Posted by Sad Panda on May 12, 2004, at 9:51:18
In reply to Social phobia meds - advice needed, posted by Joe Schmoe on May 11, 2004, at 19:17:27
> Well, I find myself in need of a medication change and I am seeing my pdoc about it this week, but I was hoping for a little input first from the gang.
>
> I suffer from social phobia and dysthymia, and at times general anxiety. In the past I have taken Celexa, Klonopin and Wellbutrin as a combo. I still felt anxious even on 2 mg/day of Klonopin which amazed my pdoc. But I was fairly functional.
>
> I discontinued the Celexa last fall (I think I was on 20 mg) since I didn't feel it was doing much and I was tired of having low libido. After a horrible two month withdrawal (and slow taper) I finally was over it but the libido never returned.
>
> Looking back I can see that I became more emotionally fragile starting around December - more thin-skinned. I began to feel more and more anxious and eventually stopped the Wellbutrin and started taking Inderal as needed. This led to a deep depression this spring. I started the Wellbutrin again which got me out of the depression but the anxiety (and some social phobic episodes) has returned and become intolerable. I am also suffering testicular pain, which I have noticed in the past when taking Wellbutrin. Testicular swelling is listed as a side effect so I was not that surprised. It started to manifest around the time the depression lifted (after 3 weeks or so at 300 mg/day of Wellbutrin SR). I am taking Aleve several times a day because of it which obviously is not a good thing.
>
> Due to a low carb diet I have lost over 30 pounds since January and am looking better (and have healthier blood chemistry) than I have in ten years.
>
> Anyway, due to both the anxiety and the pain I do not want to continue the Wellbutrin at the therapeutic antidepressant dose (300 mg/day). I am thinking of taking another antidepressant instead and maybe taking 150 or 100 mg of Wellbutrin to supplement it for the inevitable sexual side effects. I really, really don't want to regain the weight I have lost, and for that and other reasons am not attracted to the idea of taking Nardil.
>
> So, I am faced with two questions: first, have I become tolerant to the Klonopin, or did I just never reach the optimal dose in the first place? I suspect my pdoc will not like the idea of going above 2 mg/day of it after being on it for three years - she will probably assume I am developing tolerance, which is bad news if true, since it would mean increasing the dose is only a temporary solution.
>
> Second, what AD should I take for my dysthymia? Celexa did not seem to do much one way or the other but then again maybe it was helping more than I realize. I have never tried Prozac, Zoloft or Effexor. Paxil I tried for three days and couldn't stand it. Serzone was pretty worthless and very sedating.
>
> I am confused about the SSRIs because lately I have been reading about how social phobics have low dopamine, so in theory a dopamine boosting drug should help. However, drugs like Prozac and Wellbutrin, which do boost dopamine, have reputations for causing anxiety in social phobics, which makes no sense to me.
>
> So, what do you say? As an AD to go along with Klonopin (I doubt anything could replace it, except maybe Nardil, which I don't want to take) what would you recommend? Prozac, Zoloft, Celexa, Effexor? I would be interested in your experiences. Thanks.
>
>Hi Joe,
If SSRI's aren't helping then it's time to try either Nardil or Clomipramine depending on which side effects you prefer.
Cheers,
Panda.
poster:Sad Panda
thread:345896
URL: http://www.dr-bob.org/babble/20040510/msgs/346095.html