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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 10 to 34 of 45. Go back in thread:
Posted by hildi on August 5, 2002, at 20:28:07
In reply to Re: How Parnate saved my butt » cybercafe, posted by LLL on August 5, 2002, at 9:03:50
Posted by hildi on August 5, 2002, at 20:36:41
In reply to Re: How Parnate saved my butt » cybercafe, posted by Ritch on August 5, 2002, at 10:06:28
> > >you solve avoidance issues (medications or CBT), you still have approach (interest) issues to deal with. The bottom line is--if you lack the motivation and interest to interact with other new folks-all of the therapy/meds to stop avoidance behaviors are lost if the motivational issues aren't addressed. That is where the MAOI's and stimulants have a role in treatment, IMO.
> >
> > that makes good sense to me -- though some might say that if you are lacking the motivation and interest you are experiencing depression? .... though to begin with i couldn't even imagine what it would be like to avoid contact with people and not be depressed!
> >
> > .... one thing that is a little harder to get rid of is agoraphobia -- like sitting still for a 3+ hour car ride .... any idea what the best med is for this?
> >
> > .. i also find it difficult to walk up to a group of 10 girls...
> >
>
>
> Cyber,
>
> You have a good point about the depression aspect of SA. I have had recurring major (and not so major) depressions for 25 years now (sometimes 4 or more a year). There definitely is a correlation to motivation/interest and *lack* of depression! I think I just get used to being depressed and it probably isn't really being treated because of my med-induced hypomanias. When I am hypomanic I can talk to dead people (figuratively..of course)! Agoraphobia is something that tends to develop and be reinforced at the tail end of my depressions, then I will flip back into hypomania, come out of my shell, unlearn all of the agoraphobic behaviours, just about the time I get depressed again. Bummer. Meds that historically work well for agoraphobia tend to be sedative tricyclics like amitripytline. Probably Remeron would do well for that. MAOI's are good for phobias generally, but probably work best for "specific" phobias. Bottom line--like you say--if you are depressed you aren't going to be interested in socializing!
>
> MitchHi guys. Yeah- this is a good thread, I feel. I really have avoidance issues. I shut myself off and isolate. I really need to get out there, but I haven't mentally and physically felt up to it. I am still playing around, trying to find a med for me that works (and my dr. is being a jerk- he puts me on things that makes me sick and tells me to grin and bear it) and I tell myself that when I feel better I will get out there. . .
But theres more to it. You guys hit it when you said 'you need to WANT to be well" and you need to get OUT there". I am afraid to get out there. My problems are probably psychological as well as biological.
I really don't like people that much. I don't know if the right meds will ever change that part of me. I really am a loner-but I don't want to be.
I like some of the suggestions - I have to force myself to start making steps . . .
Posted by Ritch on August 6, 2002, at 0:48:21
In reply to Re: How Parnate saved my butt, posted by hildi on August 5, 2002, at 20:36:41
> > > >you solve avoidance issues (medications or CBT), you still have approach (interest) issues to deal with. The bottom line is--if you lack the motivation and interest to interact with other new folks-all of the therapy/meds to stop avoidance behaviors are lost if the motivational issues aren't addressed. That is where the MAOI's and stimulants have a role in treatment, IMO.
> > >
> > > that makes good sense to me -- though some might say that if you are lacking the motivation and interest you are experiencing depression? .... though to begin with i couldn't even imagine what it would be like to avoid contact with people and not be depressed!
> > >
> > > .... one thing that is a little harder to get rid of is agoraphobia -- like sitting still for a 3+ hour car ride .... any idea what the best med is for this?
> > >
> > > .. i also find it difficult to walk up to a group of 10 girls...
> > >
> >
> >
> > Cyber,
> >
> > You have a good point about the depression aspect of SA. I have had recurring major (and not so major) depressions for 25 years now (sometimes 4 or more a year). There definitely is a correlation to motivation/interest and *lack* of depression! I think I just get used to being depressed and it probably isn't really being treated because of my med-induced hypomanias. When I am hypomanic I can talk to dead people (figuratively..of course)! Agoraphobia is something that tends to develop and be reinforced at the tail end of my depressions, then I will flip back into hypomania, come out of my shell, unlearn all of the agoraphobic behaviours, just about the time I get depressed again. Bummer. Meds that historically work well for agoraphobia tend to be sedative tricyclics like amitripytline. Probably Remeron would do well for that. MAOI's are good for phobias generally, but probably work best for "specific" phobias. Bottom line--like you say--if you are depressed you aren't going to be interested in socializing!
> >
> > Mitch
>
> Hi guys. Yeah- this is a good thread, I feel. I really have avoidance issues. I shut myself off and isolate. I really need to get out there, but I haven't mentally and physically felt up to it. I am still playing around, trying to find a med for me that works (and my dr. is being a jerk- he puts me on things that makes me sick and tells me to grin and bear it) and I tell myself that when I feel better I will get out there. . .
> But theres more to it. You guys hit it when you said 'you need to WANT to be well" and you need to get OUT there". I am afraid to get out there. My problems are probably psychological as well as biological.
> I really don't like people that much. I don't know if the right meds will ever change that part of me. I really am a loner-but I don't want to be.
> I like some of the suggestions - I have to force myself to start making steps . . .
