Posted by action_jackson on September 7, 2002, at 1:18:55
In reply to Re: I have tried..., posted by jonh kimble on September 6, 2002, at 19:43:11
Hi Jon -
IMO I think you can treat your SP with some good results. The meds and doses - IMO most of them wouldn't be expected to help much with moderate to severe SP.>>>>>>>>>>>>>>>>
... nardil 60mgs, parnate 50mgs, adrafinil 600mgs, effexor 225 mgs, dexedrine 30mgs, deprenyl 10mgs, wellbutrin 300mgs, paxil, luvox, ritalin.
>>>>>>>>>>>>>>>>
I tried all those for SP too - (except provigil instead of adrafinil) ... sometimes alone or in combo...
For mod (especially severe) SP like I have without treatment - I do not think SSRI's usually help much. The stimulants - I think dexedrine has better mood lift than ritalin (better for SP) - but I don't think any stimulants tend to be good "taken alone" chronically for severe SP. That includes wellbutrin and provigil as well. Effexor I think most people like *less* than SSRI's for SP - tending to have more anxiety - although true that oddly Effexor often good for those with *specifically* "generalized anxiety" but *not* "primary social anxiety".
Elepryl at 10mg - most will find big energy boost - often prosexual - but unlikely help for SP taken alone.
Of the above, that leaves parnate (50mg) and Nardil (60mg). The Nardil dose was low - the Parnate dose is pretty high. But Parnate usually not much help for SP. No double blind studies, never heard of anyone reporting long term good effect myself - and there is a self employed "CBT guy in Pheonix - big website and lot of webpages who pushes Parnate - I say he is flat wrong about Parnate - I think only rarely it is the right choice for severe SP.
Nardil - your dose was low - I believe without question too low to even evaulate if it helps you for SP. You need to slowly push up the dose if you can tolerate it to 75, 90, occacionally it can take 115mg. I don't think people normally need to do this as the only option for good SP treatment - but I do think that for Nardil monotherapy to work for severe SP, it is usually going to work *IF* the dose is pushed up high enough - 60 is a low dose for most people - kind of a minimum antidperssant dose but for SP a higher dose normally required. For me, it was 90, which I did for 2.5 years (monotherapty) before switching things around, lowering Nardil and adding Klnopoin for the bulk of the time since... The high Nardil was really awesome for my energy and drive and motivation. I have heard many stories of people getting similar type results with high Nardil.
On Klonopin - you have missed perhaps the most effiective SP treatment there is - especially for those with a lot of anxiety / worry, etc. And absoulately you need to try Klnoopin - again being sure that if it doesn't work or stops working - to slowly push up the dose over time - just as with nardil. Klnoopin dose range from 1-6mg, I believe for most males 2-5. I am in 4-5 range myself, unless tweaked so I can lower dose.
Neurontin - I think is for mild cases - not severe - klonopin, nardil here. Not just because of my case. I hear this from many people. And the studies back this up - but you won't find new studies on either drug because they are "off patent" and the billions of dollars involved in pushing new drugs precludes anybody trying to effiecativly compare nardil or klonopin to zoloft or paxil for severe SP. The results would make the SSRI's look so bad ... Those studies will not happen - they have not and will not... if they did probably would be fixed somehow but won't happen anyway.
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...Only dexedrine worked for a short while then pooped out. Nardil sounds ideal but it didnt do anything before so i dont think it will now.
>>>>>>>
Makes sense to me with dexedrine. But taken alone is "off/on" rebound depression and lethargy. I don't think monotherapy is going to work with dexedrine for severe SP. A very low dose agumenting other dopamine boost makes more sense so that the "peak and dips" are mild relative to overall serononin and dopamine boost. Like a very low agument to low Nardil for example. Someone else here I think did medium dexedrine + eldepryl - also would block major dopamine dip. Mild DA dip can work out though in PM - to help sleep.Dexedrine is used sometimes for "treatment refractory depression" - works during day - wears off at night to sedation / depression / sleep...
Still Dexedrine - I don't think can be a key drug for SP - only a tweak - not one to focus on as a main treatment med.
...my hope is to try klonopin or neurontin. what do you think?
If you haven't tried Klonpoin you must. The highest success rates over placebo in the available studies. Only some stimulant, non-axiogenic antidepressant probably will need to be added in your case if you have low energy and some depression - or you lose the benefit due to depression / energy problem. I highly suggest low Nardil here (ie; maybe 60mg) - otherwise low Parnate (ie; 20-40mg) with high Klonopin.
...foggy headed and tired
Yes - that is where MAOI's are superior to SSRI's (save PRozac maybe - and SNRI Effexor). But the latter don't boost dopamine like the MAOI's. MAOI's good for energy taken alone (elepryl 10mg a good example). But Eldperyl not the SP med of choice ... Nardil is (high dose taken alone - 75-115 ... slow taper up). and KLONPIN GOTTA TRY
Good luck!!!!! Hang in there don't give up.
Chad
http://www.socialfear.com/
poster:action_jackson
thread:118810
URL: http://www.dr-bob.org/babble/20020906/msgs/119146.html