Mental Health Social anxiety/anti-anxiety/OCD meds (and depression)that don't make you tired?

[Mycophile]

This is less about anti-depressants, but a little bit, but more specifically social anxiety, and also OCD and generalized anxiety.

I've got a few types of anxiety, generalized anxiety disorder, social anxiety, ocd and some depression, but the one that I currently take Klonopin for and which can be the worst is eye-contact anxiety where I get uncomfortable making eye contact.

Because I almost always have Klonopin in my system I almost never get it, but the problem is that klonopin makes me tired, and i do my best to keep my dose down, but the other problem is stimulants increase my anxiety, and I am addicted to coffee, so it's pretty much the norm that i will be tired from my klonopin, then drink coffee, then that increases anxiety so i take more klonopin, and/or i can't fall asleep at night cause of too much coffee so i use klonopin to knock me out and wake up exhausted needing coffee, and the cycle is never ending.

I normally take about 1.5mgs of klonopin, but i usually take it at night, and i should be taking it during the day.

At my best years ago i was BRIEFLY able to get my Klonopin to 0.5mgs in the morning and 1 cup of coffee in the morning AND FELT GREAT...not too anxious and not too tired, but to do it I had to keep a PERFECT lifestyle with lots of daily exercise and good sleep hygiene.

IT'S HARD because my sleep hygiene SUCKS.

I find that to maintain this i must always go to bed the same time, always wake up the same time, keep caffeine down, exercise but not too late, no screens at night, etc.

I also take lexapro, but it does nothing for me.

So, I have a new psychopharmacologist and i am going to ask her her suggestions for other meds that may help with my social anxiety and also generalized anxiety, ocd and depression THAT DO NOT MAKE ME TIRED, but also that don't make me too wired either.

We have planned to try to help me do what i did before and get the klonopin down around 0.5 or at least no more than 1mg per day and get the coffee down to no more than 2 cups daily, but i am thinking another med may help.

Certain meds we have in mind are; Welbutrin because she is also helping me with drug cravings and getting sober and it helps with that and depression, possibly gabapentin, and i told her i heard good things about Vortioxetine which she has never heard of.

I have no interest in trying SSRIS as i am on lexapro and it's no good and was on prozac and it stopped working and i figure 2 drugs of that class is enough, and i don't want to take MAOIs with all the interactions.

I know there are other classes like SNRIs and tricylics and who knows what else.

But what I REALLY need is something that eliminates that social anxiety just like klonopin does WITHOUT making me tired.

i should note that the only other things that can help with this type of social anxiety are other GABAergics or opioids; Kratom works for it, but Kratom kils my drive to workout ENTIRELY, which is one reason I am stopping, at least for now, cause I need to and like to work out regularly.

Of course, alcohol and phenibut also work for this, as well as stronger opioids, but i am currently on naltrexone to help me not drink alcohol or use opioids and i think that is best for right now.

So....given that I am on naltrexone....is there another additional drug i could add to a SMALL dose of klonopin, or even replace the klonopin with, ( and most definitely I want to get rid of lexapro too cause it's worthless to me) that will not sedate me or stimulate me too much?

Thanks

 

[Mycophile]

Anyone ?

Lets make this simpler; all I want is suggestions for medications that help with social anxiety and OCD that aren't likely to make me tired, and not including SSRIs, MAOIs or benzos (other kinds of gabaergics are ok, just not benzos cause i'm already on klonopin )

We could be took SNRIs, Trycyclics, anything atypical or off label.

If anything could give me anything to work with that would be great.

Thanks.

 

[AlphaMethylPhenyl]

We don't really know the specifics of your situation.

Why not SSRIs? They're very safe and help with anxiety as well as depression.

Maybe propranolol or another in that class of meds. Clonidine, herbs such as chamomile, lavender, nettle, tulsi, ashwaghanda, and other mild GABAergic substances.

 

[checktest]

Wellbutrin can be mixed for anxiety (can make some people anxious but better for others, socially) and is a possible route.

Well he's on escitalopram and was on fluoxetine. For SSRIs sertraline is still there with indications for social anxiety (I've been on it.) Fluvoxamine does interact with caffeine, even if it can be beneficial for OCD. If you have never tried an SNRI they could be worth a shot before hitting up some more dangerous choices. I've spoken about vortioxetine before but again availability.

