My doctor, and psych, both are completely anti-benzos, so after multiple attempts at various ssris, they have now put me on a combination of effexor 225 mg and 30 mg mirtazipine. (called california rocket fuel by some in the US i think)

Before hand I was on effexor 150 mg for general and social anxiety, and to be honest found little effect, maybe a bit of a mood brightener but it sure as hell didn't make me want to interact with people, and it didn't stop me thinking that everyone hated me instantly in every lecture/social event I went to. And the shakes, sweats, post mortems that come along with that. The endless thoughts going round in the head that make you just want to run and hide. All these symptoms at once, and still try to progress in life? Hard one....

Has anyone had experience with these 2 drugs combined for social anxiety, or any anxiety? I've only just started so not sure what to expect. I've tried klonopin many, many times and it is like a God-send, but a) they don't prescribe it in the UK for anything other than epilepsy and b) the UK Dr's HATE prescribing benzos and 3) I hate self-prescribing. My Dr's think the SSRIs/SNRIs are the bees-knees, and the remedy for all this. I genuinely think I would need to be locked up in a psychiatric unit before they even considered alternatives.

I'd love to see them take some for a while and then be quizzed under pressure, for 10 minutes, about the subjective effects of the chemicals. I mean, do these chemicals actually do anything worth mentioning therapeutically for anxiety???

I'm just a bit lost and disillusioned by Psychiatry in general, if there are drugs that work for people out there, be it benzos, MAOIs or anti-psychotics, and genuinely improve people's quality of life (from a chronic, binge drinking, depressed hermit, to a functional person when I tried benzodiazepines) then why withhold them? I may well be addicted, but the alternative is practically dead anyway.

We only have one life and I hate to see years slip by, as I try to rationalise a part of my brain that I can't get control of (CBT). I'm actually not anti-CBT, but I need to feel some sort of relief to be able to even get to the session.

One of the few SSRIs I haven't been on is Paxil, which I have heard good reports of, can anyone genuinely recommend it for social anxiety?

Thanks if u read this,

chris

Thanks for the reply, yeah i've heard effexor w/d can be harsh.

Over here they would never hear of giving anyone clonazepam or xanax, perhaps valium for 2 weeks or so, but that's all. It's no wonder we have such huge levels of alcoholism/alcohol abuse in the UK with such poor psychiatric services.

I'd guess a lot of alcoholics out there started out self-medicating their anxiety, only to end up in at the deep end. It's perfectly acceptable for people to go out here and get completely drunk every weekend, but if i mention the word benzo to a Dr here you would have thought I had slapped them in the face.

I spent a lot of time drinking to suppress anxiety in social situations, and of course it made things worse. Now i just avoid the stuff mostly, makes anxiety 100 times worse the next day.

With regards to mirtazapine it certainly helps with sleep at night, although the sleep is somewhat disturbed, but it's too early to feel any therapeutic benefits in terms of mood/anxiety.

cheers

That is a very appropriate analogy.
Many benzo addicts started out trying to self-medicate their anxiety only to end up at an equally deep end. Neither approach is likely to work out long-term.
Many people are reluctant to invest the energy and time to get to the bottom of the actual cause of their anxiety or depression conditions. The dx's can be all over the map and often are not terribly difficult to diagnose and treat without the need for using ongoing powerful benzodiazepines or anti-psychotics.
It sounds to me like physicians in the UK are on the right track with their conservative approach to treating these conditions.

According to Dr Stephen Stahl -

"california rocket fuel (SNRI plus mirtazapine) is a combination that has a great degree of theoretical synergy, norepinephrine reuptake blockade plus aplha 2 blockade, serotonin reuptake plus 5HT2A and 5HT2C antagonism, and thus many 5HT actions plus norephinephrine actions.
Specifically, 5HT is quadruple-boosted (with reuptake blockade, alpha 2 antagonism, 5HT2A antagonism, and 5HT2C antagonism). Norepinephrine is quadruple-boosted (with reuptake blockade, aplha 2 antagonism, 5HT2A antagonism, and 5HT2C antagonism.) And there may even be a double boost of dopamine (with 5HT2A and 5HT2C antagonism.)"

It is also important to note that since dopamine is inactivated by norepinephrine reuptake in frontal cortex, which largely lacks dopamine transporters, SNRI's can increase dopamine neurotransmission in this part of the brain through it's norepinephrine reuptake action.

So all of this may explain the efficacy of california rocket fuel in treating severe depression.
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Quite a review ramdomized controlled trials have shown the effectiveness of tis combo in some, but not all, patients. It's regarded as a 'big gun' approach to depression - the paharmaceutical equivalent of ECT. My problem whn on Venlafaxine/Effexor was that I found it very activating/agitating. Then there's the risk of hypertension at higher doses and the notorious wothdrawal symptoms due to its short half life.

I've seen people do well on this combo although a few have gone into manic switch...