Posted by zeugma on August 17, 2003, at 18:03:07
In reply to Re: Lexapro for social anxiety?? » zeugma, posted by Ame Sans Vie on August 15, 2003, at 17:11:21
> First off, I'm glad you think the algorithm turned out okay. I'm going to be starting up a *very* detailed site based entirely on the treatment of anxiety disorders (e.g. clinical studies, case reports, personal experiences [that I hope Babblers wouldn't mind submitting], drug monographs, etc. ad nauseam), and becksA's posts just gave me a little incentive to get started. Any suggestions for changes to the algorithm?
>
No, other than to observe that it seems that many pdocs (including mine) are reluctant to prescribe benzodiazepines. Maybe he feels that since I've lasted this long under his care (a year) without 'needing' a benzo, he's not going to run the risk of starting me on one now. I can't say how rational or not this is. I do know that last winter, when struggling with a subtherapeutic dose of nortriptyline, and realizing for the first time (I'm 35, by the way- average age for people to begin treatment for SP is about 30 according to my cognitive therapist- a remarkable delay considering that this disorder usually has onset at 11 or so) that I had SP and knowing that Paxil was FDA-approved for this disorder, asked if I could try it or another SSRI. But Paxil can have a pharmacokinetic reaction with the TCA, and I have a history of not tolerating SSRI's very well. So in desperation I wound up trying Buspar instead. Buspar's an interesting drug- an "interesting, frustrating drug," according to the authors of the impressive new edition of the "Manual of Clinical Psychopharmacology"- and I have kept it around, not for any anxiolytic effects, but because it blocks my REM-induced headaches and makes it a lot easier to fall asleep. Also it has some antidepressant effect. The authors of this tome think it's very underrated- as does, by the way, the author of "Beyond Prozac"- and needs to be prescribed in higher doses to have any effect on SP. I know you didn't find it helpful for this at even 60 mg- I'm curious if any one else had a positive result at that dose. I think there's a better chance of my pdoc letting me try a higher dose of Buspar than a benzo. And I would probably prefer escalating the dose of a drug I know well than to try to start a new one at this point in my treatment.
One other thing- Strattera seems to really help facilitate the cognitive therapy process. It's a great clarity-inducing med, and I find myself noticing all kinds of environmental triggers that set off my SP, and can anticipate the kinds of interaction that are most unsettling, allowing me to make strategies for compensating with the situations as they arise. Prior to starting the Strattera, I just didn't feel alert enough to take careful note of these things- I would simply have emotional reactions that mostly bypassed my awareness levels until it was too late. Of course, this has a lot to do with my severe comorbid inattentive ADHD, and not indicate any special compatibility between CBT and Strattera. But I'm just throwing my experience out there.
>
> Also, I wholeheartedly agree about CBT being an integral part of any SP treatment-plan that is aimed at eventual remission (esp. CBT + medication). Perhaps you saw my posts on here and on Psychological-Babble concerning Medicaid's upcoming cancellation of therapy coverage -- if you did, you know that I very highly value my therapy (and, perhaps even more so, my therapist in particular) and I'm just infuriated that I won't be able to receive therapy after I turn 21 on Jan. 5.
> :-(
I'm glad you're getting your SP treated at a young age. Many years of my life went by where I was unable to develop skills that would help me socially or in the workplace because I was socially phobic. It's a shame that medications can be routinely covered by health plans, but CBT, because it is labor-intensive and time-consuming, is not. Maybe as more studies are done showing its efficacy, and its value in augmenting medication-assisted recovery, this will begin to change. Social anxiety actually costs the state a lot, because people afflicted with severe forms often literally can't work, leading to the loss of tons of tax-derived revenue. So it's in the government's benefit to promote forms of mental health treatment that work.... and in the interest of insurance companies to do so as well, and for the same reason.
poster:zeugma
thread:250775
URL: http://www.dr-bob.org/babble/20030812/msgs/251673.html