Most tricyclics are pretty dirty and many are sedatives. Clomipramine is strong for ocd but not the easiest drug. I did desipramine with fluoxetine, as well as amitriptyline. I think protriptyline is less sedating but I can't vouch for it personally.

Changing around the timing of your benzo and lowering the dose along with the coffee. The usual sleep hygiene and breaking sedative-stimulant cycles. Modifying what you have may be better while you work with the naltrexone and other changes. Stabilizing on the naltrexone and seeing how your routines / behavioral changes go for a couple months may be a good point, before adding on too much.

Yeah the gabaergics Lyrica and gabapentin can be tiring but may be more tolerable than some benzos dose wise.

I mean memantine can be used as an augmentation in ocd and isn't particularly tiring, but may not be easily prescribed. I've been on it and it can be good socially. Not a standard prescription.

I don't know how tianeptine would match with the naltrexone or in general. Can be tricky and not a good one with drug disorders.

Agree with AMP suggestions ^. Have you tried N-acetylcysteine as a supplement? I had a reasonable experience.

Even l-theanine or something with the caffeine.

 

[Jabberwocky]

I was having a lot of anxiety trouble caused by intrusive thoughts - I would obsessively ruminate on relationship issues and other things and that provoked great anxiety. It was especially bad in the morning when I immediately work up.

My psychiatrist prescribed 10 mg Abilify )atypical antipsychotic) taken before bed and within 2 weeks symptoms and anxiety I had for years had disappeared. When I stopped taking abilify after 4 years the same anxiety and intrusive thoughts returned.

Abilify for anxiety is off-label and probably only good for what my doctor called Obsession Only Obsessive Compulsive Disorder (i.e. Thoughts but not repetitive behaviour).

Don’t know if relevant to your circumstance but maybe worth researching further. As a bonus Abilify seems to reduce stim craving. It also does not make me particularly tired (or I don’t notice since I take it at night only).

 

[checktest]

Adjunct AAPs are definite tools with those obsessional overlaps. Those partial agonists like abilify (and brexpiprazole) and the newer cariprazine, agents on the pipeline, are very interesting. At least for some tolerability (well, maybe not akathisia) and metabolic effects alone. I don't know if Myco will go that route, but it is interesting and worth reading.

Glad to hear it worked well for you!
[I didn't have a great time with abilify.]

 

[Jabberwocky]

[I didn't have a great time with abilify.]

Neither did I when I tried to stop taking it - it is a bitch to get off of. The anxiety symptoms from withdrawal were 10 X the original I started taking it for. But it resolved in a few months or so with tapering. It’s a long term play if you want to take it.

 

[Mycophile]

We don't really know the specifics of your situation.

Why not SSRIs? They're very safe and help with anxiety as well as depression.

Maybe propranolol or another in that class of meds. Clonidine, herbs such as chamomile, lavender, nettle, tulsi, ashwaghanda, and other mild GABAergic substances.

As I mentioned, I am on lexapro and it doesn't work and i tried prozac and it petered out and i don't see why any other SSRI would be so different.

If i'm trying a new med i want a different class.

Some of the others could be interesting maybe.

 

[Mycophile]

Wellbutrin can be mixed for anxiety (can make some people anxious but better for others, socially) and is a possible route.

Well he's on escitalopram and was on fluoxetine. For SSRIs sertraline is still there with indications for social anxiety (I've been on it.) Fluvoxamine does interact with caffeine, even if it can be beneficial for OCD. If you have never tried an SNRI they could be worth a shot before hitting up some more dangerous choices. I've spoken about vortioxetine before but again availability.

Most tricyclics are pretty dirty and many are sedatives. Clomipramine is strong for ocd but not the easiest drug. I did desipramine with fluoxetine, as well as amitriptyline. I think protriptyline is less sedating but I can't vouch for it personally.

Changing around the timing of your benzo and lowering the dose along with the coffee. The usual sleep hygiene and breaking sedative-stimulant cycles. Modifying what you have may be better while you work with the naltrexone and other changes. Stabilizing on the naltrexone and seeing how your routines / behavioral changes go for a couple months may be a good point, before adding on too much.