Hildi,I was thinking about this thread later today and wanted to add to it a little more. I don't want to trash SSRI meds that badly.. but.. there is an experience that I have noticed with them. There are times where you are forced to be around folks that you "normally" wouldn't get near for any amount of money! ... and you can just stand there and BS and smile away, but when they disperse, you just experience this "WHEW!", glad they left kind of feeling. And it seems all messed up-you feel guilty for not truly liking those people. But, OTOH, who says you HAVE TO? So is the REAL problem feeling guilty or not? Obviously, if it is OK to feel "anti-social", then you are wasting your time persecuting yourself for being honest with your feelings. BUT, there are *times* when everything "clicks" with just about everybody you meet and *everybody* is OK and that feels GREAT! It is like you have found a kindred soul in everybody you meet. I like that! I really wonder if a lot of social anxiety IS just untreated depression (lack of interest). Just a couple dozen thoughts,
Mitch
Posted by cybercafe on August 6, 2002, at 13:57:01
In reply to Re: How Parnate saved my butt » cybercafe, posted by Ritch on August 5, 2002, at 10:06:28
>Remeron would do well for that. MAOI's are good for phobias generally, but probably work best for "specific" phobias. Bottom line--like you say--if you are depressed you aren't going to be interested in socializing!
i think you and lisa both have some good ideas...
you see there is active social phobia like talking to people that antidepressants and hypomania and narcissism definately solve!
but then there is passive (agitated?) agoraphobia.. like having to sit still for 2 or 3 hours in a movie theatre, for a test, in a car... and hypomania and desire to socialize doesn't really motivate me to conquer these (it probably makes my agitation more energetic)
advice?
Posted by cybercafe on August 6, 2002, at 14:00:42
In reply to Re: How Parnate saved my buttcyber, posted by jaby on August 5, 2002, at 11:39:52
> The riding in a car or bus thing is tough. It's usually just the anticipation and the first 20 minutes that are the worst for me. I just flew from LA to Chicago and that was my experience.
... you mean i'm not the only one with this problem?
> As far as walking up to a group of 10 girls, there's something wrong with you if yu DON'T have a problem with that. I was successful athlete
... you get used to it with time... like if you are talking to women 3 or 4 times a week... but i find it i take even one week off, i'm back to being mr. social phobic
> I do have a question...Do you drink at all on parnate and if so, what? Just curious.
nope sorry i don't drink... partially because i don't want a hypertensive crisis, but mainly because it stops the medication from being metabolizes for a few days and i want all the antidepressant effect i can get
Posted by cybercafe on August 6, 2002, at 14:03:12
In reply to Re: How Parnate saved my butt, posted by hildi on August 5, 2002, at 20:36:41
> I really don't like people that much. I don't know if the right meds will ever change that part of me. I really am a loner-but I don't want to be.
this is really fascinating to me... i actually talked to someone in The Real World (tm) who was like this ...
how is it that you can not like people but not want to be alone? ... i mean if you don't want to be alone, aren't you more happier when you are around people and that loneliness disappears?
Posted by LLL on August 6, 2002, at 14:04:18
In reply to Re: How Parnate saved my butt, posted by cybercafe on August 6, 2002, at 13:57:01
Right now I'd be thrilled if I could ride in a car for 20 minutes let alone worry about going for 3 hours. The only way I can crawl back out of this quicksand called Agoraphoba is with my med's (not yet on a therapeutic dose) and CBT. CBT is extremely helpful. I suggest you do an internet search, do some research and buy a couple of self help books addressing agoraphobia (usually in combination with panic.) Also, force yourself to do, do, do, regardless of how you feel! Changing your thinking changes your feelings and behavior, but changing your behavior can also change your feelings and thoughts!
Posted by hildi on August 6, 2002, at 19:38:48
In reply to Re: How Parnate saved my butt » hildi, posted by Ritch on August 6, 2002, at 0:48:21
Yeah Mitch, I get what your saying-there are many times (while I am taking my SSRI's) that I just BS my way through entire social engagements, and then, on my way home I'll be exhausted from all my 'play acting' and my mouth is sore from grinning too much.
I feel like such a fake- this is with people that I like, sometimes. Then I feel guilty from not being 'real' with them. . . but how could I be real. If I was real I would be a big downer, not laughing or joking with everyone.
It some seem that alot of this could be depression. It takes so much effort to put on this big act that "hey , I'm OK, I am this fun gal". I get totally exausted by social events for this reason- I feel I have to perform.However, there are other times, though, when I really do seem to click with everyone I meet. It is almost effortless and I think I feel almost normal- and am actually having fun. These occasions are usually those kind where I don't spend a lot of time with any one person. I think that takes a lot of pressure off of me, too.
I get scared if I think someone is actually going to be able to see how scared and depressed I really am. I don't want people to know- that is too humiliating and would make me way to vulnerable.
You know, sometimes my SSRI's make me not "give a shit". . .I don't care about being alone sometimes. . .I think they take away my cares too much where i don't feel many things, including the need to inateract with other people. I don't like this part. I want to feel, but now get blown away. What can I take that will allow that?
