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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by SteelRat on November 21, 2002, at 0:02:02
Eeackk! First time posting to an iNet help group. Antecdote: I took one look a couple of years ago at alt.depression.medications or somesuch NG, and (figuratively) ran away screaming..
Okay, my history: I had several episodes of what was probably mild or moderate depression in high-school, and a generally socially-avoidant, intorvert, "analysis-type" termperment since as far as I can remember (One non-scientific Myers-Briggs test I found said INFP, if that test still had *any* validity at all).
I was diagnosed with depression after during the first year of college (late-teens, away from home) - symptoms of not eating, extreme pessimism. Went on Zoloft (25mg/d), which worked extrememly well (I seemed hypomanic/hyperthymic for about 3 months instead of what they say is the usual 2 week period)
The next year, things progressively went to hell - I think diminished concentration and some recurrance of the depression. At this point I was at 100mg.
I came back home, and after a horrible time trying to switch to St. John's Wart at my parent's insistence (there is no recognized family history of depression, though both my parents have what might be called introverted/"depressive" temperments), my pdoc switched me to Celexa (20mg/d). After about a year, it started to cause too much sleepiness, so I switched to Wellbutrin (300mg/d).
Also about this time I started taking Lorazepam (0.5mg/d) for performance axiety, and noticed that it helped with social inhibition as well. (My performance anxiety has manifested itself as a kind of over-awareness of my voice and feelings of physical dissociation) Recently (Sept 11 to be exact) I became aware of an increase in the social inhibition - although whether this was an actual "worsening" or just a recognition of a previously unrecognized state (a "Plato's Cave experience" so to speak), and went back to the pdoc.
I had always thought that my depression was central and any anxiety was secondary to it, but started to wonder if it wasn't the reverse. The pdoc perscribed a very low-dose add-on of Risperdal to the Wellbutrin for anti-anxiety effects. I ended up taking 1/16 mg of that for 4 days. The anti-anxiety effect was wonderful (I felt like "Atlas with the world lifted from his sholders" around women for the first time in years), but I stopped taking it because of some strange depressive effect and a memory-lapse. I later learned that Risperdal is metabolized through CYP2D6, which is a contraindication for Wellbutrin.
I'm currently just taking the Wellbutrin (150mg-300mg/d) and Lorazepam (1-2mg/d) and have another appointment in a couple of days. My pdoc wants to try Risperdal, which would be fine with me (it did have wonderful effects), except for what I read about TD and other such scary stuff..
My mother would prefer for me to avoid a combination therapy (SSRI+benzo), which to me makes absolutely no sense as benzos basically ONLY affect GABA, and thus don't interfere at all with 5HT, NE, or D circuits.
My reaction to Celexa now and Paxil (2 day trial) is a feeling of being "hyperaware" and a bit "inwardly jittery" (as opposed to physically jittery), though that may just be transitory. This leads me to hypothesize that the effect is related to 5HT, since Wellbutrin doesn't affect 5HT much (I'm told). I hypothesize that the powerful anti-anxiety effect of the Risperdal was teh result of D2 action, though it was much more powerful (quantitatively and qualitatively) than the Wellbutrin, and Wellbutrin also affects D (but which subtype - is that hypothesized to be important in anxiety/inhibition?)
At this point, I don't want to deal with the Risperdal AT ALL - at least not now, and not for longer than 2 weeks in any case. Partly because of a (perhaps somewhat irrational) fear of TD, partly because I just don't really want to change my personality/temperment that much (I've read Listening To Prozac and loved it..)
The Lorazepam works very well for anxiety at the level of 1-4mg (1-2 for normal situations like dating, 3-4 for giving a class presentation). This is higher than my initial response dose of 0.5mg, which worries me some (tolerance). I'm considering asking the pdoc if I could try switching back to a low-dose of Zoloft (10-15mg/d). Although I may have poop-out effect there..
One thing the pdoc did mention about the Risperdal is that it might afford the brain a chance to "reverse" some of the fear-conditioning that's supposedly at the bottom of the anxiety, whereas the benzodiazipine just blocks the effects of anxiety. I presume because of Risperdal's effects of dopamine. Does this make any sense? (Does *anyone* really understand how long-term-potentiation [again what I assume is behind fear-conditioning in people as well as rats..] works and how it is mediated?)
