Hi
I'm here to look for advice with my social anxiety
and to say that Klonopin .5 mg a day helps.

I wish I could get a doctor to prescribve it to me.
I have tried two doctors but they wanted me to try
the various anti depressants. All of these make me
more anxious and/or don't help.
Klonopin works right away.

I have researched alot of the forums in the last few
days about the various ways and reviews of them.

Hello, anybody in my situation: what has
worked for you?

Thanks

I suffer from s.a also. I am going to tell you from experience that ALL doctors are going to try all the bull antidepressants before the prescribe you the klonopin. Chances are they will always prescribe an anti depressant and eventually include the klonopin. If u kno how to a doctor then you can get them to write the klonopin off rip.

The SSRIs are known to increase anxiety initially; it would be kinder if your doc would prescribe a benzo at least initially until the SSRI starts to work. The problem is that there may need to be a fair bit of chopping and changing before you find one that suits you.

Yes, thats what happened. Some just made me feel not human
after even a month or so, some gave me nightmares, some made me feel as if I always had to urinate- but then i never could.

I didnt understand that, exactly- and what is rip?

Prince - it would seem that SSRIs are the "go to" drug for many docs. It is true that they take some time to get used to, but, well.....I don't think much of them. It is true many people benefit, but many don't.

Have you seen a psychiatrist? They will often prescribe Klonapin or like meds. Many docs are wary of any drug that creates dependence. They do not want to deal. That's the hard truth and one you should accept. They would rather prescribe an SSRI - with all its sides. Send you on your way.

I really hope you can get the me that works for you. I have never taken benzos of any sort and that really disqualifies me. But I CAN give you my support (for what it's worth). And I DO.

Try and get a doc that will prescribe you Clonazepam prn. It truly is a miracle drug for social phobia.

You might have to try more SSRI's (GOD) SNRI's and Tricyclics. Tricyclics have shown no efficacy for Social Phobia.

You could always try clonazepam with propranolol prn. If you have asthma then Inderal should be prefered over selective beta blockers like Metoprolol. Just check with your doctor.

There are other routes you can choose. Nardil and Parnate have great efficacy for social phobia, ....more so Parnate due to it's stimulant properties. There are dietary restrictions with food high in tyramine. You would have to be fully committed to the drug as there are a lot of OTC medicines that could be fatal when mixed.

Again, ....talk to your doctor.

Lyrica (pregabalin) has approved for Generalized anxiety disorder in the EU, and supposedly the potential for dependency of Lyrica is significantly less than the potential with benzodiazepines.

This drug that was EU approved in 2004 for GAD, Generalized anxiety disorder due to it's GABA properties (gamma aminobutyric acid) This plays a BIG part in Social Phobia, ....hence the reason Clonazepam and Nardil are the gold standard when it comes to SA meds.

600mg/d has had great results in double blind studies to help social phobia, ......in fact highter doses can make you prosocial.

What?
Are you no longer advising Adderall to be included in your polypharmacy drug formula?
And, once again, there is no clinical support that Nardil or any other MAO inhibitor is considered the "gold standard" for treatment of SAD. Some doctors relegate it to "last resort" status when absolutely necessary but that is very different. I don't think you understand, among other things, the meaning of "gold standard" even though you seem to throw it around like you know what you're talking about.

Benzos mixed with stimulants can be greatly effective for social phobia, .....but the OP can't even get their doc to prescribe them clonazepam, ....so I was just presuming that a stimulant was out of the equation.

Nardil and Clonazepam have been known to be the gold standard for Social Phobia for a long time now. I'd even go as far as saying Parnate is even better, .....but harder to get prescribed.

Martind, would you mind asking Gillette for some citations to reputable sources (other than Phychobabble) regarding his "Gold Standard" of phenelzine and clonazepam? I would ask him, of course, but I'm on his Ignore list so he won't see it. Phenelzine may well have been held in high regard many years ago, and remains effective, but the interactions with other drugs remain a problem in emergency situations, even if one can be disciplined using the drug at home.

