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Author Topic: Terrible Social Anxiety/Treatment Ideas  (Read 5303 times)

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Offline RobbyR

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Terrible Social Anxiety/Treatment Ideas
« on: June 18, 2013, 08:54:04 PM »
Just wondering if anyone here, aside from being poz/being treated for it, also suffers from anxiety disorder as I do. There are many different forms and degrees of this, personally I do not have depression although like most I have my down moments. My problem is anxiety and occasional panic disorder. I've been taking paxil for some time now, and it helped some, but the panic attacks are back and I have a constant case of the jitters, plus now I have lost all interest/ability in sex. Which is making me REALLY anxious. SSRIs/anti-depressants have awful side effects. I am hoping to try a benzo regimen, and ditch the ssri, I'm hoping I can get my GP to give me Klonopin or maybe even low dose Xanax. Maybe in future when I feel I can handle it I might consider some kind of therapy, but not ready for that now.

Anyone else suffer from anxiety/panic? It can happen anywhere, anytime. Mine tends to happen in public or large sudden situations. I tried zoloft and it made me worse, and now paxil seems to be causing such bad side effects that my anxiety is getting worse. People are advising me to ditch ssri's for good and try xanax or klonopin, but I know most docs don't like to prescribe them. So what do I do? How should I ask my doc to change anxiety treatment regimens?
Started Atripla August, 2010.

Offline jkinatl2

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #1 on: June 18, 2013, 09:05:40 PM »
When I suffer from panic attacks and anxiety, I have  a prescription for Klonopin. I opted against a long-term antidepressant because the ones that didn't exacerbate the anxiety (like Welbutrin) shut down all emotional affect. I wasn't going to live like that.

I occasionally go to therapy, though haven't in several years. Being poor, I am subject to therapists who tend to come and go, assuming they are competent at all. But I do recommend someone to talk to. Even if just in the short term, it can help. Cognitive Behavioral Therapy is especially good for dealing with (and discovering tools to deal with) anxiety.

Have you given any thought as to the role Atripla is playing in your anxiety? Stopping Sustiva (a component in Atripla) turned my life around rather completely.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline RobbyR

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #2 on: June 18, 2013, 09:31:22 PM »
jk, thanks for your helpful response, I am definately considering Klonopin, IF I can get my doc to prescribe it for me. My old GP, who gave me zoloft and then the paxil which I'm on now, recently left, so I will be seeing  new GP next month. I'm hoping I can tell him I have tried the ssri's and HATE the side effects and ask for a benzo like Klonopin or maybe even like 1-2mg of Xanax I could take as needed. My anxiety is situational, and I do not have long-term depression. Paxil has helped in some instance, I have been on it 6 months, but the side effects are getting ridiculous like I feel like I'm in a trance all the time and I can't sleep.

I may try a different hiv regimen sometime but I know my anxiety is underlying and not caused by the atripla because I had it really bad before. I just feel out of sorts and don't know what to do. Should I just ask my GP to try me on Klono or Xanax?
Started Atripla August, 2010.

Offline mecch

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #3 on: June 18, 2013, 09:33:43 PM »
I'm hoping I can get my GP to give me Klonopin or maybe even low dose Xanax. Maybe in future when I feel I can handle it I might consider some kind of therapy, but not ready for that now.
Huh...  This does not make much sense, IMO.

Therapy is appropriate when someone can't handle situations, such as therapy..... 

I think you should stop avoiding this, there is no time like today, this is what therapy is for. Also a mental health professional can direct as to what drugs, and when, and how.... That's their expertise... Why are you avoiding this?
« Last Edit: June 18, 2013, 09:35:58 PM by mecch »
ďFrom each, according to his ability; to each, according to his needĒ 1875 K Marx

Offline RobbyR

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #4 on: June 18, 2013, 09:50:30 PM »
Well for one thing because in the past when I attempted to tell someone about my anxiety issues, they acted really judgmental and weird and plus it's hard for me to open up to someone I don't know about this kind of thing. I think some kind of therapy will help me, but I just feel the need to get a better grasp on my anxiety first before I'd feel comfortable spilling my guts to some therapist.

It's about trust I have difficulty trusting people for various reasons and I am scared to open up to someone I don't know. A huge trigger for my anxiety is interacting with unfamiliar people especially if they are asking me personal questions.
Started Atripla August, 2010.

Offline jkinatl2

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #5 on: June 18, 2013, 10:08:34 PM »
Here's the thing. You should NOT be on Atripla if you have underlying anxiety or depression issues. The Sustiva portion of that frug will mess you up something awful, and throwing more pills down your throat to counter the impact will ultimately prove pointless.

I URGE you to read the Sustiva/Atripla thread here:

http://forums.poz.com/index.php?topic=47901.0

to get an idea how powerful Sustiva can be. I don't feel like writing my own experiences down all over again, but they are there, along with a LOT of other people.

