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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by tina on July 5, 2001, at 9:36:33
Is anyone on this stuff? I've been reading that it may be good for social and/or general anxiety and I'd like to try it. Would like some feedback first though from people who have taken it.
thanks
tina
Posted by Joe Schmoe on July 5, 2001, at 14:16:38
In reply to Imipramine for social anxiety???, posted by tina on July 5, 2001, at 9:36:33
I was on imipramine for about a year. That was over a decade ago before all this SSRI stuff started. I was in pretty bad shape then, I was diagnosed with panic disorder although I realize now it was really social phobia since it did not occur at random.
Bottom line is it helped me a lot, enabled me to go to work and go to the store, etc. whereas before taking it, I was rapidly approaching the point where I could not function at all, couldn't make eye contact and so forth. The imipramine just stopped it cold. I could feel the "attack" trying to come on at times, it feels like a kind of tingly rush from my neck up into my head, kind of a spreading surreal feeling, I read recently that that is where the serotonin neurons are so I guess it makes sense, but anyway on imipramine I could feel the panic start and then sputter out. The tingle was weak and could not get very far.
This increase in functionality continued even after I discontinued the imipramine, even though I had no psychotherapy at all. It did something to my brain that made me a lot less vulnerable than I was before, something permanent.
Now, it did not cure me; while I can function well enough now that nobody suspects I have social phobia, I still cannot handle personal confrontations or tense situations and I need some benzodiazepine help with things like job interviews and giving presentations in front of an audience. I can, however, give a presentation to an audience even without benzos if I really have to, although it is a miserable experience and I don't perform nearly as well. Before the imipramine - no way.
The imipramine was what I needed at that time of my life. I had to take 300 mgs/day which is a large dose. Unlike the newer ADs, for some of the older ones they have blood tests where they can check whether you have an effective level of it in your system or not and see how well you are absorbing it. In my case I absorbed it very poorly and they had to keep upping the dose based on the tests. Ramping up was slow and in the meantime I was on xanax day and night for a month. Coming down from that was no fun, let me tell you.
Anyway, the imipramine allowed me to function for the most part, although I still could not handle really stressful things without benzos like xanax. Imipramine is a harsh drug with all sorts of side effects. For me the worst ones were: rapid heartbeat, often in bed at night (makes it hard to sleep); night terrors (nightmares you can't wake up from even though you try); and orgasms became much less pleasureable.
The night terrors thing was the worst. As I understand it, when you go to sleep, your body turns off your voluntary control of your muscles. This is so you do not try to physically act out your dreams (like sleepwalkers do). When you wake up this voluntary control comes back on, sometimes slowly (i.e. muscle weakness in your grip strength when you first wake up). Well, on imipramine, the voluntary control does not come back on right away. You can wake up from a nightmare in the middle of the night and be paralyzed - can't open your eyes or move, or your movements are difficult. I have memories of thrashing my head back and forth trying to wake up from a nightmare and not being able to wake up. You can't "sit straight up in bed" the way you normally can to wake up from a nightmare. That was what drove me off the imipramine in the end. I don't know how common this side effect is.
Today, with the "cleaner" SSRIs like Paxil, which does not affect your heart like imipramine does, I would not try imipramine until I had already tried the SSRIs first. I tried Paxil myself recently but the sexual side effects were too much to take. Right now I am starting on a regimen of Wellbutrin for dysthymia and Klonopin for the social anxiety. Klonopin has the greatest ( >82%) success rate of any drug for social anxiety, so I am anxious to see how I do on it. Paxil is supposed to be pretty good too, but losing the ability to climax was just too high a price to pay.
Posted by tina on July 5, 2001, at 14:42:12
In reply to Re: Imipramine for social anxiety???, posted by Joe Schmoe on July 5, 2001, at 14:16:38
Thanks for the positive feedback Joe. I do take Klonopin and have taken it for 10 years when needed.