Also, if you could be ever so splendid, ask him what triggered his social anxiety at such a late stage in his life?

You guys are way, way over my head. I read the posts three time and still didn't understand, lol.

Apparently Martin and you, Nephro have had some experience with "Gillette". He DOES sound like he knows a things or two. But, Nephro - you are the "gold standard" (for me anyway) when it comes to info about meds. And Martin - I think you are a force on this board and I like the way you think and you also seem to know a great deal.


This thread is about the original poster and their need for Klonopin. I wish I could simply say call here and you'll be taken care of. That is the med that he/she said worked and I generally take things at face value (until I learn otherwise).

Happy Thursday! Nephro, are you about 9 hours earlier than Oregon? Or is it later? LOL. I "think" it is still Thursday in the UK.

A question for you gillettecavalca:

Can you provide some citations to reputable sources regarding your "Gold Standard" of phenelzine and clonazepam? What triggered your social anxiety at such a late stage in his life?

"Phenelzine may well have been held in high regard many years ago, and remains effective, but the interactions with other drugs remain a problem in emergency situations, even if one can be disciplined using the drug at home." ~Nephro

Lil Prince - just what IS social anxiety? When you get in a crowd of people, you get sorta kinda panic attacks?

You are not referring to (I assume) just being "shy". Right? It is something bigger than that?

It is obvious I do not suffer from this or I would know. But I wouldn't mind knowing more. How does this feel?

Anyone who can give me a little education, I would appreciate it. My philosophy is this: if a med helps, prescribe it. If quality of life is improved, prescribe it. Where's the harm? And I'm not talking about all the garbage drugs (which I will have to take forever). I call them garbage drugs because often they seem to make you feel WORSE. Sometimes they are necessary and I have come to accept that.

Prince (little one) - I sincerely hope you can get the meds that work for you. Please, someone tell me why not?

gillettecavalca is THE pre-eminent authority on anxiety disorders, as well as, the "scaremongering" Dr.'s that frequent DB and tell us what not to take. Please correct me if I'm wrong your Eminence Gillette, but taking an SSRI will help with anxiety and most docs will prescribe an anti-anxiety medication, such as the Klonopin, to accompany the SSRI - I know because it's what all my docs have done.

Try Zoloft, if you haven't already. It's mild and along with Lexapro, one of the only SSRI's that don't make me anxious and agitated. My current doc gives it to his elderly and medication sensitive patients. "A kinder, gentler A/D", is what he refers to it as and he gives me 1mg Klonopin, 3 times daily to take as needed, which is 3mg's a day and he ALWAYS writes it with 3 refills and will rewrite it whenever I request it.

You're wasting your time Pillar. NOTHING works apart from clonazepam and an MAOI. On ifs, no buts, no nothing. They are the Gold Standard and everything else (especially non-drug treatment, which I don't believe he's tried personally) is rubbish. Whatever Gillette takes, everyone else has to take too.

Thank you Stressedout and thank you PNW. It's good to know that you're looking after the community here, some of which may be quite vulnerable to a variety of anxiety-related disorders.

Sorry I couldn't help you out but, as you said, this guy is a complete waste of time.

Above he says that tricyclics have shown no efficacy for social phobias, whereas on another thread he said

'Tricyclics are much much better than SSRI's in my opinion and in double blind studies for efficacy.'

and it can't be both ways.

I read a few things after some of this that all said MAOI's are to be considered only after everything else and all the other type drugs have been tried.

That is correct; they are a last resort. The sedating tricyclics can be quite effective in calming anxiety, and don't often need a benzodiazepine upon initiation.

Martind, no need to apologise. He is a waste of time, but unfortunately, not in a harmless way.

Do all the tricyclics work the same for social phobias?

I'm thinking of things such as cyclobenzeprine and methocarbomol.

Are there any dangers associated with taking things such as those for anxiety for people who have previously (or are currently) taken benzodiazepenes and wish to stop those?