Hildi
Posted by LLL on August 6, 2002, at 21:41:34
In reply to Re: How Parnate saved my butt » Ritch, posted by hildi on August 6, 2002, at 19:38:48
Cybercafe - as someone who does not suffer from depression or social anxiety disorder, and am fine in social situations, (as long as I can get there!) I can tell you that the rest of the so-called "normals" out there find socializing to be somewhat of a chore as well. I also have to force myself at times to socialize, it doesn't come naturally for me or most people. If you look around, the ones who appear to be most comfortable are those who are tanked. Since I don't drink, either on or off MAOI's, I can see there's a big difference in social situations for those who do drink and those who don't. Those who drink are medicating themselves because they too are anxious, or awkward, or self conscious or .... When I'm with people I know it's easier, but it still takes effort. Believe me, it's hard for EVERYONE and you need to give yourself more credit. People who tell you they're totally comfortable meeting and talking and socializing with others are either a)lying b)buzzed on alcohol or drugs during the process or c)so slick they're not likeable! Go easy on yourself, and keep on keeping on!
Good Luck!
Posted by Ritch on August 7, 2002, at 0:19:53
In reply to Re: How Parnate saved my butt, posted by cybercafe on August 6, 2002, at 13:57:01
> >Remeron would do well for that. MAOI's are good for phobias generally, but probably work best for "specific" phobias. Bottom line--like you say--if you are depressed you aren't going to be interested in socializing!
>
> i think you and lisa both have some good ideas...
>
> you see there is active social phobia like talking to people that antidepressants and hypomania and narcissism definately solve!
>
> but then there is passive (agitated?) agoraphobia.. like having to sit still for 2 or 3 hours in a movie theatre, for a test, in a car... and hypomania and desire to socialize doesn't really motivate me to conquer these (it probably makes my agitation more energetic)
>
> advice?
>Cyber,
That is when I tend to have *panic* attacks. Closed in rooms where I have to sit still and listen-be a captive audience in a group of strangers. UGH. College was hell, especially big lecture halls, yuck! I liked "hands-on" stuff like design classes where you have to physically move around some and work on projects. The worst possible thing was listening to a droning lecture class after class. I notice that if I dont' *feel* restless it isn't as bad. Advice-heck I don't know. I was on Prozac and Lithium and I still had panic atacks every semester-sometimes several in one class three times a week! My pdoc at that time was anti-benzo and wouldn't write for them. I actually made it through all that crap-jeez it is hard to believe.
Mitch
Posted by Ritch on August 7, 2002, at 0:38:01
In reply to Re: How Parnate saved my butt » Ritch, posted by hildi on August 6, 2002, at 19:38:48
> Yeah Mitch, I get what your saying-there are many times (while I am taking my SSRI's) that I just BS my way through entire social engagements, and then, on my way home I'll be exhausted from all my 'play acting' and my mouth is sore from grinning too much.
> I feel like such a fake- this is with people that I like, sometimes. Then I feel guilty from not being 'real' with them. . . but how could I be real. If I was real I would be a big downer, not laughing or joking with everyone.
> It some seem that alot of this could be depression. It takes so much effort to put on this big act that "hey , I'm OK, I am this fun gal". I get totally exausted by social events for this reason- I feel I have to perform.
>
> However, there are other times, though, when I really do seem to click with everyone I meet. It is almost effortless and I think I feel almost normal- and am actually having fun. These occasions are usually those kind where I don't spend a lot of time with any one person. I think that takes a lot of pressure off of me, too.
>
> I get scared if I think someone is actually going to be able to see how scared and depressed I really am. I don't want people to know- that is too humiliating and would make me way to vulnerable.
> You know, sometimes my SSRI's make me not "give a shit". . .I don't care about being alone sometimes. . .I think they take away my cares too much where i don't feel many things, including the need to inateract with other people. I don't like this part. I want to feel, but now get blown away. What can I take that will allow that?
> Hildi
Hildi,Thanks for replying. I know exactly what you mean! I am more convinced than ever that it is all bio-chemically based. When I get my bipolar major depressions (when they are poorly treated), the main symptoms are lack of interest in socializing and this tremendous BOREDOM and TIREDNESS with everything (not just social stuff). It is the "interest in everyday activities" element of the depression that is foremost. The next biggest elements that are prominent is "ability to concentrate" and "slowed thoughts" and "fatigue". I have mentioned this here before, but I think that Social Anxiety is deeply connected with that "limbic" or "depressive" ADD that you hear about. That is where SSRI's fail to some degree IMO. They are good at giving you a "thicker skin", but wouldn't it be superior to feel drawn out of your own shell-by being truly *interested* in what is going on out there (wanting to check it out), instead of just having a THICKER SHELL? That is where SSRI's fall short-motivation and interest. Motivation and interest are often attributed to dopaminergic meds. I have tried stimulants and they have helped so-so, but they tend to worsen panic (in my situation anyhow), despite their ability to improve attention and alleviate depression, etc. That is probably why the MAOI's have the overall superior edge for social phobia. They can reduce panic AND increase dopaminergic transmission which tends to promote motivationi and interest. Just a few ideas here. I don't know if my current pdoc will every write for the things. I am half-ass solving this problem with a low-dose combo of Effexor and Wellbutrin right now. However, I think that the MAOI's might be the best meds. You might want to talk to your doc about them anyhow,
good luck,
Mitch
Posted by cybercafe on August 7, 2002, at 1:34:33
In reply to Re: How Parnate saved my butt » cybercafe, posted by Ritch on August 7, 2002, at 0:19:53
> That is when I tend to have *panic* attacks. Closed in rooms where I have to sit still and listen-be a captive audience in a group of strangers. UGH. College was hell, especially big lecture halls, yuck! I liked "hands-on" stuff like design classes where you have to physically move around some and work on projects. The worst possible thing was listening to a droning lecture class after class. I notice that if I dont' *feel* restless it isn't as bad. Advice-heck I don't know. I was on Prozac and Lithium and I still had panic atacks every semester-sometimes several in one class three times a week! My pdoc at that time was anti
i would often get attacks of terror... but i am told that panic attacks are when you think you are dieing/having a heart attack? so because i was aware that what was going on was anxiety this would mean they are not panic attacks, yes? no?
