Why is Adderall NOT approved for social anxiety? - Social Anxiety Forum
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View Poll Results: Have you ever tried adderall?
No 18 45.00%
Yes, increased anxiety 2 5.00%
Yes, didnt affect anxiety / little effect 3 7.50%
Yes, helped my anxiety quite a bit 7 17.50%
Yes, completely kills my anxiety 10 25.00%
Voters: 40. You may not vote on this poll

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Old 03-24-2010, 05:55 PM   #1 (permalink)
 
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Default Why is Adderall NOT approved for social anxiety?

Me among others on this thread have found it to be simply.

Yet, time and time again doctors refuse to accept it as a treatment option and it is one of the hardest drugs to be prescribed for SA.

I've heard supposedly, it has possibility to increase anxiety, but this cannot true to the the sheer amount of anecdotal evidence.
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Old 03-24-2010, 06:31 PM   #2 (permalink)
 
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It's not approved because there are no clinical trials showing it's efficacy, the FDA requires at least two trials showing it's effective.
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Old 03-24-2010, 06:31 PM   #3 (permalink)
 
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I think there should be a distinction between anxiety and social anxiety. Adderall can cause anxiety during its effective period and as it is wearing off. Yet during its effective period, the type of anxiety that is produced (if it does produce anxiety at all) is usually a more generalized unsettled feeling not related to any stimulus. The specific anxiety induced by the social stimulus is in many cases eliminated, or greatly reduced. I have found this to be the case for myself.

So while the doctor may be right the medication can cause anxiety, it is usually not very severe and it is unrelated to any stimulus. In other words, it just seems a byproduct of CNS stimulation. Yet while it may do this, it also seems to make people insensitive to anxiety from the social stimulus. So it is very useful, since the social stimulus usually causes more anxiety and is far more debilitating in social phobia sufferers than the possible mild generalized anxiety caused by the medicine.

So it seems like there are two types of anxiety in this equation, and if you have social phobia it seems like the medicine may add a little and but also take away a whole lot in this department. So for a doctor to say it is not useful for social anxiety because it can cause anxiety, this seems to be a misunderstanding of the problem. He may just be reluctant to prescribe a highly controlled substance off-label.

Also, some doctors are just conservative period regarding controlled substances. If you have a very conservative doctor, then it may very well be futile to attempt to get this treatment from them. The best way to get this treatment without a specific ADD diagnosis would probably be to exhaust (or have exhausted) the alternatives. If you have found all other treatments unsatisfactory, and your doctor will still not prescribe them, then he is probably too conservative. There definitely exist doctors who will prescribe them for SA, though very few who will do so as a first-line treatment without a comorbid ADD diagnosis.
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Old 03-24-2010, 07:14 PM   #4 (permalink)
 
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Adderall isnt for SA, you might think it would be because it gives you energy/movitation, but thats not what SA lacks.
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Old 03-24-2010, 07:15 PM   #5 (permalink)
 
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Initially, I found stimulants to be great for social anxiety (Vyvanse and now Adderall). However, over time, the pro-social/feel good aspect starts to diminish. The only way I know to get effects back is buy taking a week or so off....or by increasing the dosage (which my Pdoc did, but we've agreed to stop going any higher).

I suppose there is some risk that individuals will abuse the drug by increasing the dose (without dr. approval) to get that initial feeling back, but, who knows...
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Old 03-24-2010, 07:22 PM   #6 (permalink)
 
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Quote:
Originally Posted by Upekkha View Post
I think there should be a distinction between anxiety and social anxiety. Adderall can cause anxiety during its effective period and as it is wearing off. Yet during its effective period, the type of anxiety that is produced (if it does produce anxiety at all) is usually a more generalized unsettled feeling not related to any stimulus. The specific anxiety induced by the social stimulus is in many cases eliminated, or greatly reduced. I have found this to be the case for myself.