What benzo, dose and duration of use? It's my understanding that cyclobenzaprine is a chemical cousin to amitriptylene and diphenhydramine. Being that it acts on histamine and not GABA I would expect little help in dealing with w/d. But I see no reason the sedative effects wouldn't calm you. I just took 2 methocarbamol(Robaxen) and felt very relaxed, not unlike my Klonopin only more sedating.

To the original poster upstream somewhere....

Social anxiety is best addressed from the emotional issues that delivered a person into the anxiety trap. The trap is that if they start drugs to reduce the anxiety they will likely become doubly dependent, on some crutch for the anxiety and the pill to avoid its WD effects. some can be quite dangerous...

Why not address the self esteem issues or the underlying cause and be done with it? its not a matter of anything except having the desire to be a better human being. Being mediocre on meds is common place, but why not be better when you CAN be better instead of only being mediocre?

social anxiety is treatable without adding a dependence to the table of troubles. One will then feed upon the other as they justify each other for the rest of your life....
Then after a few years, you can welcome the next in the emotional trifecta.....depression.
Get free of it all now, while you can.

Thanks pillar. I was thinking of for someone who has taken a lot of them over a long period of time, but that has already tapered down to almost nothing (clonazepam) but who still has issues with sleep, and thinking one of those two might help. You did mention that the Robaxin helps with relaxing and sedation, which is what I was looking for. I am asking for someone else.

Sounds like Flexiril acts differently than the Robaxin, then? I take both of those - not at the same time, but as part of pain control, but really was not aware that they had any properties that were similar to benzos.

I was thinking more in terms of tricyclic AD drugs such as clomipramine, dosulepin, trazodone, or trimipramine.

I see. So there are differences. Do those you mentioned have any of the dangers of withdrawals or stopping them as are associated with benzodiazepenes?

There will almost certainly be a withdrawal syndrome, but this can be avoided by tapering. It is not difficult in the same way it is to stop benzodiazepines, because AD drugs generally have no reinforcing properties.

What types of reinforcing properties are you talking about? Properties that increase dependence and addiction, with benzo's and not tricyclics? Or are there chemical properties that cause say tricyclics to have a weaker bond to the receptor sites in the brain?

Social anxiety is more then just a self esteem issue. I'm sure many people that suffer with social anxiety as well as many people who do not wish to be a better human being.

If it were a self esteem issue, people would be treated for their low self esteem, probably with therapy and classes on dealing with the causes of their self esteem issues. I see many people that are fine in social situations who suffer from low self esteem.

"Social anxiety disorder, also called social phobia, is an anxiety disorder in which a person has an excessive and unreasonable fear of social situations. Anxiety (intense nervousness) and self-consciousness arise from a fear of being closely watched, judged, and criticized by others."

Note the "excessive" and "unreasonable" fear.

The pleasant feelings that benzodiazepines bring about, even if it's just mild relaxation from stress, are reinforcing properties.

Antidepressants, on the other hand, do not produce immediate pleasurable feelings, and have no street or recreational value. Nobody ever takes an antidepressant and immediately thinks, "Oh, that's OK; I'd like to do that again". Their antidepressant effect takes time to work.

One exception could be tianeptine (Stablon), which I think has been made controlled in some countries due to misuse. Interestingly, it works in an opposite fashion to SSRIs, and quickly enhances re-uptake of serotonin.

Does Valium not produce the same effect as other drugs in this class or am I immune. Also as to the social anxiety piece, there are some excellent support groups on the web. I will try to get them from my daughter, who suffers from it.

Some people take more than 5mg diazepam; you're doing the right thing by keeping the dose just high enough to relieve anxiety and nothing else.

Before midazolam came along, diazepam used to be given IV like Versed, and yes, it has the same sort of effect.

stressedout,

Your reply, your post is excellent. Thank you

Nephro

I take 5 mg of Valium. It is a good drug if it is used properly and I agree that we need to keep on a low dosage.

Valium has been a life saver for me. I am border line asthmatic and when I feel that air hunger and cannot take a deep breath Valium is more effective than allergy medication.