Sorry about the long-windedness, I figured more info is better..
Posted by LyndaK on November 21, 2002, at 2:03:14
In reply to Depression and/or moderate SP?, posted by SteelRat on November 21, 2002, at 0:02:02
Gee! I thought I might be able to help, but your understanding is WAY beyond mine!
Your symptoms sound alot like mine. I used to take Zoloft but got memory/concentration problems as side-effects. I tried just about all the other SSRIs with similar results. I'm now on Remeron and feel the best that I have in a long time. It was very sedating at first, but not so bad now. Helps me go to sleep but I feel alert during the day. Remeron seems to help with my anxiety. Others have reported no help with anxiety or a worsening of their anxiety. I don't know why the difference in response, but that seems to be the case with most drugs and the individuality of people.
I applaude your knowledge.
Hope you find something that works well for you.Lynda
Posted by bluedog on November 21, 2002, at 10:25:49
In reply to Depression and/or moderate SP?, posted by SteelRat on November 21, 2002, at 0:02:02
You seem to have done plenty of research already.
I can only offer you my personal experience.
I have a primary diagnosis of social anxiety with secondary major depression. Like yourself my social anxiety is moderate with only certain situations triggering the anxiety with depression guaranteed to follow soon after. Pubs(bars) and clubs and parties where members of the opposite sex are present provides the most challenging environment for my condition. Family gatherings and gatherings of close friends and even the work environment are generally OK unless I am put on the spot and made the centre of attention. Dealing with clients at work also is not too bad unless a member of the opposite sex who I find attractive is involved. I generally feel preety ashamed at my inadequacy in these situations and I get extremely depressed and lonely about the whole situation. I can really relate to the feelings of disassociation you get. I can be in a crowded bar and feel like I'm a third party spectator watching the whole scene through a video camera.
Following is my experience with medications.
1. My first and absolute favourite medication was actually ALCOHOL (you didn't say whether self medication was a factor in your post). It is such a shame that ALCOHOL has such terrible side effects. If it wasn't for the brain damage, the hangovers and the crippling depression that ALCOHOL precipitates I would highly recommend it. Unfortunately for me ALCOHOL was a one way ticket to skid row and I had to stop using it to save my life.
2. Next came AROPAX (PAXIL in the US). I never got over the vicious anxiety that this drug gave me and I had a constant feeling that I had just drunk 8 strong black coffees in short succession. I also couldn't stop clenching my jaw and grinding my teeth and even though I've never had a seizure I had a feeling like I was always on the verge of having a seizure. Also had awful sexual side effects
3. AURORIX (MOCLOBEMIDE) - This MAOI actually helped me and had absolutely zero side effects. This drug probably saved my life at the time (about 7-8 years ago) and I'd say for a few years my symptoms went into a sort of remission. This drug was prescribed by a GP at the time and I was never told to restrict my diet in any way and I didn't have any problems. In fact I didn't even now you had to restrict your diet with MAOI's until I came to this message board. I woke up one morning and was no longer depressed and I simply stopped taking the drug.
3. However over the coming years circumstances in my life started to overtake me again and my illness slowly but surely came back to terrorise me. It was really sneaky and I was not even aware that it was happening. I continued to self medicate big time. Anyway one night I woke up with MAJOR panic attacks (I'd beem having minor panic attacks for 6-12 months) My GP put me straight onto ZOLOFT and referred me to my psychiatrist. ZOLOFT had the same effect on me as PAXIL.
4. Next came EFFEXOR. I believe this drug was responsible for pushing me from self medication on social occasions into full blown alcoholism. I was like some sort of demon and just one alcoholic drink would cause me to lose total control. EFFEXOR apparently competes for the same enzyme pathways in the liver as alcohol. The effexor wins this battle hands down and your blood alcohol content spikes out of control. If you self medicate I would recommend you stay away from EFFEXOR. Also causes sexual side effects and I won't even get into the withdrawal symptoms.