thanks for the reply :)
Posted by cybercafe on August 7, 2002, at 1:38:05
In reply to Re: How Parnate saved my butt » hildi, posted by Ritch on August 7, 2002, at 0:38:01
>foremost. The next biggest elements that are prominent is "ability to concentrate" and "slowed thoughts" and "fatigue". I have mentioned this
Hey Mitch ... question... my doc says that after your depression remits, it takes 3 to 5 months for you to get your cognitive function back... have you found this to be the case?
Posted by Ritch on August 7, 2002, at 9:53:02
In reply to Re: How Parnate saved my butt, posted by cybercafe on August 7, 2002, at 1:38:05
>i would often get attacks of terror... but i am told that panic attacks are when you think you are dieing/having a heart attack? so because i was aware that what was going on was anxiety this would mean they are not panic attacks, yes? no?
They tend to come on very rapidly. My experience is a sudden feeling of depersonalization and unreality followed immediately by flushed skin with racing heartbeat (often sweating hands, too). I just bite my lip, pinch my arm and ride it out. They usually last about 20-30 seconds or so. The trouble is when the damn things fade and then come back and repeat over and over. I think I would be oddly *relieved* if it *were* a heart attack instead.
> >foremost. The next biggest elements that are prominent is "ability to concentrate" and "slowed thoughts" and "fatigue". I have mentioned this
>
> Hey Mitch ... question... my doc says that after your depression remits, it takes 3 to 5 months for you to get your cognitive function back... have you found this to be the case?There's no way I can really find out, because my moods cycle so rapidly. :)
Mitch
Posted by LLL on August 7, 2002, at 10:59:46
In reply to Re: How Parnate saved my butt, posted by cybercafe on August 7, 2002, at 1:34:33
Panic attacks are just as you described. Some people think they are going to die, others are having heart attacks, others feel like they're going crazy etc. It's all panic attack. You're thinking before any of this takes place, like "oh my God, what if I had one now and couldn't leave" and then of course you become more anxious and think more anxious thoughts until you've spun yourself up to panic. This takes only seconds to do. Try to become aware of your anxious thoughts.
Once you do you can begin to see how you trigger them and can begin to "let these thoughts go". When you're not aware of how your thinking precipitates the panic it seems as if the panic or "terror" just comes out of the blue. The truth is there are automatic, almost habitual, irrational thoughts that come before these symptoms. Again, I highly recommend you buy some self help books on panic disorder so you can begin some CBT.
Posted by hildi on August 7, 2002, at 16:47:08
In reply to Re: How Parnate saved my butt » hildi, posted by Ritch on August 7, 2002, at 0:38:01
> > Yeah Mitch, I get what your saying-there are many times (while I am taking my SSRI's) that I just BS my way through entire social engagements, and then, on my way home I'll be exhausted from all my 'play acting' and my mouth is sore from grinning too much.
> > I feel like such a fake- this is with people that I like, sometimes. Then I feel guilty from not being 'real' with them. . . but how could I be real. If I was real I would be a big downer, not laughing or joking with everyone.
> > It some seem that alot of this could be depression. It takes so much effort to put on this big act that "hey , I'm OK, I am this fun gal". I get totally exausted by social events for this reason- I feel I have to perform.
> >
> > However, there are other times, though, when I really do seem to click with everyone I meet. It is almost effortless and I think I feel almost normal- and am actually having fun. These occasions are usually those kind where I don't spend a lot of time with any one person. I think that takes a lot of pressure off of me, too.
> >
> > I get scared if I think someone is actually going to be able to see how scared and depressed I really am. I don't want people to know- that is too humiliating and would make me way to vulnerable.
> > You know, sometimes my SSRI's make me not "give a shit". . .I don't care about being alone sometimes. . .I think they take away my cares too much where i don't feel many things, including the need to inateract with other people. I don't like this part. I want to feel, but now get blown away. What can I take that will allow that?