Yeah the gabaergics Lyrica and gabapentin can be tiring but may be more tolerable than some benzos dose wise.

I mean memantine can be used as an augmentation in ocd and isn't particularly tiring, but may not be easily prescribed. I've been on it and it can be good socially. Not a standard prescription.

I don't know how tianeptine would match with the naltrexone or in general. Can be tricky and not a good one with drug disorders.

Agree with AMP suggestions ^. Have you tried N-acetylcysteine as a supplement? I had a reasonable experience.

Even l-theanine or something with the caffeine.

Thanks.

Some interesting suggestions.

No i have never tried N-acetylcysteine.

What does it do and could it help with social anxiety?

I am considering Welbutrin and my doctor is suggesting it so maybe i might try that.

I was having problems with abusing dexadrine and so that is one reason i was afraid to take welbutrin because even though i am trying hard not take dexadrine, kratom or drink alcohol now and have gone without all of them for about 3 weeks, i had heard someone here say that if i messed up and took dexadrine/adderall on Welbutrin it would be REALLY REALLY dangerous and so I was afraid, but i told my psychopharmacologist that and she said that that is not at all true and she knows lots of people who are on both adderall and welbutrin and that yes, it could increase anxiety and would not recommend it, but that it's not like if she puts me on Welbutrin and i did ocassionally fuck up and take dexadrine/adderall that i'd die or something, like a mixture of an MAOI like DXM with an SSRI like prozac, or liking drinking a bottle of vodka while shooting up lol, and that they do NOT DIRECTLY interfere with eacother, so that eased my concerns...even though i plan to go as long as possible without dexadrine.

Yes, i heard luvox interacts with caffeine and i drink too much caffeine, even though i want to cut down or even quit in a perfect world, which is why even though i was once suggested it and on it for a couple days i immediately decided to get off cause i figured i'd drink too much coffee and mess with myself some how so i don't think i should try that.

I do agree that the lifestyle habits of changing when and how much klonopin i take and cutting down caffeine with better sleep hygene and diet and exercise is the best thing to do, but i'm likely to also need another med at some point i think since my lexapro does nothing and i just have these concerns that maybe going SUPER low on klonopin, like 0.5, would not work for my anxiety, and that more could be sedating, but i dont' know.

Years back i DID briefly pull off a period of being on 0.5mgs of klonopin only in the morning and only 1 cup of coffee a day and no other drugs with intense daily exercise and it was the best i have felt in years, and that is my goal to get back there, so it's doable, but it was VERY hard to maintain and once i had some bad things happen in my life, like an injury and surgery i had at that point, it all want to shit, and i have trouble keeping up good habits and staying off drugs or staying at low dosages of drugs even when i find i can do it for a short time so i don't know what else could help me do something like that more easily.

Do you have any outside-of-the-box ideas as to what could make it easier to keep klonopin and caffeine down?

And what exactly is memantine and why do you think i couldn't get it prescribed?

Also, why do you think it would be hard for me to get prescribed vortioxetine and would you recommend that?

I brought that up to my doctor the other day cause i saw a commericial about it the night before and she'd never heard of it but she is somewhat open minded if the drug is actually past phase 3 trials and has accepted usage so maybe i could convince her.

 

[Mycophile]

I was having a lot of anxiety trouble caused by intrusive thoughts - I would obsessively ruminate on relationship issues and other things and that provoked great anxiety. It was especially bad in the morning when I immediately work up.

My psychiatrist prescribed 10 mg Abilify )atypical antipsychotic) taken before bed and within 2 weeks symptoms and anxiety I had for years had disappeared. When I stopped taking abilify after 4 years the same anxiety and intrusive thoughts returned.

Abilify for anxiety is off-label and probably only good for what my doctor called Obsession Only Obsessive Compulsive Disorder (i.e. Thoughts but not repetitive behaviour).

Don’t know if relevant to your circumstance but maybe worth researching further. As a bonus Abilify seems to reduce stim craving. It also does not make me particularly tired (or I don’t notice since I take it at night only).

Hmm, that's interesting.

I do also have very obsessive ruminating thoughts in a very similar way where i pretty much always have a complex in my life that i return to regularly with negative thought patterns i can't seem to escape, and yes, i don't engage in nearly so many compulsions as i do have the obsessive thoughts.