Bottom line: A person with a history of major depressive/anxiety disorder has NO business taking Atripla. Especially when there are SO MANY other drugs out there.

As to therapy, it's the hardest thing you will ever do, asking for help. But if you are dishonest with your doctor, who is areguably the most important relationship an HIV positive person ever has, then how are you helping yourself? A good therapist can give you the tools you need to conquer these issues when they arise, and I agree that a medication you can take "as needed" is WAY more important for anxiety than a broad antidepressant, whose side effects can (irony!) CAUSE anxiety and depressive issues such as lack of emotional affect and impotence.

Asking for help and pursuing it will be the hardest part. But if you value your life enough to take HIV meds, I submt that you value it enough to be your own hero in this instance.

Two other things that popped into my head:

1. People who jusge you need to be called out. If you can't do it in person, write their supervisor or licensing body. If they judge YOU, they are likely judging others. And people might be dying thanks to their incompetence.

2. I know you have trouble opening up to strangers... but here you are :) And you are surrounded by people who want to help, who have been in your shoes. And maybe these posts are being read by people who are STILL in your shoes, but don't even have the courage to post about it. You are already doing a lot of good, just by posting this topic.



"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline mecch

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #6 on: June 18, 2013, 10:17:24 PM »
Well for one thing because in the past when I attempted to tell someone about my anxiety issues, they acted really judgmental and weird and plus it's hard for me to open up to someone I don't know about this kind of thing. I think some kind of therapy will help me, but I just feel the need to get a better grasp on my anxiety first before I'd feel comfortable spilling my guts to some therapist.

It's about trust I have difficulty trusting people for various reasons and I am scared to open up to someone I don't know. A huge trigger for my anxiety is interacting with unfamiliar people especially if they are asking me personal questions.

Well you opened up to us, a bunch of strangers, and nobody judged you for having anxiety! And the idea of therapy is that the therapist IS someone you know, and trust.  Only an unknown person the first couple of sessions.

Consider that in therapy you are opening up to a known person, that's scarey... Because finally you are somewhat talking to YOURSELF in therapy... maybe that is more off-putting, than telling a kind stranger your troubles.

Also, yes, get off Sustiva.....
ďFrom each, according to his ability; to each, according to his needĒ 1875 K Marx

Offline Jeff G

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #7 on: June 18, 2013, 10:19:11 PM »
Also, yes, get off Sustiva.....

 This ^

Offline buginme2

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #8 on: June 18, 2013, 11:13:26 PM »
I have no scientific proof abut this but I think HIV itself can worsen anxiety.

I had never had anxiety or depression.  One of the first "symptoms" I had that there was something wrong with me was I would get these moments were I couldn't breath.  After I was diagnosed with HIV and they ran my 1000th test, it was determined that I had anxiety.

I take Xanax for it, but only when I need it which is now about once a month.  In the beginning it was much more.  If you are experiencing anxiety on a continual basis then Xanax isn't for you.  If its occasional then by all means.

Oh and stop the Atripla, when I switched to Complera it was like the whole world became much clearer and the anxiety did lesson (although it didn't go away).

Offline RobbyR

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #9 on: June 18, 2013, 11:36:30 PM »
I've heard about Atripla causing underlying anxiety to be worse, but I tried Complera on atrial basis last year & it made me downright depressed guess it was the eplivera or whatever component in it? The doc put me back on Atripla & added Paxil & a beta blocer to take as needed but I still have anxiety & panic. So maybe I should try a PI regimen. Or Stribild. My sense is that I'll need some type of medication for my anxiety even if I ditch Atripla because my anxiety has been around and has been pretty bad even long before I ever started Atripla. So my hunch is that it's underlying.

But I'm def going to consider therapy at some point, & switching HIV regimens. I've got to get off this ssri tho it's fucking me up!
Started Atripla August, 2010.

Offline tednlou2

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #10 on: June 19, 2013, 01:59:34 AM »
I have anxiety and panic disorder.  It usually happens in public, but also at home.  It has gotten much better.  Still bad, but not nearly as debilitating.  I do take about 1.5mgs of Xanax a day.  I was also put on a beta-blocker to help.  It does help, as well as giving me very good bp/pulse numbers. 

I have often wondered whether HIV, without even knowing you have it, can exacerbate it.  I put my infection back to 2001.  Around 2002, I began taking classes at school.  I had so much anxiety.  I remember being asked to read something in class, and I had a panic attack.  I began sweating with my voice shaky.  I know many would say this was due to going back to school after a few years of not being in school.  But, I never had issues like that.  I was happy to be back in school. 