The reason I asked about the imipramine is because I can't tolerate SSRI's at all. I've tried several and they all have the same very intense reaction in my body. I feel just awful. I throw up, I shake, I am basically incapable of functioning at all.
I was on an MAOI for 3 years and remember it helping but I still had to take the klonopin. I am on a TCA now but it doesn't cover the anxiety one bit. I haven't had a single side offect with MAOI's or TCA's. I'm kind of an opposite side effect person. The AD's that are supposed to have minimal SE's kill me and the ones that are supposed to be awful, don't bother me at all.Thanks again Joe. You've made my day.
Be well
Tina> I was on imipramine for about a year. That was over a decade ago before all this SSRI stuff started. I was in pretty bad shape then, I was diagnosed with panic disorder although I realize now it was really social phobia since it did not occur at random.
>
> Bottom line is it helped me a lot, enabled me to go to work and go to the store, etc. whereas before taking it, I was rapidly approaching the point where I could not function at all, couldn't make eye contact and so forth. The imipramine just stopped it cold. I could feel the "attack" trying to come on at times, it feels like a kind of tingly rush from my neck up into my head, kind of a spreading surreal feeling, I read recently that that is where the serotonin neurons are so I guess it makes sense, but anyway on imipramine I could feel the panic start and then sputter out. The tingle was weak and could not get very far.
>
> This increase in functionality continued even after I discontinued the imipramine, even though I had no psychotherapy at all. It did something to my brain that made me a lot less vulnerable than I was before, something permanent.
>
> Now, it did not cure me; while I can function well enough now that nobody suspects I have social phobia, I still cannot handle personal confrontations or tense situations and I need some benzodiazepine help with things like job interviews and giving presentations in front of an audience. I can, however, give a presentation to an audience even without benzos if I really have to, although it is a miserable experience and I don't perform nearly as well. Before the imipramine - no way.
>
> The imipramine was what I needed at that time of my life. I had to take 300 mgs/day which is a large dose. Unlike the newer ADs, for some of the older ones they have blood tests where they can check whether you have an effective level of it in your system or not and see how well you are absorbing it. In my case I absorbed it very poorly and they had to keep upping the dose based on the tests. Ramping up was slow and in the meantime I was on xanax day and night for a month. Coming down from that was no fun, let me tell you.
>
> Anyway, the imipramine allowed me to function for the most part, although I still could not handle really stressful things without benzos like xanax. Imipramine is a harsh drug with all sorts of side effects. For me the worst ones were: rapid heartbeat, often in bed at night (makes it hard to sleep); night terrors (nightmares you can't wake up from even though you try); and orgasms became much less pleasureable.
>
> The night terrors thing was the worst. As I understand it, when you go to sleep, your body turns off your voluntary control of your muscles. This is so you do not try to physically act out your dreams (like sleepwalkers do). When you wake up this voluntary control comes back on, sometimes slowly (i.e. muscle weakness in your grip strength when you first wake up). Well, on imipramine, the voluntary control does not come back on right away. You can wake up from a nightmare in the middle of the night and be paralyzed - can't open your eyes or move, or your movements are difficult. I have memories of thrashing my head back and forth trying to wake up from a nightmare and not being able to wake up. You can't "sit straight up in bed" the way you normally can to wake up from a nightmare. That was what drove me off the imipramine in the end. I don't know how common this side effect is.
>
> Today, with the "cleaner" SSRIs like Paxil, which does not affect your heart like imipramine does, I would not try imipramine until I had already tried the SSRIs first. I tried Paxil myself recently but the sexual side effects were too much to take. Right now I am starting on a regimen of Wellbutrin for dysthymia and Klonopin for the social anxiety. Klonopin has the greatest ( >82%) success rate of any drug for social anxiety, so I am anxious to see how I do on it. Paxil is supposed to be pretty good too, but losing the ability to climax was just too high a price to pay.