My family Dr after 12 years has finally prescribed Valium and 30 mg of codeine for my pain. I refuse to take anything stronger. I am lucky his nurse had a talk with him.

I do notice if I take a Valium I have very vivid dreams and even some nightmares. My old Dr told me he had noticed that too when he was on it. I don't take it but once a day . It makes me very sleepy.

Streesed out I agree that was very good information.

You are welcome. "Walk a mile in my footsteps" would be a good way to look at this.

I wish there was a healthy way to get rid of stress, nervousness, anxiety, uncontrolled brain firing, but without insurance, buying drugs online or on the street is our only option. sad isn't it?

There are things you can do, but when you've tried them all (properly) then one cannot be blamed for looking for medication.

That is not your only option. I refuse to pay my ridiculous co-pays once a week for therapy for my anxiety and panic. So I bought the workbook that my therapist suggested - "Managing Your Anxiety and Panic", and luckily enough, the place I bought it from gave me the therapist's guide for free. So now I am my own therapist, and am working through the workbook. It's been very good for me, as I use less of my klonopin to get "outside" activities done now. That's just ONE example of how you can help yourself.

There are doctors and therapists Psychiatrists and Psychologists in particula) practicing in mental health hospitals, that also provide outpatient care, that will allow you to see them and pay by a sliding scale fee.

Perhaps calling around to the hospitals, clinics and even therapists in your area you may find a doctor and a therapist that will take you on as a patient and allow you to pay according a sliding scale fee.

It's not easy. It starts with therapy as well as seeing a Psychiatrist to diagnose what is the underlying cause of stress. You can't just walk in and say "Hi Doc, I'm stressed, hand me some benzos." It's not quite that easy. It's a long path and sometimes they never quite figure out what is wrong although they have some pretty good ideas.

One thing I would mention is be careful of your family history. I have noticed if you mention that a relative has a certain disorder they will look for a way to see if you too have a disorder. Granted mental health issues can be genetic, but I find all to often they misdiagnose a patient because they feel if one relative has it, chances are the patient has it. Try with a clean slate first.

With regards to "talking therapy", I had the incredible good luck to fall into the hands of a retired psychology professor, who was trained in the "old school" in Germany and went on to get a masters and then a PhD-Ed from Duke.
Plus, he had 30 years of teaching under his belt.

He is the only talking therapist who ever did me any good and I had the good fortune and money to see him for ten years.

Every other talking therapist I have seen has left me cold, and I now realize how lucky I was to find the old "Professor".

The odds of finding someone with this kind of training and experience are slim to non, in the US, at least.

While advances have been made in the understanding of brain chemistry, I am sad that the old fashioned, "One on One" type of therapy is now going the way of the covered wagon.

During the ten years of seeing the professor, I took no medication, but made great advances in my journey toward mental health.

Talking therapy did not completely rid me of anxiety and I spent 12+ years with a Psyciatrist who handed out benzos and SSRI's and fancied himself to be a top level talking therapist.
In the end, my MD. turned out to be quite mad.

Today, I am lucky enough to have found a young Asian MD. at a public clinic and have reduced my level of valium use to 15mg per day.
At the rate doctors move around, he may not be there next visit and I will be left to my own devices again.

The struggle for true mental health is a journey and not a destination, But as I grow older, I find less to fear and could care less what others think of me.
That change has helped :>)

Whatever path one chooses to try, expect no sudden miricles (but possible sudden insights ?)
It's a life long struggle for everyone and do not believe the people who appear to be happy as all get out, all the time, as they have their own private demons.

Good Luck to all of us.

Wow, you've really been through a lot. I wonder if it's just easier for Dr.s to hand out drugs, or if there is a shortage of good Drs. so they get so busy they don't have time for one on one therapy?

your'e right Ballerina59 ,thanks

I would try a beta-blocker. I use metoprolol and i'll say anything. Just read my posts.

Paxil works for me.