It began happening at stores.  I would have to leave my cart and flee.  It caused me to avoid going to crowded places by myself.  After you have an anxiety issue going through security at the airport or courthouse, or at the bank, you begin to think they will think you're nervous for doing something wrong.  It has gotten better.  But, I was recently on this trolley ride.  It was hot and crowded.  I broke out in a sweat and was breathing heavily.  I couldn't wait until I could get off. 

It can also happen when I'm having a good time laughing.  My therapist says positive stimuli can confuse the brain, thinking it is a negative.  I do think my therapist has helped-- some.  However, if you have a chemical imbalance causing it, then talk therapy cannot fix it alone.  It may help to teach you to talk yourself down-- it isn't a heart attack, you're not going to die, this has happened before and goes away, but it can't solve the underlying problem.  At least not for me. 

Anxiety can cause so many physical symptoms.  It can make you feel lousy, physically.  There are so many times I feel crappy and think something is wrong with me physically.  But, I think most times it is anxiety, even when I don't think it is.  I recently got into a debate/argument.  That kind of thing causes my anxiety to jump.  I began having a panic attack just reading what the person wrote.  The next few days, I felt awful.  I am sure it was lingering effects from the confrontation, and the flood of those fight or flight chemicals that are released when it is not neccessary.  I hate it.  I want to be "normal."

I wish you the best as you deal with this.  I know how awful it is.  I know many are anti-benzo.  I am not sure what I would do without it.  I have not had any addiction issue.  The script is for 4mgs a day.  I let refills expire.  Some think I don't take enough.  Others do have addiction to them.  The one thing my therapist has taught me is that I have to put myself into situations that I want to avoid. 

Offline BT65

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #11 on: June 19, 2013, 05:10:51 AM »
I had anxiety and panic to such a point it caused me to pass out.  Seriously, I was writing out a check at Kroger in the past, and all of a sudden, everything went dark and I passed out.  And I had many panic/anxiety attacks previously and after. 

I could not take Sustiva because of that very thing, plus underlying depression.  If you're having an issue with anxiety you need to get off this.  Look at it this way, if one person tells you, you can consider it.  When two people tell you, you should really think about it.  If more than two people tell you, you should listen and take what they're saying seriously.

I have been on every benzo there is, and got into a horrible addiction issue because of this.  And withdrawal from benzo's is not pretty, and can cause seizures.  I would try everything else before adding a benzo. 

Everyone has issues trusting other people.  I haven't met anyone who doesn't.  Cognitive behavioral therapy, as JK said, is very beneficial, especially for people who have anxiety/panic.  Learning to change the thought process is very important when dealing with this.  I suggest you try therapy, whether or not you "trust" someone. 

I'm not saying benzo's should never be used, but they were meant for short term relief.  Long term, continual use of benzo's is not a good idea.  As I've said, withdrawal is horrible (trust me, I know), and learning how to deal with the anxiety without having to pop an extra pill, is the point you want to get to. 

Also, as everyone has said, and I've said, get off the Atripla.  It's not going to be helpful to add a med to counter a problem, when you're on a med that adds to it.
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Offline Ann

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #12 on: June 19, 2013, 06:06:35 AM »
Robbie, Complera includes a med called rilpivirine (trade name Edurant) and it's from the same class of meds as Sustiva (NNRTI).

Side effects can include:

Edurant can cause depression or mood changes. Be sure to contact your health care provider immediately if you are feeling said or hopeless, feeling anxious or restless, or have thoughts of hurting yourself (suicide) or have tried to hurt yourself.

Common side effects of Edurant include trouble sleeping (insomnia), headache and rash.

source

It may be that NNRTIs are not a good fit for you, considering your pre-existing anxiety issues. You really never should have been put on Sustiva in the first place.

I can suggest a PI combo that seems to have one of the lowest side-effect profiles out there (and is very effective against hiv) - Prezista, Norvir and Truvada. (You're already on the components of Truvada.)

When it was time for me to start meds, I thoroughly researched the available combos. I wanted to avoid NNRTIs because I have a history of getting CNS side-effects on meds that can cause CNS side-effects. The Prezista-based combo looked like the way to go, I did, and I couldn't be happier with it. It's a once-a-day combo, if that matters to you. (It did me.)

Good luck. You shouldn't have to be tinkering with heavy-duty psych meds when a switch out of the NNRTI class is probably all you really need.
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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline oksikoko

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #13 on: June 19, 2013, 12:35:36 PM »
I have no scientific proof abut this but I think HIV itself can worsen anxiety.

Oddly, I used to have severe-ish panic attacks (blurry vision, heart racing, irresistible urge to flee, the usual MŁnchian stuff), but I haven't had any pretty much since my HIV diagnosis. Of course, as I love to say, I started taking anti-psychotic medication about 4 months into the process, so who knows what's affecting what. In any event, all things considered, I feel calm as a pre-pickled cucumber. Most of the time. I haven't had the opportunity to test for anxiety in a social situation since then, but it doesn't sound scary. I'll let you know once the opportunity comes up.

