceived rejection?
b) Drugs that are effective for the physiological aspects (heart pounding, sweating, abject terror) of social anxiety, such as klonopin and Nardil, don't help with the "social paranoia" aspect of social anxiety, meaning the beliefs and thought processes that people are looking at them, judghing them negatively, etc.
c) SSRIs + Antipsychotics are pretty damned good for the following: anger outbursts, feelings of frustration, and social parania.
d) klonopin, on its own, causes depression and anger issues to worsen.
e) drugs that increase dopamine production and availability as the main effect increase anger, frustration and rumination?
This has been my general experience with meds. Insofar as social anxiety is concerned, a combination of risperdal plus lexapro has proven much more effective at addressing issues such as anger, suspicion of others' intent, and social paranoia than any other medication, even more than the so called "gold standards" of SP treatment, like Nardil and Klonopin. I've really begun trusting people more and actually looking forward to social gatherings, so I guess the social reward mechanism has very weakly started to kick in. My guess is it will get stronger as time goes by. Also, meds that cause oxytocin release, such as Vilazodone might do, will also probably have profound effects on prosocial behavior.
Posted by Phillipa on June 21, 2009, at 23:50:05
In reply to Has anyone else noticed that....., posted by Michael Bell on June 21, 2009, at 23:28:22
Michael sounds like your meds are working and that is great. I've never exerienced a paranoia of others looking at me though with my anxiety. Love Phillipa
Posted by cactus on June 22, 2009, at 4:30:21
In reply to Has anyone else noticed that....., posted by Michael Bell on June 21, 2009, at 23:28:22
> Has anyone else noticed that:
>
> a) medications that have norepinephrine reuptake inhibition as one of their mechanisms of action, such as reboxetine, and tramadol, increase emotional instability, increase the feeling that others are judging you/staring at you, etc., and increase sensitivity to perceived rejection?
>
> b) Drugs that are effective for the physiological aspects (heart pounding, sweating, abject terror) of social anxiety, such as klonopin and Nardil, don't help with the "social paranoia" aspect of social anxiety, meaning the beliefs and thought processes that people are looking at them, judghing them negatively, etc.
>
> c) SSRIs + Antipsychotics are pretty damned good for the following: anger outbursts, feelings of frustration, and social parania.
>
> d) klonopin, on its own, causes depression and anger issues to worsen.
>
> e) drugs that increase dopamine production and availability as the main effect increase anger, frustration and rumination?
>
> This has been my general experience with meds. Insofar as social anxiety is concerned, a combination of risperdal plus lexapro has proven much more effective at addressing issues such as anger, suspicion of others' intent, and social paranoia than any other medication, even more than the so called "gold standards" of SP treatment, like Nardil and Klonopin. I've really begun trusting people more and actually looking forward to social gatherings, so I guess the social reward mechanism has very weakly started to kick in. My guess is it will get stronger as time goes by. Also, meds that cause oxytocin release, such as Vilazodone might do, will also probably have profound effects on prosocial behavior.WOW, we are all so, so different, I'm ALMOST the total opposite to you. It just goes to show how differently we are all wired. This is a very interesting topic, thanks for bringing it up.
I'm just starting to find that:-
a. reboxetine is just starting to mess with my emotional stability but not tramal. I've been on reboxetine now for 2 and a half months, it was amazing at first.
b. klonopin/rivotril (clonazepam) has been a life saver for me and does help greatly with SP, anxiety etc....I've never tried Nardil and don't plan too.
c. SSRI and AP's are quite possibly the worst drugs I have ever taken, and I've tried loads of them and will never ever take them again in this life time.
d. I'm one of the people who doesn't get depressed from klonopin/rivotril at all. I'm lucky, it has saved my life on numerous occasions and is awesome for SP, anxiety etc.. for me, even on it's own.
e. DA's (dopamine agonists) were amazing for my mind, positive thinking, socialising, calming and energizing BUT my body didn't like them. I put up with the constant vomiting because I felt so good upstairs. I had to stop them in the end because they made me so sick, even in small doses. I was so upset when I had to give ropinirole away.