5. When I finally stopped self medicating 6 months ago my Pdoc prescribed DIAZEPAM (VALIUM). I LOVED DIAZEPAM. To me it filled the gaping hole that alcohol had left. Unfortunately my tolerance built up rapidly and I found myself taking more and more each night to try and get the same effect. Instead of alcohol binges I went on DIAZEPAM binges. I don't know if the other BENZO"S have the same effect but if you have a tendency to self medicate I would be very wary of these drugs. It's almost 3 months since I last took DIAZEPAM but I still crave this drug even more than I ever craved alcohol. I was too ashamed to admit to my Pdoc about what had happened and I am still considering asking him for another prescription.
6. Generic CELEXA (CITALOPRAM) together with the EFFEXOR- made me way too drowsy and the sexual side effects were even worse than PAXIL
7. This finally leads to my current drug...generic PROZAC. I initially took PROZAC at a 10mg dose to help me get over the EFFEXOR withdrawal, stayed at 10mg a without it really helping but then went up to 20mg. Although it created some initial anxiety (the 8 coffe effect)At this stage I can say that PROZAC is absolutely fantastic for both my depression and my social anxiety. I am feeling hope again for the first time in years and was able to go to a bar with friends and NOT drift off into my own world or fall into feelings of depression. I was also able to have only one beer and stop at that one beer (something I havn't managed to do in years). At 20mg, sexual side effects are present but are tolerable with the worst thing being slight ejaculatory delay.
The above are my personal experiences. Hope it helps a little
Posted by LyndaK on November 22, 2002, at 2:37:35
In reply to Re: Depression and/or moderate SP?, posted by bluedog on November 21, 2002, at 10:25:49
Bluedog,
I'm curious why you didn't go back to Aurorix if it worked so well.?
Posted by bluedog on November 22, 2002, at 5:05:05
In reply to Re: Depression and/or moderate SP? » bluedog, posted by LyndaK on November 22, 2002, at 2:37:35
> Bluedog,
> I'm curious why you didn't go back to Aurorix if it worked so well.?
That's a very good question. When I was finally referred to my psychiatrist I was in such a bad state that I simply went along with what he considered would be the best medication for my condition at the time, which was the EFFEXOR. Once I was on the EFFEXOR because I was getting an anti-depressant effect I was very reluctant to change to anything else.Even until recently I never really questioned my psychiatrist and simply went along with whatever he recommended for my treatment. I can say that I didn't really care about my treatment that much because I was drinking myself to oblivion almost every night and my appointments with my psychiatrist were usually in the haze of a chronic hangover. I was simply not thinking straight at the time.
At the moment I am very pleased with the PROZAC and it's helping my social anxiety and depression to such an extent that I have recently become much more assertive and have started taking a much more active interest in my treatment. For example I only really discovered the difference between MAOI's and SSRI's about 3 months ago.
When I was taking the AURORIX 7-8 years ago my social anxiety was not even diagnosed. Only the depression was recognised by my GP at the time. I was only diagnosed with social anxiety after I was referred to my psychiatrist which is about 18 months ago now. If the PROZAC stops working I will definitely discuss the option of going to AURORIX with my psychiatrist but I get the feeling he is not really that keen on the MAOI's
Posted by bluedog on November 22, 2002, at 9:51:02
In reply to Re: Depression and/or moderate SP?, posted by bluedog on November 21, 2002, at 10:25:49
>
> 3. AURORIX (MOCLOBEMIDE) - This MAOI actually helped me and had absolutely zero side effects. This drug probably saved my life at the time (about 7-8 years ago)CORRECTION: it was actually only 4-5 years ago (not 7-8 years ago). Probably not relevant but I like to get my info as accurate as I can. (as far as I am aware of at least)
Posted by SteelRat on November 22, 2002, at 22:08:34
In reply to Re: Depression and/or moderate SP? » LyndaK, posted by bluedog on November 22, 2002, at 5:05:05
Do the MAOIs have differential effects on different neurotransmitters? What is known about the method of action of Aurori?
This is the end of the thread.
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