RobbyR, it's much much easier said than done, but when I used to have this problem with panic and anxiety on a regular basis, it really did help to do all those breathing tricks that seem silly at the time - just stopping and taking regular deep breaths, repeating to yourself that there is nothing wrong, your brain misfired slightly and everything will be OK in a few minutes. Again, much easier said than done, but the only times I was able to avert complete panic and flight were when I tried as hard as possible to be very aware that I was in the middle of something comparable to a seizure and that I just needed to wait it out until it passed. And that it would pass, and that everything would be fine when it was over.

I sent an apologetic e-mail to someone at an ASO because I had one in the middle of volunteering for a crowded event and had to leave before I passed out or screamed or something. She responded that no apology was necessary; she had made an entire flight late once when the same thing happened on a plane, and she understood. My point is that other people may not be thinking what you think they're thinking about your panic attack.

As for therapy, I was dismissive of the concept, but I have one now who I've been seeing since early January. I'm just now starting to see how things we talked about in February / March are becoming relevant to choices I need to make now. He pretty much knows the stuff I don't even tell doctors and at no point have I felt judged. It took time to feel comfortable, but they're there to help you process things and see missed connections, not to make you feel bad about situations you find yourself in or choices you've made.

Good luck. :)
Code: [Select]
2013-10-03:                ☣ VL (?) off treatment ☣ CD4 (?) off treatment
2013-10-03:                ☣ VL (=) undetectable ☣ CD4 (+) 1105
2013-05-23:                ☣ VL (=) undetectable ☣ CD4 (-) 945
2013-02-25:                ☣ VL (-) undetectable ☣ CD4 (+) 1123
2012-12-16: Enter Stribild
2012-11-20: HIV+           ☣ VL (→) 132,683      ☣ CD4 (→) 920
2012-04-01: HIV-
Dates in this signature file conform to ISO 8601. ;-)

If no one complains, nothing will ever change.

Offline RobbyR

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #14 on: June 19, 2013, 06:44:51 PM »
Thanks everyone for such helpful responses, I enjoyed reading them, it's helpful to know many endure similar anxiety issues at times. Anxiety is a big pain in the ass, and certain medications can make it worse. I suspect maybe all of you are right about the sustiva thing. Atripla did good things for me, but I always had underlying anxiety and panic disorder even before becoming poz and starting hiv treatment. But I think the sustiva is messing with me and making the anxiety worse in some cases.

I did try Complera as I mentioned way back, but it gave me serious depression (which I never had before) and awful insomnia. So I went back on Atripla. However I think the time has come for a new clean slate hiv regimen. Its good to have so many options, I'm considering Prezista, Norvir, Truvada at the top of my list, and also thinking of Stribild because I LOVE the one pill once a day thing. Bottom line anxiety is irritating enough without a secondary medication possibly making it worse!

My doc has been great, she's always told me to never feel married to a regimen, and so today I took the first step and called her office to request a change. I want to go over all the options to find a good fit for me. Atripla's been great, but the night sweats, jitters, and insomnia and anxiety have gotten bad.

As far as the anxiety goes, I think in my case it won't be as simple as just changing hiv meds, although ditching sustiva will hopefully help me a lot. I will need to adjust to my new hiv regimen and then if my underlying anxiety is still there I am going to ask for some Xanax or Klonopin, because I do NOT want to keep taking this ssri right on! And I don't think I could manage my anxiety with no anxiety meds at all because I suffer from panic disorder and have for many years since I was a kid. I am planning on seeking therapy in the near future however.

One last thing about Atripla, I found it interesting when I switched to Complera briefly many months ago that I actually felt like I was having withdrawals from Atripla! Like I got these weird brain zaps and stuff. And when I went back on it after about a month, the first night, it was like this euphoria swept over me. Doc told me it was probably the sustiva component messing with my body. Sustiva is a pretty weird drug. I've been blessed to have Trazodone to help me get through the nights, but I'm hopeful a new sustiva-less regimen might make my anxiety and night terrors better.
Started Atripla August, 2010.

Offline Jmarksto

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #15 on: June 22, 2013, 01:58:10 AM »
I have no scientific proof abut this but I think HIV itself can worsen anxiety. 

I think there is something to this.  I never had anxiety pre HIV, and since then have thought that my anxiety was just mentally adjusting to being poz, but as time goes on I think its the little bug that is bugging me.  In full disclosure, I am on Complera, which Ann has pointed out has an NNRTI.