I also use a beta blocker called Inderal and klonopin. Have you been to see a psychiatrist? Because of my insurance, I had to go to one and it was his idea to use the klonopin long term. We would talk some each visit but it really didn't do that much good. After a while, I was able to get my family doc to prescribe these two maintenance meds for me and no longer had to see the shrink. Over time my social anxiety has improved. It *will* get better but you just need to do some exposure therapy and the meds will help you enter the situations.

xxx off topic deleted xxx

May I ask why you use metoprolol and not inderal, and do you know the differences between the two?

Metoprolol is a blood pressure medicine. My husband uses it. Didn't know it could be used for anything else.

From reading on the web it seems they're very similar medications, I'm just wondering which works better for social anxiety and which is prescribed more for it.

Metoprolol can be used off label for social anxiety if it does not lower BP too much. http://en.wikipedia.org/wiki/Beta_blocker

Metoprolol is more selective on cardiac function than some of the other beta-blockers and has less effect on bronchial receptors, meaning less airways resistance, so may be safer for those who suffer from certain respiratory conditions.

Propranolol is the classic beta-blocker prescribed for physical symptoms of anxiety, and is licensed for this use in the UK.

When I was younger and had to give a speech in class or a presentation at work, my heart felt like it was pounding. The Inderal stopped the pounding.

Speaking from my own personal experience with extreme anxiety, especially in social situations. I used to start sweating profusely and feel like my skin was crawling off when strangers started a conversation with me. Most Recently I have been using a 45mg Remeron/10mg Valium per day combo. Remeron at night and 5mg valium twice per day. I know everyone responds differently but this seems to be the magic formula for me. Tried Celexa, Wellbutrin, Lexapro, and they only increased my anxiety. With this current combination I just feel level and smooth. Once again, this is just what is working for me. You may have to try multiple combo's as i did before finding the right cocktail. Best of luck to you

Giving a speach or presentation or being talked by strangers are, in my opinion, natural reasons to feel anxiety and to be nervous. It is normal and most people feel some level of anxiety, sweating, trembling, palpitations, and other side effects... which do not really require medication... the strange thing would be not to feel any anxiety and not to have some reaction... that is how humans evolved...
If you start taking anxiety medication to fight what most people live with or solve with practice... you may only ad to the problem...

True, very true. I am working with my primary to get off of my xanax that he has had me on for 18 years. I'm doing this for myself. I feel better by just taking the steps of talking to him about it. He wants to get my other medical issues in tact before we do this, because I also have a heart condition.

I agree with Admin that the biggest part of the battle is training yourself and facing your fears. I worked for a while at a men's recovery center as a counselor and that experience in itself brought me a long way out of my shell. Standing in front of 20 men and trying to encourage them to stay the course was absolutely frightening everytime i did it. At that time I was on no meds, but the whole time I felt like I was literally floating. Like I would pass out at any minute. After facing my fears for months though I still suffered way too much fear. Sometimes I would have to excuse myself to the restroom and rinse my face with cold water and get my breathing under control.

I guess it is a personal decision to use something responsibly just to level the playing field. I myself use a relatively low dosage of tranqulizer. 1 10mg split in two doses throughout the day. I was handicapped for so long by my condition that I am extremely grateful for a medication that keeps me from hiding in bathrooms throughout social gatherings, trying to gather my strength for another forray into the lion's den.

Yeah that is pretty bad. I completely understand where your coming from. A lot of us here do.

Taz if you don't mind me asking what specific heart condition. I am in nursing school and I'm such a nerd that I get excited talking and learning about people's conditions. Totally understand if its too personal tho

I have cardiomyapathy. I got damage to the muscle in my left ventricle when I was in labor with my son 18 years ago.

I am sorry to hear that Taz. Weakened heart muscle fibers are a tough one. No issues with your mitral valve as of yet? Just maybe a decrease in the ability of that ventricle to deliver systemic blood flow. Weak contractions? What specific issues is this causing you. Poor circulation?