So while the doctor may be right the medication can cause anxiety, it is usually not very severe and it is unrelated to any stimulus. In other words, it just seems a byproduct of CNS stimulation. Yet while it may do this, it also seems to make people insensitive to anxiety from the social stimulus. So it is very useful, since the social stimulus usually causes more anxiety and is far more debilitating in social phobia sufferers than the possible mild generalized anxiety caused by the medicine.

So it seems like there are two types of anxiety in this equation, and if you have social phobia it seems like the medicine may add a little and but also take away a whole lot in this department. So for a doctor to say it is not useful for social anxiety because it can cause anxiety, this seems to be a misunderstanding of the problem. He may just be reluctant to prescribe a highly controlled substance off-label.

Also, some doctors are just conservative period regarding controlled substances. If you have a very conservative doctor, then it may very well be futile to attempt to get this treatment from them. The best way to get this treatment without a specific ADD diagnosis would probably be to exhaust (or have exhausted) the alternatives. If you have found all other treatments unsatisfactory, and your doctor will still not prescribe them, then he is probably too conservative. There definitely exist doctors who will prescribe them for SA, though very few who will do so as a first-line treatment without a comorbid ADD diagnosis.

How long did it take for the pro-social effects to go away? (assuming you were taking it daily) What was your initial dose?
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Old 03-24-2010, 11:02 PM   #7 (permalink)
 
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Quote:
Originally Posted by mike8803 View Post
Adderall isnt for SA, you might think it would be because it gives you energy/movitation, but thats not what SA lacks.
Actually its one of the best meds for social anxiety, and it doesnt work because it gives you energie and motivation, look at ritalin, most ppl dont like it here wile it gives you those 2.

Its a shame amphetamines arent prescribed more often for differend conditions then ADHD since they have potential for a lot of differend disorders, i think a big reason why they arent prescribed more often is also the tolerance problem, wich can be overcome once understanding the mechanisms behind it.
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Old 03-24-2010, 11:15 PM   #8 (permalink)
 
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Originally Posted by Ash09 View Post
It's not approved because there are no clinical trials showing it's efficacy, the FDA requires at least two trials showing it's effective.
1. Adderall went generic years ago, thus there is nobody to pay to test generic mixed amphetamine salts for the treatment of SA. No economic incentive = no clinical trial.

2. It's a C-II drug. No way in (non-existent) hell is the DEA going to put up with amphetamines being commonly used to treat SA. The DEA doesn't give a damn if it works -- their only objective is to keep junkies from having fun with it and there is less out there for potential diversion to such junkies if you and & I & all other legitimate patients can't get it.

3. If you're not happy with the DEA please feel free to write your federal elected officials (I sure have).
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Old 03-24-2010, 11:42 PM   #9 (permalink)
 
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Quote:
Originally Posted by Ash09 View Post
It's not approved because there are no clinical trials showing it's efficacy, the FDA requires at least two trials showing it's effective.
+1
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Old 03-25-2010, 12:03 AM   #10 (permalink)
 
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What makes AD/HD more deserving of stimulant treatment than SA? Stimulants are commonly accepted as the best treatment for AD/HD, and psychiatrists usually don't have a problem writing monthly prescriptions for C-II stimulants if a patient has officially been diagnosed with AD/HD. But if you mention using stimulants for anything else, they go crazy. Really, does the DEA routinely check to make sure the medications prescribed are approved for the diagnosed condition(s)? And so what if they aren't? Doctors are allowed to use their own discretion and prescribe off-label if necessary. I seriously don't understand how a doctor can choose to decrease treatment options and tell a patient that they're s.hit out of luck when other traditional treatments fail. Their idiocy is supposed to keep them safe from the DEA's scrutiny/bullying so they can continue practicing medicine. But what's the point in treating patients if you're not willing to go the distance and make sure they are getting relief of their symptoms? I guess it's all about job security and money. But if they're not knowledgeable and confident enough to back up their prescribing practices, then they shouldn't be practicing in the first place. It's so frustrating to think about because there's literally nothing we can do.
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Old 03-25-2010, 12:22 AM   #11 (permalink)
 