Robby; regarding therapy -- having spent my share of time in therapy (pre and post hiv) the one thing I have learned is that you really have to be comfortable with the therapist.  If your situation allows you the luxury (and I recognize that for many this is a luxury) of selecting from a range of therapists, the first step is to find someone that has direct experience with similar conditions and situations.  I recommend conducting an initial phone interview and asking pointed questions about the topics you have felt judged for in the past -- such as "how many hiv patients have you worked with in the past?".  Once you have identified two or three, I would schedule an appointment with the understanding that you are still in the process of finding the right fit -- use the first meeting to ask them questions and see if they are someone you may feel comfortable opening up to.  I do think that with the right therapist (someone who understands your situation, has compassion, and can offer key insights) the results can be very powerful.

I wish you well,
jm
03/15/12 Negative
06/15/12 Positive
07/11/12 CD4 790          VL 4,000
08/06/12 CD4 816/38%   VL 49,300
08/20/12 Started Complera
11/06/12 CD4   819/41% VL 38
02/11/13 CD4   935/41% VL UD
06/06/13 CD4   816/41% VL UD
10/28/13 CD4 1131/45%  VL 25
02/25/14 CD4   792/37%  VL UD
07/09/14 CD4 1004/39%   VL UD

Offline RobbyR

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #16 on: June 22, 2013, 06:31:12 PM »
Thanks again everyone for the helpful responses. Good to know others deal with this anxiety crap. I would say mine is daily anxiety to varying degrees, and it can go from zero to 60 in no time at all if I'm triggered. The meds help take the edge off just a bit, but even on ssri and beta blockers I'm still paranoid and anxious a lot. The one medical thing I haven't tried yet is a benzo. Maybe it would help. Also considering therapy when I feel I am ready to put myself in that situation.

I think my issue is general social anxiety but mainly panic disorder or agoraphobia. I hate open spaces where there are large crowds. I am not sure to what degree sustiva makes it worse, because I had terrible anxiety way before ever starting hiv meds. So part of me is skeptical if I changed hiv regimens my anxiety would improve, because I had anxiety as far back as I can remember, way before hiv. I actually have way more stress in my life over the anxiety than the hiv, which thanks to meds I rarely even think about!

I would be cool with maybe supplementing my ssri with a low dose xanax or klono, to see if that helps totally get rid of my panic once and for all.
Started Atripla August, 2010.

Offline Miss Philicia

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #17 on: June 22, 2013, 08:41:51 PM »
Klonopin does wonders for general anxiety disorder, IMO. It has the longest half-life of a benzo.
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Offline RobbyR

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #18 on: June 23, 2013, 10:23:10 PM »
Klonopin does wonders for general anxiety disorder, IMO. It has the longest half-life of a benzo.

Miss P, I have heard great things about Klonopin, and Xanax also. I'd like to try a low-dose of either, maybe like 1-2 mg, either alone or to supplement my paxil. I know a lot of docs now don't like to prescribe them because they are benzos and it's like they assume everyone would abuse them which is bullshit. I know people who have taken xanax/klonopin for years for the same type of anxiety as me and they do just fine. My anxiety has been better on my ssri but I still get panic attacks and dread, so I feel like adding a benzo might be worth a try. How should I ask my doc for a benzo tho, because they are so anal about prescribing them.
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Offline tednlou2

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #19 on: June 24, 2013, 01:39:20 AM »
Miss P, I have heard great things about Klonopin, and Xanax also. I'd like to try a low-dose of either, maybe like 1-2 mg, either alone or to supplement my paxil. I know a lot of docs now don't like to prescribe them because they are benzos and it's like they assume everyone would abuse them which is bullshit. I know people who have taken xanax/klonopin for years for the same type of anxiety as me and they do just fine. My anxiety has been better on my ssri but I still get panic attacks and dread, so I feel like adding a benzo might be worth a try. How should I ask my doc for a benzo tho, because they are so anal about prescribing them.

I've been on Xanax for several years now.  As I said, I end up letting refills expire.  I haven't had any addiction issues with them.  Having said that, many do have issues.  The other thing I hear some docs say is that benzos can cause anxiety to actually get worse-- rebound or some term.  For me, I don't know what I would do without it-- at least until the depression med and therapy allow me to not have the anxiety.  I hope I get to the point where I am fairly anxiety-free.  I hate the thought that this will be my reality for years to come.  I just want to be "normal." 

At this point, with a family history of strokes, I feel I need to do all I can to control my anxiety.  When it is bad, my blood pressure is up and my head pounding.  I do worry about anxiety causing a stroke, by spiking my bp.  If I began taking more and more of the Xanax, I would have to access whether I need to get off it.  I often think I could benefit from taking a little more.  Right now, I take 1mg in the beginning of the day and a half mg in the evening.  If I'm having a bad anxiety day (usually from meeting new people, traveling, etc), I will take an additional half mg.  The script is written for 4mgs per day. 

