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Discussion Starter · #1 ·
Well, to deal with a new diagnosis of inattentive AD(H)D my psychiatrist has offered me the following choices (although she admitted it might prove positive for SAD as well):

Strattera
Ritalin
Dexedrine

I'm not even going to bother with the Strattera. My first inclination is to go with the dextroamphetamine but I figured I'd see about peoples' experiences with these drugs first. I've also got GAD (though not nearly to the same extent as SAD) and I was wondering if one of these tends to make people a lot more anxious than the other, or if there's anything else I should keep in mind.
 

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Well, to deal with a new diagnosis of inattentive AD(H)D my psychiatrist has offered me the following choices (although she admitted it might prove positive for SAD as well):

Strattera
Ritalin
Dexedrine

I'm not even going to bother with the Strattera. My first inclination is to go with the dextroamphetamine but I figured I'd see about peoples' experiences with these drugs first. I've also got GAD (though not nearly to the same extent as SAD) and I was wondering if one of these tends to make people a lot more anxious than the other, or if there's anything else I should keep in mind.
Why not bother with the Strattera first? I'd do that before messing with amphetamines......
 

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I've never been diagnosed with ADHD-I, but I suspect I have it. I was able to get a Ritalin SR prescription when I complained to my pdoc about my neverending fatigue. It helps some, but wears off quickly. Does nothing either way for anxiety.

Never tried amphetamines, but some here say Adderall actually helps with SA. Dexedrine isn't exactly the same, but would probably be the most helpful of those choices.
 

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Discussion Starter · #4 ·
Why not bother with the Strattera first? I'd do that before messing with amphetamines......
I have enough experience with noradrenergic drugs to know that it's targeting the wrong thing entirely for me. There is only 1 drug I've tried that had an undoubtedly positive effect on my mood, motivation, and ability to focus - wellbutrin. And that's the only dopaminergic I've taken so far.

So my psychiatrist and I have arrived at two possibilities. The stimulants (despite all the marketing efforts to make you believe otherwise, strattera IS a stimulant), and non-selective MAO inhibitors (unlike the other classes of antidepressants, they boost dopamine levels as well). The most likely candidate is Parnate as its side effect profile is favorable, and it's basically an amphetamine derivative that also happens to have similar action.

The MAOI choice isn't going to be for a while. I have to taper off the nortriptyline I'm currently on, followed by a 2 week wash-out, so I'm looking at probably at least 2 months before I can try that out. But my psychiatrist wants me to admit myself for the first week so that my response to the drug can be monitored.

In the meantime though, the stimulants can be tried out, and I don't want to waste any more time. I've tried many different medications since I went to my doctor a year and a half ago, working my way up the list slowly, but not really being helped by anything so far. I took a year off school to deal with this, now I had to put it on hold for a second year. Life continues to pass me by though, and I'm getting impatient. Going back to school is a very concrete goal for me, and even if I manage to start next fall, I'm already 6 years behind!! So forgive me if I'm not that interested in wasting more time trying a drug that in all likelihood is not going to work.

Never tried amphetamines, but some here say Adderall actually helps with SA. Dexedrine isn't exactly the same, but would probably be the most helpful of those choices.
Adderall is nearly 75% dextroamphetamine, with the other 25% being levoamphetamine. My understanding is that dextroamphetamine alone is milder in the way of peripheral side effects, and I think that's the reason my pdoc didn't even bother bringing up the idea of Adderall.

I'm just a bit nervous about going down this road though. I used to basically run off of caffeine but have almost completely removed it from my diet in the past year or so. Now caffeine makes me really jittery and just anxious and physically uncomfortable. I know amphetamines are supposed to be a bit more powerful than caffeine (although I guess that all depends on the dose), so I'm hoping to just find a low dose that gives me the cognitive benefits without much of a body load, or making me feel high.
 

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The MAOI choice isn't going to be for a while. I have to taper off the nortriptyline I'm currently on, followed by a 2 week wash-out, so I'm looking at probably at least 2 months before I can try that out. But my psychiatrist wants me to admit myself for the first week so that my response to the drug can be monitored.
Primary noradrenergic TCAs like nortriptyline can be combined with MAOIs like Parnate if one does it in the right order (TCA first, then slowly titrating the MAOI up). In fact this does make the therapy safer as the chance of a tyramine-induced hypertensive reaction is reduced when the norepinephrine transporter is blocked. Because of it's significant serotonergic effect Clomipramine is contraindicated in combination with irreversible MAOIs, the same is true for parenteral TCAs (but those are seldom used anyway). Of course one can also taper the noradrenergic TCA off when the MAOI begins to work.
 

