Social Anxiety Support Forum banner
1 - 10 of 10 Posts

·
Registered
Joined
·
103 Posts
Discussion Starter · #1 ·
5 days to go until I see my psychiatrist again and have to give him my decision about antidepressants (or something else) so I've been reading like crazy.

I'm still really on the fence about antidepressants. So many anecdotes everywhere on the Internet about not really working, weight gain, sexual dysfunction, etc. The problem is you have to take them for a couple months or more to see if it works, etc. and if you take something like Effexor, it can potentially be a long and difficult process to come off of it too (my sister used to take it for panic attacks). I don't know if I'm ready to hop on a several years journey to figure out if any of them work even for me... I did try Wellbutrin for something else once. I don't recall it doing anything for my SA.

So my second option is benzos. My current train of thought is that if I know that I have something to take that will help when I have an event to go to (I'm talking something significant, not just everyday going to the store), it could lessen the anticipatory anxiety as well as in the moment anxiety. I could take it on a as needed basis and maybe do the group CBT at the same time.

Third option is Adderall. I have been reading over and over how this works really great. Can this be used on a as needed basis as well (ie. once a month or less)? I'm in Canada, can you get that prescribed by a doc here for something other than ADHD? And considering all the controversy surrounding it, is there even a chance that my doc would prescribe it before I try antidepressants (which I don't really want to try anyway)?

And finally, I read a post by Medline somewhere on here about a cocktail of Adderall + Klonopin (+ Bupropion). How do you take that? I mean do you take that every day or only on as needed basis? Can you even get something like that prescribed?? Is this a last resort type of thing?

My head is spinning and getting a headache from reading about all the different drugs, drug classes and cocktails!
 

·
Registered
Joined
·
2,403 Posts
First line treatment for generalized social anxiety disorder should be a good SSRI like Lexapro or Zoloft. If you 'just' have situational anxiety with primary physical symptoms then the unselective beta blocker Inderal is a very good choice, if it's "more in your head" then a benzodiazpine like Xanax or Klonopin as needed is perfect. Adderall in combination with a potent benzo is for sure extremely effective, but it's very hard to get that prescribed (if you have no ADHD) and it's just for treatment resistant social phobia [off label]. I would go for Lexapro, it's considererd an effective and in general well tolerated drug, weight neutral, fast-acting and if you're a girl you shouldn't worry about sexual dysfuntion as it is mostly ejaculation disorder. ;)
 

·
Registered
Joined
·
5,337 Posts
Yeah for first line treatment I agree with medline, lexapro and zoloft are probly your best bet, either could be combined with wellbutrin or trazadone if necessary, depending on what (if any) side effects you experience.
 

·
Registered
Joined
·
103 Posts
Discussion Starter · #4 ·
My symptoms are mostly cognitive (probably because I avoid a lot of things) but in more intense situations, I will also get some physical symptoms (racing heart, shortness of breath, excessive sweating, blank mind).

So maybe I will give in and give Lexapro a try and see if he will accept to prescribe Wellbutrin (which I know I can tolerate) with it.

However, I have several major anxiety-inducing events coming up in mid-September (an 18-hr trip by train on my own, a full day of giving presentations in front of people - no choice, can't avoid it - and a wedding with 300 guests). All this in a span of about 1-2 weeks! And I'm already freaking out. I have six pills of 1mg Ativans that I asked my regular doctor to prescribe me (this was before I found this forum) but never took them for social things. Would it be better to ask for Xanax or Klonopin for those events until the antidepressants kick in or will my Ativans do the trick? And how much of it should I take?
 

·
Registered
Joined
·
5,337 Posts
You could ask for Xanax or Klonopin for PRN (as needed) use, sure. But I would try the ativan out in a moderately anxiety provoking social setting first, to see if it does indeed work for you.
 

·
Registered
Joined
·
103 Posts
Discussion Starter · #6 ·
Update: I have now read a lot of posts on Nardil and it looks very promising compared to SSRIs. Should I really try an SSRI first? This Nardil stuff really sounds good in theory... and the food restrictions do not worry me. Although the weight gain stuff does worry me.

I'm also thinking Inderal for the presentations and probably Xanax for the wedding and the train trip as suggested.

Now I'm worried about what my psychiatrist will think when I come in with all the drugs suggestions. What if he doesn't want to prescribe the Inderal or benzos? Will he think I'm going drug crazy or something?

PS = I did use Ativan once before to go to the dentist (2mg on hour before) and it really didn't do much but the dentist is a whole other dimension of anxiety + pain.
 

·
Registered
Joined
·
5,337 Posts
Well since the side effects of nardil overall don't seem to be too much worse than those of an SSRI, and your not concerned about the diet restrictions I guess it might be an option. The only other thing to consider is probly that it's medical drug-drug interactions can be potentially more troublesome than that of an SS/SNRI, not trying to put you off, just something to be aware of.
 

·
Registered
Joined
·
103 Posts
Discussion Starter · #8 ·
Ok, I changed my mind again (yes, I am a VERY indecisive person... :blush) but I think I am getting closer to what my final decision will be.

I'm back to wanting to give Lexapro + Wellbutrin a try and keep Nardil on the back burner as a back up if this does not work.

And the Inderal and Xanax as needed.

Now, the real question is if my doctor will agree to that... (we only met the one time and I didn't really like him all that much but since it took a year to get an appointment, I guess I can't complain). If he refuses, I'll see if my GP will prescribe them (she is very open-minded, she knows me fairly well and knows I do my research before I ask her for anything).
 

·
Registered
Joined
·
103 Posts
Discussion Starter · #9 ·
Well, I was crazy nervous about going to the doc today (he asked me why but I couldn't really give him an answer). I had made a 3-page chart of my symptoms, how I manage it, etc. and felt kinda stupid. And I talked at about a mile a minute without breathing (which is what I do when I'm very nervous but have to speak up)... Ugh!

He says I have social anxiety with remnants of major depression (from many many years ago and which was not treated professionally). I personally believe it could also be dysthymia but he's the doctor so I could be wrong and it doesn't really matter anyway.

So he prescribed Lexapro (well, Cipralex here in Canada) - 5mg for 6 days then 10mg on the 7th day. He said we would consider Wellbutrin in a month if needed.

He also prescribed Klonopin (0.5mg) as needed. He did not really want to consider Xanax (too dangerous, addictive, short half-life, etc.)

He did not prescribe the Inderal but said we could consider it when I see him again next week... Not sure why...
 

·
Registered
Joined
·
1,936 Posts
I think doctors like to make as few med changes as they can in any one visit. Otherwise, how would they have any idea of what's helping you or which med might be causing a particular side effect?
 
1 - 10 of 10 Posts
Top