I'm glad your meds are working for you. I haven't had to take an AD for over 2 years, reboxetine was so good at first but now I'm not so sure. I also take 200mg modafinil, 6mg clonazepam. Maybe it's back to TCA's for me or I could try Moclobemide ( Aurorix, Manerix) again. It's been over 15 years since I gave that a go. Peace C
Posted by Brainbeard on June 22, 2009, at 9:13:49
In reply to Has anyone else noticed that....., posted by Michael Bell on June 21, 2009, at 23:28:22
Noradrenaline reuptake inhibition can make me grumpy. It can intensify and prolong feelings of anger in me. Very bad for relational/social conflicts.
Benzo's are not particularly pro-social for me, but not anti-social either.
Low dose Risperdal (0.5mg) was pretty pro-social for me all by itself. I can only imagine what it will do in combination with an (S)SRI.
Paxil made me pro-social, to a certain point. Certainly in combination with booze any social paranoia got completely killed.
I have no experience with Klonopin, but it's known to be able to cause or worsen depression. Any benzo could do that though. I find Ativan (lorazepam) pretty antidepressing.
> e) drugs that increase dopamine production and availability as the main effect increase anger, frustration and rumination?Well, anger, frustration - possibly, that can happen. But ANXIETY - surely. Most stimulating meds are anxiogenic, i.e. causing anxiety. And dopeminergic meds tend to make me go in hyperfocus/tunnel-vision mode - which can cuase/worsen both anxious obsessions and addictive behaviour (like obsessive surfing).
Posted by Brainbeard on June 22, 2009, at 9:14:59
In reply to Re: Has anyone else noticed that....., posted by Brainbeard on June 22, 2009, at 9:13:49
By the way, Michael, how much Risperdal did you take with your SSRI?
Posted by HyperFocus on June 22, 2009, at 17:13:29
In reply to Has anyone else noticed that....., posted by Michael Bell on June 21, 2009, at 23:28:22
> Has anyone else noticed that:
>
> a) medications that have norepinephrine reuptake inhibition as one of their mechanisms of action, such as reboxetine, and tramadol, increase emotional instability, increase the feeling that others are judging you/staring at you, etc., and increase sensitivity to perceived rejection?
~On a high-dose of amitryptiline I'm actually less paranoid immediately after.>
> b) Drugs that are effective for the physiological aspects (heart pounding, sweating, abject terror) of social anxiety, such as klonopin and Nardil, don't help with the "social paranoia" aspect of social anxiety, meaning the beliefs and thought processes that people are looking at them, judghing them negatively, etc.
~Yes benzos work on my anxiety but they don't extinguish any of the destructive thought processes. Years of taking benzos haven't helped my SP change permanently at all.
>
> c) SSRIs + Antipsychotics are pretty damned good for the following: anger outbursts, feelings of frustration, and social parania.
~Haven't had this experience yet.
>
> d) klonopin, on its own, causes depression and anger issues to worsen.
>
~Klonopin makes me anhedonic and very unmotivated - well, more than usual.
> e) drugs that increase dopamine production and availability as the main effect increase anger, frustration and rumination?
~Took amineptine and tianeptine and sulpiride low dose but never noticed this
>
> This has been my general experience with meds. Insofar as social anxiety is concerned, a combination of risperdal plus lexapro has proven much more effective at addressing issues such as anger, suspicion of others' intent, and social paranoia than any other medication, even more than the so called "gold standards" of SP treatment, like Nardil and Klonopin. I've really begun trusting people more and actually looking forward to social gatherings, so I guess the social reward mechanism has very weakly started to kick in. My guess is it will get stronger as time goes by. Also, meds that cause oxytocin release, such as Vilazodone might do, will also probably have profound effects on prosocial behavior.~Also therapy is very important
Posted by Michael Bell on June 22, 2009, at 22:53:32
In reply to Re: Has anyone else noticed that....., posted by Brainbeard on June 22, 2009, at 9:14:59
> By the way, Michael, how much Risperdal did you take with your SSRI?
.75 mg per night of risperdal plus 10mg lexapro. Best ever for social paranoia. And the ACT (acceptance commitment therapy) has been very effective also.
Posted by sukarno on June 26, 2009, at 12:09:02
In reply to Has anyone else noticed that....., posted by Michael Bell on June 21, 2009, at 23:28:22
"a) medications that have norepinephrine reuptake inhibition as one of their mechanisms of action, such as reboxetine, and tramadol, increase emotional instability, increase the feeling that others are judging you/staring at you, etc., and increase sensitivity to perceived rejection?"