Sure, i have some compulsive behaviors like asking for reassurance from friends and i like to have certain things in a certain order, but usually the problem is not in compulsive behaviors i do but in obsessive ruminating thoughts that i have.

But TYPICAL anti-psychotics like Risperdal scare me and are not right for me.

MANY years back an ASSHOLE doctor had it in his head that i was not just anxious or OCD but a paranoid schizophrenic and I'd tell him i had trouble with eye contact, which now does not happen due to klonopin, and sometimes thinking people are staring at me or talking about me, but that was as far as it went.

He almost SADISTICALLY wanted to suggest that perhaps i might also think those same people were following me in cars and shit like that.

I'm like ''NO DUDE I'M NOT FUCKING CRAZY!!''

And he was such an asshole.

The Risperdal just made my throat dry and gave me weird dreams.

He also gave me Buspar which did NOTHING and I consider it a sugar pill, but i know some people find it works for them.

I kept asking him for klonopin at the time because i knew it would help me but he refused out of fear he'd lose his license, and as a result i had a traumatic panic attack in public, found a new doctor and got on klonopin which has helped me ever since, but again, the tiredness is an issue.

So i don't want to try any kind of anti-psychotic that is like Risperdal.

Is Abilify like Risperdal?

Also, i am almost guaranteed to use kratom and drink alcohol again later in life, and i doubt I'll NEVER use dexadrine or adderall again, so can it be safely combined with those things?

 

[Burnt Offerings]

I was going to suggest looking into the atypical antipsychotics like aripriprazole/brexpiprazole too...I know that some people have had success using those drugs but I'm not terribly familiar with how they work and haven't seriously researched them. Might be something to research though

 

[Jabberwocky]

Hmm, that's interesting.

Also, i am almost guaranteed to use kratom and drink alcohol again later in life, and i doubt I'll NEVER use dexadrine or adderall again, so can it be safely combined with those things?

My psychiatrist prescribes dexamfetamine and abilify together no problem - so I presume there is no issue with adderall.

 

[Mycophile]

My psychiatrist prescribes dexamfetamine and abilify together no problem - so I presume there is no issue with adderall.

So is abilify different than something like Risperdal which did nothing from me, and if so, how?

 

[Jabberwocky]

So is abilify different than something like Risperdal which did nothing from me, and if so, how?

Different drugs but same class of drug (second generation non-typical antipsychotic). Abilify has much longer half life and much few side effects according to the literature. That is, it is more tolerable to more people.

It does not make sense to write off a whole class of drugs (i.e. atypical antipsychotics) because each one operates slightly differently and has different effects. For example, seroquel did nothing for my anxiety but abilify did. The only way to know is to try unfortunately.

 

[checktest]

Scholar, Microsoft academic, pubmed, wiki, examine are some resources for looking up material.

1 | NAC - what it do, boo

We don't quite know. ~Precursor to cysteine and as such a precursor of glutathione, with antioxidant properties mainly known in tylenol overdoses.

Thought to modulate glutamatergic transmission, perhaps EAAT and others. I am interested/curious about possible effects on System xc- cystine glutamate antiporter.

Here's a random paper for NAC augmentation of citalopram. Not a great journal by any means.

Efficacy of N-Acetylcysteine Augmentation on Obsessive Compulsive Disorder: A Multicenter Randomized Double Blind Placebo Controlled Clinical Trial

Objective: Glutamate is considered a target for treating obsessive-compulsive disorder (OCD). The efficacy and safety of the nutritional supplement of N-Acetylcysteine (NAC) as an adjuvant to serotonin reuptake inhibitor (SSRI) for treating children ...

www.ncbi.nlm.nih.gov

2 | Box

I don't know what is in the box to say what is out of the box. Different routines can be beneficial for different people.

What's in the box?!

3 | Memantine

Generally known as an NMDA antagonist used in Alzheimer's (similar to an old flu drug actually and pleasingly quasi-cubic in structure), memantine has other possible mechanisms of action including D2 agonism...and System Xc- affinity. Definitely glutamate stuff.