Posted by Waterlily on July 5, 2001, at 16:16:30
In reply to Imipramine for social anxiety???, posted by tina on July 5, 2001, at 9:36:33
I take imipramine for general anxiety - 75 mg. at bedtime. It's really difficult for me to say whether or not it has helped - let me give you the lowdown on how I got here: Major depression about 6 years ago after the birth of my youngest - took Zoloft and then later changed to Wellbutrin, which I still take. Last year around this time I had my first panic attacks and took Paxil (didn't like this and stopped after a month) and Ativan. Things settled down for a couple of months and then I had generalized anxiety almost to the point of agorophobia until November, when my psychiatrist started me on imipramine. I started with 25 mg and went slowly up from there. Within about a week of being on 75 mg, I felt much better - until my doctor told me that this dose is not generally considered therapeutic. I had my blood level drawn at this appointment and armed with the knowledge that I had experienced a placebo effect, I got anxious and depressed all over again. My doctor then called with the results of the test, which showed that the level was getting close to 'toxic', a big surprise for us both. After this I didn't know what to think. I started therapy for the first time in February and don't need to take Ativan anymore. Whether it's the therapy or the imipramine or both that is the cause of my success with beating anxiety I don't know. What I can say is that it wouldn't hurt to try. I don't have nightmares. The only bothersome side effect is dry mouth, which is tolerable and much preferred to constant anxiety.
Hope it works out for you!
Posted by Elizabeth on July 6, 2001, at 1:22:04
In reply to Imipramine for social anxiety???, posted by tina on July 5, 2001, at 9:36:33
> Is anyone on this stuff? I've been reading that it may be good for social and/or general anxiety and I'd like to try it. Would like some feedback first though from people who have taken it.
Tricyclics are supposed to be less effective for social anxiety than MAOIs and benzodiazepines (and, possibly, SSRIs). But since social anxiety comes in many flavours, if you've tried the preferred treatments without success, a TCA such as imipramine might be worth a try.
Good luck!
-elizabeth
Posted by SalArmy4me on July 6, 2001, at 4:51:47
In reply to Imipramine for social anxiety???, posted by tina on July 5, 2001, at 9:36:33
Simpson, H. Blair MD, PhD, et al. Imipramine in the Treatment of Social Phobia. J. of Clinical Psychopharmacology. 18(2):132-135, Apr 98:
"The findings from this 8-week open trial of imipramine do not support the efficacy of imipramine in social phobia. Although social anxiety and avoidance (as measured by the LSAS) decreased over the course of the study; this decrease was considered clinically significant in only three subjects. The mean reduction in the LSAS score was 15% and 18% for the intent-to-treat and completer groups, respectively; the overall response rate (based on the Clinical Global Impression Scale of 1 or 2, very much or much improved) was 20% and 22%, respectively. In comparison, in an 8-week double-blind placebo-controlled trial, phenelzine achieved a 45% reduction in the LSAS score and a response rate of 64% whereas placebo achieved a 12% reduction in the LSAS score and a response rate of 23%. In summary, the response to imipramine was comparable with that of placebo in this controlled trial. [4]
Side effects to imipramine were a significant problem. Ten of the 15 subjects had side effects that significantly interfered with their functioning. Six subjects dropped out of the study because of adverse effects. Although it is possible that a slower initial dosing of imipramine might have led to less dropout, two of the six subjects who dropped out suffered a rash, an idiosyncratic adverse effect thought to be independent of dosage, and nine subjects completed the trial despite the high initial dosing. The high rate of adverse effects in those who completed the trial may have been due to the fact that the medication was raised as high as was tolerable to achieve-in most cases unsuccessfully-a good therapeutic response. Most significantly, the only two subjects who remained on imipramine at the end of the trial stopped the medication within 2 months because of side effects. Despite the high rate of adverse effects, activation or jitteriness as a result of imipramine was not a significant problem in the sample, in contrast to what is commonly seen in panic disorder [19] and to what was reported by Jackson and Lydiard [13] in two cases of social phobia..."
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