Pamelor (nortriptyline) is a norepinephrine reuptake inhibitor and it worked very well for me. Maybe SNRIs work differently? I had no panic attacks or depression while on Pamelor and also felt full of motivation and could concentrate easily on any task at hand. I had straight A's in school while on that medication.
"b) Drugs that are effective for the physiological aspects (heart pounding, sweating, abject terror) of social anxiety, such as klonopin and Nardil, don't help with the "social paranoia" aspect of social anxiety, meaning the beliefs and thought processes that people are looking at them, judghing them negatively, etc."
I found that Klonopin and other benzodiazepines lower my inhibitions to the point where I am able to socialize with others and feel a sense of confidence. It makes me worry less about what others think. Everyone is different though in their reactions to drugs.
"c) SSRIs + Antipsychotics are pretty damned good for the following: anger outbursts, feelings of frustration, and social parania."
I don't know about antipsychotics, but SSRIs tend to cause emotional blunting/numbing and are helpful for that. Prozac made me feel very stable, yet numb so that I didn't feel particularly happy or sad about anything. It is hard to describe, but I would say it felt "artificial". I also didn't feel angry about anything either. Amazing stuff in that regard. ;-)
"d) klonopin, on its own, causes depression and anger issues to worsen."
Yes, definitely. I experienced depression. Benzodiazepines lower inhibitions, so people prone to anger can experience outbursts of anger or even rage, although that is not common. I read recently that BZDs stimulate the aggression center of the brain.
"e) drugs that increase dopamine production and availability as the main effect increase anger, frustration and rumination?"
Well, I only take Stablon, which is mild in its dopamine-boosting effects, but it is enough that I feel a desire to gamble or seek out excitement or pleasure. Fortunately I can restrain myself and not gamble or anything else, but dopamine indeed increases reward seeking behavior...at least I think it does from what I read.
Posted by Brainbeard on June 27, 2009, at 5:01:32
In reply to Re: Has anyone else noticed that....., posted by sukarno on June 26, 2009, at 12:09:02
> Well, I only take Stablon, which is mild in its dopamine-boosting effects, but it is enough that I feel a desire to gamble or seek out excitement or pleasure. Fortunately I can restrain myself and not gamble or anything else, but dopamine indeed increases reward seeking behavior...at least I think it does from what I read.
Interesting. I have been experimenting with tianeptine (Stablon) too. The regular 3 x 12.5mg a day, but also other dosages. (Not very high though - that stuff is way too expensive for that). It also stimulated pleasure-seeking behaviour in me. But the thing is, the SSRIs do so too in my case. Very pronounced. SSRIs even seem to increase my 'mental libido' (while decreasing my physical libido). I think we really know squat yet about SSRIs working mechanisms. They seem to have some pro-dopaminergic properties, though in the long run they're obviously anti-dopaminergic. I'm currently theorizing about the possibility that it might be the SSRIs anti-dopaminergic effect rather than their serotonergic effect that is mostly responsible for their anti-OCD potential.
Posted by sowhysosad on June 27, 2009, at 8:43:26
In reply to Has anyone else noticed that....., posted by Michael Bell on June 21, 2009, at 23:28:22
I think you're onto something there. Imipramine definitely had that effect on me.
It also induced symptoms of atypical depression, and they say personal rejection sensitivity is common with typical.
Could there be a link? Is norepinephrine the culprit for some of us as you suggest?
> Has anyone else noticed that:
>
> a) medications that have norepinephrine reuptake inhibition as one of their mechanisms of action, such as reboxetine, and tramadol, increase emotional instability, increase the feeling that others are judging you/staring at you, etc., and increase sensitivity to perceived rejection?
Posted by sowhysosad on June 27, 2009, at 8:48:38
In reply to Has anyone else noticed that....., posted by Michael Bell on June 21, 2009, at 23:28:22
Just noticed this observation too, and I've found exactly the same thing with dopaminergic supplements.
Had to pull back on them due to temper tantrums, frustration and increased rumination.
We seem to react to things in a really similar way! The main difference being my issues are with unipolar depression and, I'm beginning to suspect, leanings towards OCD.
> Has anyone else noticed that:
> e) drugs that increase dopamine production and availability as the main effect increase anger, frustration and rumination?
This is the end of the thread.
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