Offline Miss Philicia

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #20 on: June 24, 2013, 02:31:14 AM »
Miss P, I have heard great things about Klonopin, and Xanax also. I'd like to try a low-dose of either, maybe like 1-2 mg, either alone or to supplement my paxil. I know a lot of docs now don't like to prescribe them because they are benzos and it's like they assume everyone would abuse them which is bullshit. I know people who have taken xanax/klonopin for years for the same type of anxiety as me and they do just fine. My anxiety has been better on my ssri but I still get panic attacks and dread, so I feel like adding a benzo might be worth a try. How should I ask my doc for a benzo tho, because they are so anal about prescribing them.

Xanax has a short half-life, so for example, it's great to use if you are having out patient surgery that you won't have anesthesia, as a way to reduce any anxiety. Klonopin is better if your anxiety happens throughout the day, or general anxiety disorder -- it's more of a smooth ride and doesn't hit you over the head. Put it this way -- if you only have a panic attack once a week xanax is probably a good fit. If you have them daily klonopin is better. If you want to fall asleep for six hours on an overnight flight to Europe then take valium. With something like klonopin I also find it fine to drive a car, assuming the dose is something normal like 0.5 or 1 mg.

I think they use Paxil more for social anxiety, but have you had a psychologist actually officially diagnose what type of anxiety you have?
« Last Edit: June 24, 2013, 02:36:19 AM by Miss Philicia »
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Offline tednlou2

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #21 on: June 24, 2013, 02:44:14 AM »
Xanax has a short half-life, so for example, it's great to use if you are having out patient surgery that you won't have anesthesia, as a way to reduce any anxiety. Klonopin is better if your anxiety happens throughout the day, or general anxiety disorder -- it's more of a smooth ride and doesn't hit you over the head. Put it this way -- if you only have a panic attack once a week xanax is probably a good fit. If you have them daily klonopin is better. If you want to fall asleep for six hours on an overnight flight to Europe then take valium. With something like klonopin I also find it fine to drive a car, assuming the dose is something normal like 0.5 or 1 mg.

I think they use Paxil more for social anxiety, but have you had a psychologist actually officially diagnose what type of anxiety you have?

I need to look into Klonopin.  I had never even heard of it, until hearing you and a few others talk about it.  I thought it was the same as Xanax, basically.  It sounds much better for the kind of anxiety I have.

Offline BT65

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #22 on: June 24, 2013, 05:17:43 AM »
Klonopin does wonders for general anxiety disorder, IMO. It has the longest half-life of a benzo.

Valium actually has a longer half-life, but not by much. 

Robby, have you ever tried cognitive behavioral therapy? 
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Offline Ann

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #23 on: June 24, 2013, 07:40:57 AM »

I know a lot of docs now don't like to prescribe them because they are benzos and it's like they assume everyone would abuse them which is bullshit.

//snip//

How should I ask my doc for a benzo tho, because they are so anal about prescribing them.


Many doctors are "anal" (lol) about prescribing benzos not only because a minority may abuse them, but more importantly because even when a person is not abusing them, but using them as directed, they become physically and psychologically addicted.

You don't have to abuse drugs like benzos or opiates to become addicted. These meds can be extremely difficult to stop using, so think carefully before you ask for them. I think the phrase is "be careful what you wish for".
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Offline Miss Philicia

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #24 on: June 24, 2013, 08:57:13 AM »
I don't find klonopin any more "addicting" than the fact I have to pop four pills daily for HIV. I guess that I'm addicted to those to. And anti-diarrhea medication.

But yes it's true that benzos can be abused, but with klonopin for example, even abusing it is relatively safe. You don't get super high when you take 10 of them at once, and (forget the term) it doesn't make your tongue cut off your breathing when sleeping. So doctors consider it fairly safe even in that respect. Now, the danger with benzos and abuse as I see it is mixing them with alcohol. That's simply a big ole Liza Minnelli no-no and while I joke about it on this forum I absolutely never do that. OK, I did it one time and woke up on the sofa with vomit coming out of my mouth. Not fetch.
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Offline RobbyR

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #25 on: June 24, 2013, 02:25:55 PM »
Well my thing is the pretty bad side effects ssri's have just create more anxiety and while the paxil has helped my anxiety, it has pretty much destroyed my libido and sexual function at age 30. And I still get panic attacks, it just keeps my anxiety somewhat in check. Compared to other ssri I have tried paxil has been the best for me, but I still would rather supplement with a benzo like klonopin or replace my ssri ith a benzo I could take as needed.

I have not yet seen a pdoc, only gp, I hope to though. Social anxiety is very debilitating and I often have days where I don't want to leave the house for fear of being judged or looked at. My anti-depressant has helped me to function much more, but I still get panicky and have jitters. Bottom line I am just going to ask my doc next time if I can try Klonopin and see what he thinks. Just because some people build tolerance to benzos or abuse them doesn't mean everyone will. And the side effects are much less than ssris.
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Offline BT65

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #26 on: June 24, 2013, 04:54:42 PM »
Robby, no one's telling you not to ask your doctor for a short term trial of Klonopin.  But benzo's are really supposed to be used short term.  If used daily, not even abusing them, benzo's do build a physical addiction that's difficult to withdraw from. That's why I was suggesting cognitive behavioral therapy.  You just have to find a therapist who can utilize this type of therapy effectively.