I have about 35% blood flow. I take lynoxon, lasix, and potassium. Oh I retan fluid everyday. My heart enlarges. Hard to breath sometimes.

for me clonazepam is the only thing that works good, ive been on a ton of meds for sa including alot of the ssris and snris

I have found that metoprolol, a beta blocker works. Doctors actually use them to help face 50-100 patients a day.

Since my heart attack in 2004, I have taken Metoprolol every day along with an Ace Inhibitor, HCTZ and Lipitor.

I can tell when I have forgotten to take the Metoprolol as I start to feel nervous and shakey.
It feels exactly like forgetting to take Valium and many times I have taken Valium but still feel nervous.

A quick check of BP and Pulse Rate gives me the answer.
If my resting Pulse Rate gets into the 90's or higher, 25mg of Metoprolol will bring the pulse rate down and my symtoms of anxiety go away.

In the beginning, I took these medications on a schedule, as the cardiologist recommended.
The result was too intense, with very low BP and Pulse Rate.
This resulted in dizziness, bumping into things and no energy at all.
When the cardiologist brushed off my reports of problems, I took it on myself to check my BP and Pulse many times a day and adjust the dosages to maintain a healthy BP-Pulse.
This has worked out well and I am able to function.

In closing, I believe Metoprolol and it's cousins are very powerfull drugs and possibly dangerous, unless one gets a home BP-Pulse monitor to check the pulse rate ?

There is a good reason they are banned from some Olympic sports.
Lowering my resting pulse rate to 50bpm allows me to hold a rifle scope dead on with no shaking.
Very handy for Olympic shooters and Hit Men !

Your milage may vary ?

Is this a cure for anxiety ?
Don't know. My shrink of 12 years never mentioned it, but he was not very smart, as I learned much too late.

For an Anxiety attack Xanax has always been the trick but for "Social Anxiety" a 2mg Roche Klonipin does the trick. Whether facing a crowd or going inro a business meeting or even having a conversation one on one or a moe intimate social setting the k's do best for me. Like I said though, facing a frightening anxiety-panic attack surely go with the QR XANAX for fast relief - 1mg usually does the trick, 2mg is pretty strong if using a decent brand, i.e. old skool upjhon or Pfzer. And just a note, Lorazepam or for me was always worthless unless I wanted to remain Anxiety ridden and go to sleep & Valium was always great for muscle aches/spasms but hardly worked for Social anxiety. I suggest a quality (Brand Name) Klonopin and start out at 0.5mg and go up 0.5mg every 30minutes to 1 hour while peaking at around 2mg-3mg(keep in mind weight and body tolerance plays a large part in meds being helpful/beneficial and you being functional and in turn you being a recreational drug user). Hope this helps.


-NUTSHELL

the only two drugs (other than SSRIs, which i hate for many reasons) i know about for social anxiety are beta blockers and long-term benzos like klonopin or valium.

i can't take beta blockers, NOTE: if you are asthmatic, do not take beta blockers. tell your doctor - you don't want to end up with an asthma attack that your inhaler won't stop.

i don't have social anxiety, i have PD, so i take klonopin anyway.

I'd agree that 0.5mg may be a good, if rather large for the benzo-naive, starting dose, but I wouldn't recommend repeat-dosing every hour or so. It is a long-acting drug, so I would say it's better to wait until another day to try a different dose, because like you correctly say, one should take the absolute minimum amount to relieve excessive anxiety and no more.

It would take one hell of a tolerance to take 3mg and stay functional.

In addition, anxiety is normal. It's only when it becomes crippling and disabling that meds should be considered. Once you begin taking benzodiazepines for situations that would normally induce normal anxiety, the chances are you always will.

when my husband had issues w/anxiety after both his parents died, he was put on .5 klonopin 2x/day. worked like a charm for him. that's not social anxiety, but i'm guessing you could start with a dose like that - or even lower (.25 2x/day), then titrate by .25 - .5 up until you were okay. do it very slowly. klonopin is long-acting; give it a couple of days.

Paxil works for me with S.A. maybe ask your doc for that..

i can't recommend an SSRI/SNRI simply for social anxiety. the side effects are too much for something that is intermittent.