Posted by mattdds on September 2, 2003, at 14:59:25
In reply to Re: Facial twitches in SA, posted by Budgie on September 1, 2003, at 21:17:13
Hey Chris,
Glad you enjoyed your break.
>>Yes, the tics are very obvious and people have commented on it before, which is maybe why I'm more self-conscious about that than anything else, why it's spiraled into such a big problem.
In CBT, your therapist will likely help you work on coming to a complete (or as close to it as you can get) acceptance of the tics. We can talk a lot more about this on psychological. I know this approach may sound insensitive, but since the tics seem somewhat stubborn, and resistant to current medical methods, it may be advantageous to attack *not* the tics, but the thoughts about the tics, which according to CBT ideology, is what really causes the unhappiness and anxiety. I'm not at all minimizing your suffering that's resulted from this problem. I understand SA very well, and have some very deep seated insecurities of my own (real and imagined). I'm just suggesting the path that led me to feel a whole lot better.
>>It's really remained a mystery to me, what the biological basis of it is. I always thought that twitches and neurologic problems like that are caused by too little dopamine in one's system, as with Parkinson's
You are absolutely right. This just goes to show how little we understand about movement disorders in general. In Parkinson's, like you mentioned, the therapeutic goal is usually to *enhance* dopaminergic transmission. Weird, eh?
But the bottom line is that it helped. My only concern about trying those (the reason I haven't) is because they can sometimes *cause* serious movement disorders, sometimes irreversible ones. I'm not an expert on this class of drugs, but maybe in your case the benefits would outweigh the risks. So I would say that another trial is something to talk to your doc about. Be sure to discuss all the pros and cons. I think the Zyprexa sedation subsides after a while, as with most drugs.
Before doing that (trying Zyprexa) again, I would certainly give the benzos a shot.
Oh yeah. Do these tics only happen when you're anxious in social situations? Or do they happen spontaneously, like while you're alone?
From the little I understand about MAOI pharmacology, phenelzine (Nardil) and the other hydrazine MAOI isocarboxazid also inhibit GABA transaminase, increasing GABA transmission. This is thought to be why phenelzine is good for panic and SA. Parnate is a non-hydrazine, and does not directly increase brain GABA (although I think I've read that it does *indirectly* somehow).
But before you ditch the Parnate for Nardil, I'd try to augment with a benzo, namely Klonopin.
Best of luck to you,
Matt
poster:mattdds
thread:255797
URL: http://www.dr-bob.org/babble/20030902/msgs/256367.html