> > Hildi
>
>
> Hildi,
>
> Thanks for replying. I know exactly what you mean! I am more convinced than ever that it is all bio-chemically based. When I get my bipolar major depressions (when they are poorly treated), the main symptoms are lack of interest in socializing and this tremendous BOREDOM and TIREDNESS with everything (not just social stuff). It is the "interest in everyday activities" element of the depression that is foremost. The next biggest elements that are prominent is "ability to concentrate" and "slowed thoughts" and "fatigue". I have mentioned this here before, but I think that Social Anxiety is deeply connected with that "limbic" or "depressive" ADD that you hear about. That is where SSRI's fail to some degree IMO. They are good at giving you a "thicker skin", but wouldn't it be superior to feel drawn out of your own shell-by being truly *interested* in what is going on out there (wanting to check it out), instead of just having a THICKER SHELL? That is where SSRI's fall short-motivation and interest. Motivation and interest are often attributed to dopaminergic meds. I have tried stimulants and they have helped so-so, but they tend to worsen panic (in my situation anyhow), despite their ability to improve attention and alleviate depression, etc. That is probably why the MAOI's have the overall superior edge for social phobia. They can reduce panic AND increase dopaminergic transmission which tends to promote motivationi and interest. Just a few ideas here. I don't know if my current pdoc will every write for the things. I am half-ass solving this problem with a low-dose combo of Effexor and Wellbutrin right now. However, I think that the MAOI's might be the best meds. You might want to talk to your doc about them anyhow,
>
> good luck,
>
> Mitch
>
>
Hi Mitch. I did try to talk to my dr. about MAOI's and he wouldn't listen. he is really 'pissed' at me and not open to any of my suggestions. After going off of zoloft because of physical sick symptoms ( shakiness, nausea, fainting spells, more) and maybe hypomanic symptoms (racing thoughts, major irritability, hyper and obsessing over things and thoughts) dr. tried me on celexa and effexor. I hated both of them.
Well, now he says I'm expecting too much, too bad about feeling like shit and just deal with it. he pretty much just threw his hands up in the air and said "I give Up".
So, he gave me paxil-which I didn't want, and told me he won't even discuss anything else.
I am having extreme anxiety attacks on the paxil. I don't want to up the dose because I can't afford it, also I am experiencing a very wierd side effect from paxil CR at 12.5 mg- intense interest in sex!! All I can think about!~ Is this mania?
I am going to TRY to get the dr. to talk to me tomorrow- I am going to PLEAD with him to give me a benzo-I was really against this (because I'm an alcoholic, 9 years sober) but I have changed my thoughts on this big time. If I am going to be dependent on a med, I want it to be something that at least will help me. I am thinking, if I can do benzos for a little while while I clean my body of AD's I may then be able to try an MAOI.
The dr. even suggested benzos to me twice. He knows my situation and doesn't think it would be a problem. BUT, he is really acting wierd with me. I think I insulted his manhood or something by questioning him too much, sometimes in fromt of his collegues. This is when his attitute changed tremendously.
I might be out of luck completely now with this guy. If I cannot get some relief from this anxiety I am afraid I WILL go back to drinking. I used drinking for many years for anxiety. I cannot go it alone.
Hildi
Posted by Geezer on August 7, 2002, at 19:02:57
In reply to Re: How Parnate saved my butt, posted by hildi on August 7, 2002, at 16:47:08
Hi Hildi,
What the h*** is wrong with this pdoc??!!! How did it happen you were discussing things in front of his collegues - he should never let that happen. I haven't read the entire thread - so kind of shooting from the hip here. You are showing some real signs of bipolar disorder and I don't think this ding-a-ling is doing you any favors. Seems to me some of your symptoms could be due to the destabilizing effects of SSRIs you have been given (unless you have used stabilizers at the same time - can't believe he wouldn't try that - although I had one who didn't for 20 years). I have been sober since 1975, clean since 1985, just had to take a benzo (.5mg klonopin) starting a month ago. I find Klonopin gives me no euphoria and have not increased the dose. You might need to use something to hold you togeather.
You are in good hands with Mitch.....he has helped me more than once.
Wishing you the best,
Geezer
Posted by cybercafe on August 7, 2002, at 23:30:28
In reply to Re: How Parnate saved my butt » cybercafe, posted by Ritch on August 7, 2002, at 9:53:02
> They tend to come on very rapidly. My experience is a sudden feeling of depersonalization and unreality followed immediately by flushed skin with racing heartbeat
(often sweating hands, too). I just bite my lip, pinch my arm and ride it out. They usually last about 20-30 seconds or so. The trouble is when the damn things fade and then come back and repeat over and over. I think I would be oddly *relieved* if it *were* a heart attack instead.i tend to get really embarrassed and feel like i'm going to lose control... voice cracks, feel like i'm going to start crying or otherwise lose control... but just as i realize i'm about to cry or something i get an even more major adrenalin rush... as i can't believe it's going to happen or let it happen... and i then put fourth great effort to try and cover up my physical symptoms by... distracting my audience... by..talking faster? ... or trying to act like my totally unbased emotions of FEAR and shame and embarrassment are based on something real (i.e. bring up a topic or talk about something in a way that is based on real emotion) ... or just wait for the fear to go away meanwhile completely not believing that anyone can experience so much fear... and in response to nothing...
so at first did you think it was a heart attack or some other deathly illness? ... i ask because diagnostic criteria indicates that a panic attack is a belief you are going to die/are having a heart attack
> There's no way I can really find out, because my moods cycle so rapidly. :)
hmmm... i find cycling goes away when i totally eliminate all stress (don't leave my house except for martial arts or to visit friends or to work out?)
i guess it's weird that parnate doesn't cause me to cycle at all though
Posted by cybercafe on August 7, 2002, at 23:37:17
In reply to Re: How Parnate saved my butt » cybercafe, posted by LLL on August 7, 2002, at 10:59:46
> Panic attacks are just as you described. Some people think they are going to die, others are having heart attacks, others feel like they're going crazy etc. It's all panic attack. You're
so no one really recognizes that it's all just anxiety?