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Originally Posted by korey View Post
What makes AD/HD more deserving of stimulant treatment than SA?
The fact that it can be used to treat ADHD effectively for years/indefinitely, but SA without comorbid ADHD generally has you developing tolerance to the helpful effects really quickly?
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Old 03-25-2010, 01:05 AM   #12 (permalink)
 
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Originally Posted by korey View Post
What makes AD/HD more deserving of stimulant treatment than SA?
I suspect the standard excuse would be that we have a s***load of non-controlled SA treatments, like every SSRI/SNRI under the sun (ignoring the fact that many of them don't work for many SA patients).

When it comes to ADD drug treatments there really isn't anything other than stimulants, with Wellbutrin be the only non-controlled one and being too weak to really work.

Clearly, those of us who can't function socially need treatment at least as much as little Timmy who drives teachers insane because he acts like a kid and won't sit down and shut up in class. We all know that magically rich white kids "suffer" from ADD at vastly higher rates than do poor kids. This means that doctors & lawyers want their Timmy to bring home straight "A"s and they're going to drug him if that's what it takes to get an "A+" out of him. At 36 I have a harder time getting drugs than Timmy at age 8 -- ironic given that I'm college educated and as an adult for over half my life can give informed consent that little Timmy can't.

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Originally Posted by korey View Post
Stimulants are commonly accepted as the best treatment for AD/HD, and psychiatrists usually don't have a problem writing monthly prescriptions for C-II stimulants if a patient has officially been diagnosed with AD/HD. But if you mention using stimulants for anything else, they go crazy.
Agree. Just do a Google search for amphetamine use in the treatment of depression. You'll get so few hits that it seems like you just typed in the most exotic & esoteric thing possible.

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Doctors are allowed to use their own discretion and prescribe off-label if necessary.
Off-label prescribing is very common. In fact, I'm confident most folks on antipsychotics don't have any psychotic symptoms at all. But when docs play with C-IIs they're putting their career in the balance if they can't 100% fully justify its use to all who look over their shoulder and can yank their license to practice medicine. They get to enjoy the government second guessing their medical decisions.

Quote:
I seriously don't understand how a doctor can choose to decrease treatment options and tell a patient that they're s.hit out of luck when other traditional treatments fail.
If you earned $300,000 a year would you risk your job as an MD? Saying you're "s*** out of luck" is a whole lot cheaper than losing a career worth many millions over a lifetime. It's a disgrace the way we treat legitimate patients in desperate need. We regularly deny amphetamines to most depression patients even if the other option could well be suicide in some cases. This is part of the DEA's "Better Dead Than Addicted" program that show such great compassion for human life and suffering.

Quote:
Their idiocy is supposed to keep them safe from the DEA's scrutiny/bullying so they can continue practicing medicine.
Yup. Don't forget state regulators as well who issue their license to practice medicine.

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But what's the point in treating patients if you're not willing to go the distance and make sure they are getting relief of their symptoms?
The point has six figures and puts them in the highest tax bracket.

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It's so frustrating to think about because there's literally nothing we can do.
Yes, I feel very frustrated about this issue as well as you've surely noticed. You can relentlessly phone, e-mail, and snail mail your elected officials about how their asinine War On Drugs leaves many legitimate patients as collateral damage.
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Old 03-25-2010, 01:37 AM   #13 (permalink)
 
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Originally Posted by UltraShy View Post
1. Adderall went generic years ago, thus there is nobody to pay to test generic mixed amphetamine salts for the treatment of SA. No economic incentive = no clinical trial.

2. It's a C-II drug. No way in (non-existent) hell is the DEA going to put up with amphetamines being commonly used to treat SA. The DEA doesn't give a damn if it works -- their only objective is to keep junkies from having fun with it and there is less out there for potential diversion to such junkies if you and & I & all other legitimate patients can't get it.