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Dexedrine helped my SA a great deal by increasing confidence as well as giving me a serene "its all good" sort of mood. It seems contradictory being that its a stimulant but amphetamines work that way for some people, its nothing like caffeine jitters. Unfortunately I couldn't stay on them for long because I have a tendency for psychosis/paranoia. That shouldn't be a problem with most people if you don't take more than the prescribed dose or use them to stay awake for days (abuse them). I read somewhere that Dextroamphetamine is thought to be the part of Adderall that has most to do with increased mental acuity, so if ADD is part of the diagnosis that may be something to consider.
 

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He must be psychiatrist or psychian or pharmacist so for us it is hard to understand.
Not at all, he's probably just been around them awhile personally, and has researched a lot.

Lemme break it down for you:
"Primary noradrenergic TCAs like nortriptyline can be combined with MAOIs like Parnate if one does it in the right order (TCA first, then slowly titrating the MAOI up). In fact this does make the therapy safer as the chance of a tyramine-induced hypertensive reaction is reduced when the norepinephrine transporter is blocked. Because of it's significant serotonergic effect Clomipramine is contraindicated in combination with irreversible MAOIs, the same is true for parenteral TCAs (but those are seldom used anyway). Of course one can also taper the noradrenergic TCA off when the MAOI begins to work."
Tricyclic antidepressants like nortriptyline act on norepinephrine and can be combined with monoamine oxidase inhibitors (MAOIs) if you use the TCA first then the MAOI. If the TCA is present, it blocks the mechanism that causes hypertensive reaction in MAOIs; however, some TCAs that work on serotonin can't be combined with MAOIs because of just that reaction even while blocking that mechanism. You can also taper the norepinephrine-reuptaking inhibiting of the TCA by lowering dosage while you up your dosage of the MAOI.
 

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Equilibrian Epicurius
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Psychostimulants treat many symptoms of SAD that other medications have little to no effect on. Having experimented with Adderall at varying doses the last couple months, I've discovered that it's such a great social tool that even when you're with someone you know well and aren't anxious around them, the amount of ebullience it can induce can bring socializing to a new level. Increased spontaneity, social drive, and disinhibition makes being sociable fun and easy rather than exhausting. Combine it with a huge spike in confidence and self-acceptance, and you have potentially the best medication for SA out there.

The combination of selegiline and methylphenidate could potentially be a long-term SA solution, AND could carry the benefit of rewiring your brain over time to enhance your personality and social skills. It should also be noted that being on psychostimulants gives you an opportunity to feel what it's like to be free of social anxiety, providing insight on how to interpret situations rationally in the future.
 

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wifi2010012-
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Psychostimulants treat many symptoms of SAD that other medications have little to no effect on.
So that means that all these psychiatrists all over the world are stupid that is why they don't prescibe them. If psychostimulants are that affective in the long term psychiatrists would prescribe them for sad.
 

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Equilibrian Epicurius
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So that means that all these psychiatrists all over the world are stupid that is why they don't prescibe them. If psychostimulants are that affective in the long term psychiatrists would prescribe them for sad.
a) Schedule II substances are considered drugs of high abuse potential (cocaine is Schedule II as well) which makes most doctors reluctant to prescribe them.

b) My psychiatrist currently has two patients who he prescribes Adderall to for social anxiety.
 

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a) Schedule II substances are considered drugs of high abuse potential (cocaine is Schedule II as well) which makes most doctors reluctant to prescribe them.

b) My psychiatrist currently has two patients who he prescribes Adderall to for social anxiety.
Why then Adderall after all this time is not FDA approved for SAD?

and see this

[edit] Schedule II controlled substances
Main article: List of Schedule II drugs
"Placement on schedules; findings required

Except.... The findings required for each of the schedules are as follows:

Schedule II.-

(A) The drug or other substance has a high potential for abuse.

(B) The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions.

(C) Abuse of the drug or other substances may lead to severe psychological or physical dependence." [9]

Except when dispensed directly by a practitioner, other than a pharmacist, to an ultimate user, no controlled substance in schedule II, which is a prescription drug as determined under the Federal Food, Drug, and Cosmetic Act [21 U.S.C. 301 et seq.], may be dispensed without the written prescription of a practitioner, except that in emergency situations, as prescribed by the Secretary by regulation after consultation with the Attorney General, such drug may be dispensed upon oral prescription in accordance with section 503(b) of that Act [21 U.S.C. 353 (b)]. Prescriptions shall be retained in conformity with the requirements of section 827 of this title. No prescription for a controlled substance in schedule II may be refilled.[10]Notably no emergency situation provisions exist outside the Controlled Substances Act's "closed system" although this closed system may be unavailable or nonfunctioning in the event of accidents in remote areas or disasters such as hurricanes and earthquakes. Acts which would widely be considered morally imperative remain offenses subject to heavy penalties.[11]

These drugs vary in potency: for example Fentanyl is about 80 times as potent as morphine. (Heroin is roughly four times as potent.) More significantly, they vary in nature. Pharmacology and CSA scheduling have a weak relationship.