>thinking before any of this takes place, like "oh my God, what if I had one now and couldn't leave" and then of course you become
hmmm... i thought people who had panic attacks thought they were having something else (heart attacks for example)...
... so how is it that you can go from "i hope i don't have one of those panic attacks" to "i'm having a panic attack" to "no wait a sec -- i'm actually dieing here" ... why don't people realize that they're just having panic attacks.. or do they?>symptoms. Again, I highly recommend you buy some self help books on panic disorder so you can begin some CBT.
hmmm... i'll take a look, thanks :)
Posted by Ritch on August 8, 2002, at 1:19:18
In reply to Re: How Parnate saved my butt, posted by hildi on August 7, 2002, at 16:47:08
> > > Yeah Mitch, I get what your saying-there are many times (while I am taking my SSRI's) that I just BS my way through entire social engagements, and then, on my way home I'll be exhausted from all my 'play acting' and my mouth is sore from grinning too much.
> > > I feel like such a fake- this is with people that I like, sometimes. Then I feel guilty from not being 'real' with them. . . but how could I be real. If I was real I would be a big downer, not laughing or joking with everyone.
> > > It some seem that alot of this could be depression. It takes so much effort to put on this big act that "hey , I'm OK, I am this fun gal". I get totally exausted by social events for this reason- I feel I have to perform.
> > >
> > > However, there are other times, though, when I really do seem to click with everyone I meet. It is almost effortless and I think I feel almost normal- and am actually having fun. These occasions are usually those kind where I don't spend a lot of time with any one person. I think that takes a lot of pressure off of me, too.
> > >
> > > I get scared if I think someone is actually going to be able to see how scared and depressed I really am. I don't want people to know- that is too humiliating and would make me way to vulnerable.
> > > You know, sometimes my SSRI's make me not "give a shit". . .I don't care about being alone sometimes. . .I think they take away my cares too much where i don't feel many things, including the need to inateract with other people. I don't like this part. I want to feel, but now get blown away. What can I take that will allow that?
> > > Hildi
> >
> >
> > Hildi,
> >
> > Thanks for replying. I know exactly what you mean! I am more convinced than ever that it is all bio-chemically based. When I get my bipolar major depressions (when they are poorly treated), the main symptoms are lack of interest in socializing and this tremendous BOREDOM and TIREDNESS with everything (not just social stuff). It is the "interest in everyday activities" element of the depression that is foremost. The next biggest elements that are prominent is "ability to concentrate" and "slowed thoughts" and "fatigue". I have mentioned this here before, but I think that Social Anxiety is deeply connected with that "limbic" or "depressive" ADD that you hear about. That is where SSRI's fail to some degree IMO. They are good at giving you a "thicker skin", but wouldn't it be superior to feel drawn out of your own shell-by being truly *interested* in what is going on out there (wanting to check it out), instead of just having a THICKER SHELL? That is where SSRI's fall short-motivation and interest. Motivation and interest are often attributed to dopaminergic meds. I have tried stimulants and they have helped so-so, but they tend to worsen panic (in my situation anyhow), despite their ability to improve attention and alleviate depression, etc. That is probably why the MAOI's have the overall superior edge for social phobia. They can reduce panic AND increase dopaminergic transmission which tends to promote motivationi and interest. Just a few ideas here. I don't know if my current pdoc will every write for the things. I am half-ass solving this problem with a low-dose combo of Effexor and Wellbutrin right now. However, I think that the MAOI's might be the best meds. You might want to talk to your doc about them anyhow,
> >
> > good luck,
> >
> > Mitch
> >
> >
> Hi Mitch. I did try to talk to my dr. about MAOI's and he wouldn't listen. he is really 'pissed' at me and not open to any of my suggestions. After going off of zoloft because of physical sick symptoms ( shakiness, nausea, fainting spells, more) and maybe hypomanic symptoms (racing thoughts, major irritability, hyper and obsessing over things and thoughts) dr. tried me on celexa and effexor. I hated both of them.
> Well, now he says I'm expecting too much, too bad about feeling like shit and just deal with it. he pretty much just threw his hands up in the air and said "I give Up".
> So, he gave me paxil-which I didn't want, and told me he won't even discuss anything else.
> I am having extreme anxiety attacks on the paxil. I don't want to up the dose because I can't afford it, also I am experiencing a very wierd side effect from paxil CR at 12.5 mg- intense interest in sex!! All I can think about!~ Is this mania?
> I am going to TRY to get the dr. to talk to me tomorrow- I am going to PLEAD with him to give me a benzo-I was really against this (because I'm an alcoholic, 9 years sober) but I have changed my thoughts on this big time. If I am going to be dependent on a med, I want it to be something that at least will help me. I am thinking, if I can do benzos for a little while while I clean my body of AD's I may then be able to try an MAOI.
> The dr. even suggested benzos to me twice. He knows my situation and doesn't think it would be a problem. BUT, he is really acting wierd with me. I think I insulted his manhood or something by questioning him too much, sometimes in fromt of his collegues. This is when his attitute changed tremendously.