3. If you're not happy with the DEA please feel free to write your federal elected officials (I sure have).

I've tried both Rx adderall and generic. Rx is much better. It didn't do anything but sorta help me focus, have a good workout and stay up for 24+hrs.
In the bold there....and big box Pharma wins again. They will help you but only if they can profit from it.
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Old 03-25-2010, 01:48 AM   #14 (permalink)
 
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The fact that it can be used to treat ADHD effectively for years/indefinitely, but SA without comorbid ADHD generally has you developing tolerance to the helpful effects really quickly?
All depends on the person. Definitely not universal as I have been on it for many years and developed 0 tolerance whatsoever.

As for whether adderall helps or worsens my anxiety, that all depends on the exact kind of anxiety you are describing. Adderall helps my anxiety in some situations and worsens it in others.
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Old 03-25-2010, 01:49 AM   #15 (permalink)
 
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I've tried both Rx adderall and generic. Rx is much better.
It's my understanding that both immediate release generic adderall and dextroamphetamine currently only have one US maker: Teva, a huge generic drug maker based in Israel (which I once noticed I own stock in through an emerging markets index fund).

It seems Teva bought out Barr's dex IR operation, and still sells it with the "B" emblem on one side.
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Old 03-25-2010, 01:54 AM   #16 (permalink)
 
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Originally Posted by UltraShy View Post
It's my understanding that both immediate release generic adderall and dextroamphetamine currently only have one US maker: Teva, a huge generic drug maker based in Israel (which I once noticed I own stock in through an emerging markets index fund).

It seems Teva bought out Barr's dex IR operation, and still sells it with the "B" emblem on one side.
Interesting. I love reading about who makes what now. The Rx kind I had was the 30mgXR in those little balls. The generic was this one. Both different doses though and felt different when I took them.
Sorry threadjack..

Lots of off label uses for all kinds of drugs. It's just that now that it's a schedule II drug they just aren't dispensing it like they did before.
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Old 03-25-2010, 02:19 AM   #17 (permalink)
 
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I think generic Adderall IR as well as generic Dexedrine IR have three or more manufacturers: http://www.drugs.com/imprints.php?ac...troamphetamine http://www.drugs.com/imprints.php?ac...troamphetamine

Sandoz, Ranbaxy, Mallinckrodt, Barr (or Teva if that is who you say owns Barr)
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Old 03-25-2010, 04:56 AM   #18 (permalink)
 
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Because it's legal speed. The FDA probably think people ends like amphetamine addicts or something. How many people drink alcohol without becoming an alcoholic? The FDA doesn't like drugs that works too good, end of story. More than 50% percent of the worlds criminality is drugs related. http://www.wodc.nl/images/1790B_summ...m44-201188.pdf
I never believe that drug legalization will happen because too much is earned by lots of people on combating drugs.How many jobs would get lost?? I wonder how many people earn money to fight drugs(war on drugs???). I think if legalization will happen the economy collapses. I think America doesn't want to make it legal for that reason.
It's a cycle. Mexico and other countries make drugs to live, while other countries fight against drugs (without success) for jobs. Sorry for my English
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Old 03-25-2010, 09:58 AM   #19 (permalink)
 
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Asking amphetamine for SA is a waste of time, go into the ADD route, tell your psychiatrist your ADD symptons and say that you think that is the cause. If you would make it possible for him to give a ADD diagnosis he wont have to risk losing he's license as he just prescribes a normal treatment.
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Old 03-25-2010, 12:16 PM   #20 (permalink)
 
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Quote:
Originally Posted by crayzyMed View Post
Asking amphetamine for SA is a waste of time, go into the ADD route, tell your psychiatrist your ADD symptons and say that you think that is the cause. If you would make it possible for him to give a ADD diagnosis he wont have to risk losing he's license as he just prescribes a normal treatment.
Everyone wins.
This is what I did and my doc immediately gave me adderall (no ritalin or strattera first...just got the addy right away). I really do have ADD though so I didn't feel like I was making anything up and it also helps my SA alot.
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