Drugs in this schedule include:

Cocaine (used as a topical anesthetic);
Methylphenidate (Ritalin and Concerta) & Dexmethylphenidate (Focalin) (used in treatment of Attention Deficit Disorder);
Opium and opium tincture (laudanum), which is used as a potent antidiarrheal;
Methadone (used in treatment of heroin addiction as well as for treatment of extreme chronic pain)
Oxycodone (semi-synthetic opioid; active ingredient in Percocet, OxyContin, and Percodan)
Fentanyl and Most other strong pure opioid agonists, i.e. levorphanol, opium, or oxymorphone;
Morphine
Mixed Amphetamine Salts Under brand name Adderall
Dextroamphetamine (Dexedrine) Dextromethamphetamine (Desoxyn)
Hydromorphone (Dilaudid)
Pure codeine and any drug for non-parenteral administration containing the equivalent of more than 90 mg of codeine per dosage unit.;
Pure hydrocodone and any drug for non-parenteral administration containing no other active ingredients or more than 15 mg per dosage unit.;
Secobarbital (Seconal)
Pethidine (USAN: Meperidine; Demerol)
Phencyclidine (PCP);
Short-acting barbiturates, such as pentobarbital, (Nembutal (now out of production));
Amphetamines were originally placed on Schedule III, but were moved to Schedule II in 1971. Injectable methamphetamine has always been on Schedule II;
Nabilone (Cesamet) A synthetic cannabinoid. An analogue to dronabinol (Marinol) which is a Schedule III drug.
Tapentadol (Nucynta) A new drug with mixed opioid agonist and norepinepherine re-uptake inhibitor activity.
 

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Because attention disorders are so fashionable! Irritated moms and teachers all claim their kids have AD/HD at the first sign of disobedience, and since all little kids are upstanding citizens (lol), it's unlikely that they'll abuse the speed they're prescribed.
 

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Equilibrian Epicurius
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Why then Adderall after all this time is not FDA approved for SAD?
The two main reasons it isn't approved by the FDA are likely lack of scientific research and controlled studies concerning Adderall's effect on various anxiety/phobia disorders, and the fact that stimulants are actually anxiogenic for most people. Although there are many different types of anxieties/phobias, the pharmaceuticals used to treat these target primarily the serotonin and GABA systems.
 

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Anxiety disorders should not be treated with stimulants. That said, I believe that there is theoretically potential for stimulants to help with social anxiety disorder in that it may increase success in social scenarios which could reduce anxiety.

As for comparing the different medications:

Here is a comparison of Adderall vs Vyvanse. And here is a comparison of Adderall vs Ritalin.

I would especially warn you that Adderall has levoamphetamine which effects the norepinephrine pathway or something that begins with nor. And that is associated with anxiety.
 

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wifi2010012-
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Yeah, I'm an idiot. I just got confused because taking a stimulant for an anxiety disorder is extremely counterintuitive. It might theoretically work for the ADHD combo because it is possible that the social anxiety is due to inability to "focus" and realize the social cues et cetra.

But the stimulant medications are highly associated with increased anxiety.
 

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Discussion Starter · #20 ·
Well from all the reading I've been doing, Dexedrine - which doesn't have the levoamphetamine - is often anxiolytic for people, and anxiety is much more heavily associated with withdrawal from the drug than it is as a side effect.

So I've come to the conclusion that I might as well give the Dexedrine a shot. Similarly "clean"-acting Focalin and Desoxyn aren't available in Canada anyways, so I think if a stimulant is going to help me, it's this one. Of course, I'm going to make sure I work up from as small a dose as possible so I don't suddenly get hit with overwhelming anxiety. I actually told my psychiatrist I didn't want to take any stimulants because I can barely handle caffeine lately (might have to do with the nortriptyline I'm taking though), and although she knows that social anxiety/GAD are definitely the issues that are the most urgent, she didn't seem too concerned. It's not like I have to use the medication for a month before I know whether it's working or not, so I might as well trust her.

A big part of the social anxiety just comes from a total lack of self-esteem. I think there could potentially be long-term benefits here by using the opportunity to build up some confidence.
 
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