> I might be out of luck completely now with this guy. If I cannot get some relief from this anxiety I am afraid I WILL go back to drinking. I used drinking for many years for anxiety. I cannot go it alone.
> HildiHildi,
The reason your pdoc won't write for MAOI's is because of your past drinking history-I feel pretty sure on that one. He is afraid if he puts you on Nardil or Parnate, you might start drinking again and have a fatal interaction with the meds, then his ass is out hanging in the wind. What you might want to do is mention the "safer" (but somewhat less effective) MAOI's such as moclobemide or seligiline, and see what he says about them. You don't have dietary restrictions with those (at the recommended dosages), and alcohol is "ok" as long as it is moderate and low. If that doesn't pan out, you can discuss benzodiazepines (which might work fine). You do have a lot of options.
Mitch
Posted by Ritch on August 8, 2002, at 1:29:49
In reply to Re: How Parnate saved my butt, posted by cybercafe on August 7, 2002, at 23:30:28
> > They tend to come on very rapidly. My experience is a sudden feeling of depersonalization and unreality followed immediately by flushed skin with racing heartbeat
> (often sweating hands, too). I just bite my lip, pinch my arm and ride it out. They usually last about 20-30 seconds or so. The trouble is when the damn things fade and then come back and repeat over and over. I think I would be oddly *relieved* if it *were* a heart attack instead.
>
> i tend to get really embarrassed and feel like i'm going to lose control... voice cracks, feel like i'm going to start crying or otherwise lose control... but just as i realize i'm about to cry or something i get an even more major adrenalin rush... as i can't believe it's going to happen or let it happen... and i then put fourth great effort to try and cover up my physical symptoms by... distracting my audience... by..talking faster? ... or trying to act like my totally unbased emotions of FEAR and shame and embarrassment are based on something real (i.e. bring up a topic or talk about something in a way that is based on real emotion) ... or just wait for the fear to go away meanwhile completely not believing that anyone can experience so much fear... and in response to nothing...
>
> so at first did you think it was a heart attack or some other deathly illness? ... i ask because diagnostic criteria indicates that a panic attack is a belief you are going to die/are having a heart attack
>
> > There's no way I can really find out, because my moods cycle so rapidly. :)
>
> hmmm... i find cycling goes away when i totally eliminate all stress (don't leave my house except for martial arts or to visit friends or to work out?)
>
> i guess it's weird that parnate doesn't cause me to cycle at all though
>
Cyber,When I first had panic attacks (in the early '80's), I *did* think there was something physically wrong (similar to heart attack, etc.). But after I discussed things with my therapist (did biofeedback,etc.), I realized it was all mental with physical symptoms. So, during all of the subsequent panic attacks I KNEW that I wasn't having a heart attack, but I STILL experienced this horrible thing, despite that knowledge. That was probably what "enabled" me to go to college and finish while enduring the attacks. I never did any formal CBT, however. That is something I am going to take on soon (thanks for the reminder LLL). I must say that benzos thus far are the *only* meds that have been successful at PREVENTING a panic attack.
Mitch
Posted by LLL on August 8, 2002, at 8:55:41
In reply to Re: How Parnate saved my butt, posted by cybercafe on August 7, 2002, at 23:30:28
One More Time - yes you are having panic attacks. Each person interprets the symptoms differently. I never thought I was having a heart attack, and only sometimes did I think I might die if I didn't leave. For the most part it was just as you describe with the strong desire to LEAVE from wherever I was.
And again, you play a role in this regardless of your biochemistry. Your thinking about these past experiences influence your future ones and what you think about it at the time it occurs can either inflate or deflate the intensity of the experience. Drugs can only do so much. So, once again I highly recommend you read up on panic and agoraphobia and how YOU can begin to assist yourself in responding differently to this and thus diminish their hold on you over time.
Posted by hildi on August 8, 2002, at 15:00:29
In reply to Re: How Parnate saved my butt » hildi, posted by Geezer on August 7, 2002, at 19:02:57
> Hi Hildi,
>
> What the h*** is wrong with this pdoc??!!! How did it happen you were discussing things in front of his collegues - he should never let that happen. I haven't read the entire thread - so kind of shooting from the hip here. You are showing some real signs of bipolar disorder and I don't think this ding-a-ling is doing you any favors. Seems to me some of your symptoms could be due to the destabilizing effects of SSRIs you have been given (unless you have used stabilizers at the same time - can't believe he wouldn't try that - although I had one who didn't for 20 years). I have been sober since 1975, clean since 1985, just had to take a benzo (.5mg klonopin) starting a month ago. I find Klonopin gives me no euphoria and have not increased the dose. You might need to use something to hold you togeather.
>
> You are in good hands with Mitch.....he has helped me more than once.
>
> Wishing you the best,
>
> GeezerHi Geezer. Thanks for the reply and the kind words of encouragement. Also thanks for confirming that its OK to take a benzo. I thought about this long and hard, and even was suggested benzos by my dr, but I fought against it. The stigma of being an alcoholic on benzos, the reactions I'd get from some around me, my pride, all these were things I was worried about. I fought hard against going on ad's, too, long ago. I guess it's about being dependent on something else that scared me (and still does). But you know, I feel different now. I am dependent on these SSRI's anyhow. And these meds have a multitude of withdrawal symptoms. I don't feel good on these, but they do help a little- while increasing other problems.