Actually when I used Klonopin it did nothing for me, but because I was used to high doses of like Xanax and Valium.  It is a milder benzo.  And I'm probably talking out of term since many people are able to use it once in a while and not daily.  But in reality, all benzo's, if used daily on a consistent basis, are addicting.  Not that you shouldn't try it.  If the anxiety is debilitating then by all means get something to help you function.  I still stand by trying CBT (along with the Klonopin).  It really does work.
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Offline RobbyR

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #27 on: June 24, 2013, 07:07:18 PM »
If I had it to do over, I would not have started ssri's because they have killed my sex drive and have helped my anxiety somewhat but there are days when I feel so panicky and scared it's like I am not taking anything. So I am flat out going to ask my doc if I can try Xanax or Klonopin (maybe a better option) and start some type of cbt also.
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Offline oksikoko

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #28 on: June 24, 2013, 07:12:33 PM »
If I had it to do over, I would not have started ssri's because they have killed my sex drive and have helped my anxiety somewhat but there are days when I feel so panicky and scared it's like I am not taking anything. So I am flat out going to ask my doc if I can try Xanax or Klonopin (maybe a better option) and start some type of cbt also.

1) I am not a doctor. Talk to your doctor.

2) I was mis-prescribed SSRIs (many of them) which activated mania (among other problems) causing massive life disruption (among other problems).

SSRIs are dangerous for certain people, though they are prescribed like multivitamins, even by general practitioners with no background in psychiatry. It may be worth asking your doctor for information on this topic. Or it may not. Ask your doctor.
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Offline RobbyR

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #29 on: June 24, 2013, 09:47:54 PM »
1) I am not a doctor. Talk to your doctor.

2) I was mis-prescribed SSRIs (many of them) which activated mania (among other problems) causing massive life disruption (among other problems).

SSRIs are dangerous for certain people, though they are prescribed like multivitamins, even by general practitioners with no background in psychiatry. It may be worth asking your doctor for information on this topic. Or it may not. Ask your doctor.


Excellent points you made. I think too many GPs throw out ssri's and don't tell people what the side effects are going into it. Like I said my anxiety has improved on paxil, but some days I just feel numb and in a haze. Not that it's altogether unpleasant, compared to when I took Zoloft, that stuff made me feel like I was on crack! It made me freaking paranoid and manic as hell. Paxil is better but I would like to decrease my dosage of it. I plan on seeking behavioral therapy but I know realistically my anxiety and panic are so bad I don't ever see myself not being on some kind of meds. I think benzos get a bad wrap. My friend has taken Klonopin for years and she is also on Prozac granted, but she swears by the Klonopin she NEVER has anxiety anymore! I want to get where she is! I am not ready to give up on my current med because it keeps me somewhat sane but I'd like to try adding a benzo and see if my panic attacks will go away. Thanks again for the response.
« Last Edit: June 24, 2013, 09:50:16 PM by RobbyR »
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Offline oksikoko

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #30 on: June 24, 2013, 09:59:47 PM »
...when I took Zoloft, that stuff made me feel like I was on crack! It made me freaking paranoid and manic as hell.

Does your medical plan include psychiatry or are you seeing a GP for this? Sorry if that was stated above and I missed it. If you have the option of a bona fide psychiatrist, as wary as I am, I would recommend you talk to one about this in particular. Psychiatrists don't treat diseases. They treat symptoms. And several very different conditions share a few similar symptoms. If you give the "wrong" drug to the "wrong" person, you can make things much worse. An SSRI should make, for example, a person with anxiety feel calmer (eventually). An SSRI can make, for example, someone who's bipolar, manic. Mania is more than just "feeling wired", so we're all armchair diagnosing here. A single manic episode can potentially destroy your life in ways you may never recover from. Or it can just be an annoyance. It depends on the circumstances, and you do not want to take that chance.

I really don't mean to stir the pot or confuse you during a vulnerable period, so please be sure you're telling all of these things to a psychiatrist if at all possible. It's all relevant and withholding anything, intentionally or unintentionally, from the person writing prescriptions can lead to misdiagnosis with serious results in this psychopharmacological wonderland we inhabit.
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Offline BT65

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #31 on: June 25, 2013, 04:55:09 AM »
Benzo's got a "bad wrap" because so many people got strung out on them (me included) and they are extremely difficult to discontinue.  Because of extraneous circumstances I stopped them (plus other meds) I was on cold turkey and I can tell you I've never had such severe withdrawals.  Worse than heroin.  But as I said above, there are those people who are able to tolerate them low-dose, and only take them as needed.  So I wasn't trying to talk you out of it; just trying to let you know the big picture, if you will.

Psychiatrists are trained to treat mental illness, which, to me, are like "brain diseases."  As Oksi said, they are usually better at matching meds to what you're experiencing, than a regular GP.  One thing about psychiatrists is, some persons expect them to spend a long time with them, when in reality most psychiatrists will only see someone for about 5 minutes.  It used to be different long ago, but with more mental illness being realized and more people wanting treatment, things have changed.  Of course years ago mental illness was still stigmatized so more people did not seek treatment. 

If the Paxil is working the way you want it to, then ok.  But if it's causing you a lot of distress, you could always change it out.  I know it sucks to keep changing meds, but there may be a better fit for you with something else.  And I understand, I've changed antidepressants many times.  I'm hoping the regimen I have now will last.  Anyway, good luck and let us know how things are going!
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Offline cswalters1

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #32 on: July 15, 2013, 07:03:55 PM »
for RobbyR,

I had an anxiety disorder long before I became positive, which is recently.  It is difficult sometimes, but I am one of those who uses Xanax, my Dr. has no problem prescribing, although, there was a small glitch, because it is contraindicated  for Stribild which I am now on (2 months) my Infectious Disease Dr spoke with my primary and now it is ok.  I use about 5 to 10 a month, so no history of abuse. 

The real issue for me was not the anxiety, but the way my friends react to it, most people don't understand.  They wonder why I wont go to the mall at Christmas, go to concerts, street fairs or anywhere that crowds may occur.  They also don't understand that sometimes, I can't leave my house.  Much of their incredulity comes from the fact that my job is very public, I speak to large crowds.  As part of my work, I have found ways to "hide' inside a work persona which allows me to "get" through it.  After which I need considerable down time.  I know it is rough, I hope you find something that works for you.  Routine helps, my friends know I am not spontaneous, so they have adapted to making definite plans, keeping to them, and not asking me to do things which they know are triggers.

Offline oksikoko

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #33 on: July 15, 2013, 07:26:43 PM »
The real issue for me was not the anxiety, but the way my friends react to it, most people don't understand.  They wonder why I wont go to the mall at Christmas, go to concerts, street fairs or anywhere that crowds may occur.  They also don't understand that sometimes, I can't leave my house.  Much of their incredulity comes from the fact that my job is very public, I speak to large crowds.  As part of my work, I have found ways to "hide' inside a work persona which allows me to "get" through it. 

This is an interesting point, cswalters. I always thought of the same idea, not as a persona, per se but rather that when the social structure is so clearly defined (I am teacher, you are student or vice versa), then there's no anxiety at all. But if I have to convince you to like me over a drink? Nope. Nope. Nope.

I used to teach (lectures in front of medium sized groups) at university in Seattle and a high school Siberia. I used to be a singer too, fronting for a very flamboyant pianist, so lots of judging eyes were aimed our way. That's no problem. But I couldn't sit down with you and have coffee and talk one on one for five minutes. That's just too stressful. Of course, some people could talk to each other one on one all day, but would never be able to stand in front of a room full of people and talk without a beta blocker or something.

People who haven't experienced either of these sorts of anxieties have trouble seeing the distinction, I think. I did find that as the one grew (intersocial) it affected the other (performance), though. I think I'd have trouble teaching a class again, for example. Not that anyone would allow me in front of a group of developing minds, haha.
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Offline cswalters1

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Re: Terrible Social Anxiety/Treatment Ideas
« Reply #34 on: July 17, 2013, 07:44:51 AM »
This is an interesting point, cswalters. I always thought of the same idea, not as a persona, per se but rather that when the social structure is so clearly defined (I am teacher, you are student or vice versa), then there's no anxiety at all. But if I have to convince you to like me over a drink? Nope. Nope. Nope.

I used to teach (lectures in front of medium sized groups) at university in Seattle and a high school Siberia. I used to be a singer too, fronting for a very flamboyant pianist, so lots of judging eyes were aimed our way. That's no problem. But I couldn't sit down with you and have coffee and talk one on one for five minutes. That's just too stressful. Of course, some people could talk to each other one on one all day, but would never be able to stand in front of a room full of people and talk without a beta blocker or something.

People who haven't experienced either of these sorts of anxieties have trouble seeing the distinction, I think. I did find that as the one grew (intersocial) it affected the other (performance), though. I think I'd have trouble teaching a class again, for example. Not that anyone would allow me in front of a group of developing minds, haha.

You are obviously very intelligent, I am sure you were, and still would be a wonderful teacher.  Isn't it wonderful you can now teach an entire class room without being in the room.. .I telework three days a week, it makes it alot easier on me.  Thanks for the feedback and your extraordinary lens.

 


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