I went to dr. today about anxiety meds. Hey was not happy to see me and was impatient. He says to up the paxil dose and won't talk about it any more.
his solutions has always been to up the dose. On Prozac I was hyper, aggressive, irritable, racing thoughts and sexual obsession and he says "up the dose". On zoloft I was physically sick, angry, apathatic, and he says again to 'up the dose'.
When I tried Effexor and Celexa and said the same thing.
Now here he goes again.
I have had it. i ordered some meds online for myself... they won't be here for a month, though.
Till then I don't know what I'll be able to do. What can I take to deal with this anxiety in between then? I cannot sleep either, so I need to buy something for that.
But I don't know if I should try upping the paxil like dr. said.?? paxil scares me.
Oh, by the way, about being bipolar- dr.laughs at this. Says I am not. So what 'am I ?', I ask- he shrugs it off. He does not like me to ask questions of any sort. I really hate this man right now. My life is in his hands and he is playing with my head.
Hildi
Posted by hildi on August 8, 2002, at 15:14:26
In reply to Re: How Parnate saved my butt » hildi, posted by Ritch on August 8, 2002, at 1:19:18
Hi Mitch. Moclobemide or Seligiline are safer? Do they work, though? I hear such great things about nardil and Parnate, but not much about these two.
I don't know if it is the drinking that makes him avoid prescribing an MAOI. For he has suggested benzos for me before, and when I said I didn't think it was a good idea, me being an alcoholic and all, dr said he saw nothing wrong with me being on benzos. This is the same dr. who works at the mental health clinic where I went through detox. He knows my full history of alcoholism. So it seems wierd that he would be OK with benzos but not with MAOIs.
I think ther is more to it. The way he is acting with me now confirms it. He seems to want to be in control and maybe thinks I am too opinionated. he is asian, and I don't mean to sound rasist, but maybe he prefers women to be more silent and demure. He has complained about my questions and attitute on more than one occasion. Now I don't even know how to act with this guy. I feel helpless. I try every angle with him and he treats my with disdain.
i went there today to talk about my over-the -top anxiety. His solution? Same as always: UP the SSRI. He couldn't get me back out the door fast enough.
I left there, again, feeling like shit.
I hate this game. I feel like I am a joke to this man. I feel like he has this power over me and is oppressing me.
I am totally broke, just lost my job, place to live, . . . and want to start waitressing for fast cash. Plus, waitress hours would work well with my school hours. Well, I cannot start this job yet because my anxiety is too over the top- cannot even put on my make-up or write a check, much less serve hot coffee!
i feel trapped!
hildi
Posted by Ritch on August 9, 2002, at 0:03:14
In reply to Re: How Parnate saved my butt, posted by hildi on August 8, 2002, at 15:14:26
> Hi Mitch. Moclobemide or Seligiline are safer? Do they work, though? I hear such great things about nardil and Parnate, but not much about these two.
> I don't know if it is the drinking that makes him avoid prescribing an MAOI. For he has suggested benzos for me before, and when I said I didn't think it was a good idea, me being an alcoholic and all, dr said he saw nothing wrong with me being on benzos. This is the same dr. who works at the mental health clinic where I went through detox. He knows my full history of alcoholism. So it seems wierd that he would be OK with benzos but not with MAOIs.
> I think ther is more to it. The way he is acting with me now confirms it. He seems to want to be in control and maybe thinks I am too opinionated. he is asian, and I don't mean to sound rasist, but maybe he prefers women to be more silent and demure. He has complained about my questions and attitute on more than one occasion. Now I don't even know how to act with this guy. I feel helpless. I try every angle with him and he treats my with disdain.
> i went there today to talk about my over-the -top anxiety. His solution? Same as always: UP the SSRI. He couldn't get me back out the door fast enough.
> I left there, again, feeling like shit.
> I hate this game. I feel like I am a joke to this man. I feel like he has this power over me and is oppressing me.
> I am totally broke, just lost my job, place to live, . . . and want to start waitressing for fast cash. Plus, waitress hours would work well with my school hours. Well, I cannot start this job yet because my anxiety is too over the top- cannot even put on my make-up or write a check, much less serve hot coffee!
> i feel trapped!
> hildiI really still think he will not write for the MAOI's due to your past alcoholism. It *could* be that he is worried about their safety generally, but I think it is the past substance abuse issue. There was a poster here who was being prescribed MAOI's for quite some time and happened to casually mention during a therapy session about casually using cocaine a few times in high school----the pdoc immediately discontinued her MAOI's! The danger is very real for alcohol/stimulant induced death from interaction with an MAOI. That also explains why he is willing to write for benzos. If you fall off the wagon and drink too much on benzos, you aren't going to risk a hypertensive reaction like you might with an MAOI. My suggestion? Let him write for the benzo and see about reducing the SSRI after a time. If that doesn't pan out, then press the MAOI issue (and perhaps bring up a *safer* MAOI like selegiline or moclobemide as a potential first trial). I read your post above about ordering meds online. If you have ordered MAOI's such as phenelzine or tranylcypromine and are not under a doctor's supervison when taking them you can be playing Russian roulette for real.
please be careful,
Mitch
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