Memantine protects thalamocortical hyper-glutamatergic transmission induced by NMDA receptor antagonism via activation of system xc<sup/> - PubMed

Deficiencies in N-methyl-d-aspartate (NMDA)/glutamate receptor (NMDAR) signaling have been considered central to the cognitive impairments of schizophrenia; however, an NMDAR antagonist memantine (MEM) improves cognitive impairments of Alzheimer's disease and schizophrenia. These mechanisms of...

www.ncbi.nlm.nih.gov

Off-label and investigatory, though recent reviews have been promoting more for OCD.

4 | Vortioxetine

Well I don't know quite where you are and vortioxetine is a newer drug. Insurance coverage appears to be expanding but it could be expensive. I don't know what fits your case but it was highly beneficial for me. I think it is over marketed, even though I have done much better on it.

Some of the AAPs really do have reasonable uses for that obsessional stuff. Funny you mention the reassurance stuff- my bipolar friend benefited from abilify I think (maybe it was seroquel as well, she was on some combos) with that. She used to call almost daily for some things but the AAPs really helped. Now we talk more without large amounts of the reassurances.

Yeah, we're still in the try and see phase for a lot.

 

[AlphaMethylPhenyl]

As I mentioned, I am on lexapro and it doesn't work and i tried prozac and it petered out and i don't see why any other SSRI would be so different.

If i'm trying a new med i want a different class.

Some of the others could be interesting maybe.

Go ahead and ask the person who probably knows what best to next try.

 

[checktest]

Your psych / psychiatric professionals are the best to communicate with in regards to any changes. They can evaluate you in person and ask you relevant questions. They also are trained and can know more than random people on the internet.

Not that people can't make mistakes or that bad circumstances exist of course, or misinterpretations.

 

[Mycophile]

Different drugs but same class of drug (second generation non-typical antipsychotic). Abilify has much longer half life and much few side effects according to the literature. That is, it is more tolerable to more people.

It does not make sense to write off a whole class of drugs (i.e. atypical antipsychotics) because each one operates slightly differently and has different effects. For example, seroquel did nothing for my anxiety but abilify did. The only way to know is to try unfortunately.

Yeah that makes sense.

They aren't the same drug afterall.

I'll ask my psychopharmacologist what she thinks.

 

[Mycophile]

Scholar, Microsoft academic, pubmed, wiki, examine are some resources for looking up material.

1 | NAC - what it do, boo

We don't quite know. ~Precursor to cysteine and as such a precursor of glutathione, with antioxidant properties mainly known in tylenol overdoses.

Thought to modulate glutamatergic transmission, perhaps EAAT and others. I am interested/curious about possible effects on System xc- cystine glutamate antiporter.

Here's a random paper for NAC augmentation of citalopram. Not a great journal by any means.

Efficacy of N-Acetylcysteine Augmentation on Obsessive Compulsive Disorder: A Multicenter Randomized Double Blind Placebo Controlled Clinical Trial

Objective: Glutamate is considered a target for treating obsessive-compulsive disorder (OCD). The efficacy and safety of the nutritional supplement of N-Acetylcysteine (NAC) as an adjuvant to serotonin reuptake inhibitor (SSRI) for treating children ...

www.ncbi.nlm.nih.gov

2 | Box

I don't know what is in the box to say what is out of the box. Different routines can be beneficial for different people.

What's in the box?!

3 | Memantine

Generally known as an NMDA antagonist used in Alzheimer's (similar to an old flu drug actually and pleasingly quasi-cubic in structure), memantine has other possible mechanisms of action including D2 agonism...and System Xc- affinity. Definitely glutamate stuff.

Memantine protects thalamocortical hyper-glutamatergic transmission induced by NMDA receptor antagonism via activation of system xc<sup/> - PubMed

Deficiencies in N-methyl-d-aspartate (NMDA)/glutamate receptor (NMDAR) signaling have been considered central to the cognitive impairments of schizophrenia; however, an NMDAR antagonist memantine (MEM) improves cognitive impairments of Alzheimer's disease and schizophrenia. These mechanisms of...

www.ncbi.nlm.nih.gov

Off-label and investigatory, though recent reviews have been promoting more for OCD.

4 | Vortioxetine

Well I don't know quite where you are and vortioxetine is a newer drug. Insurance coverage appears to be expanding but it could be expensive. I don't know what fits your case but it was highly beneficial for me. I think it is over marketed, even though I have done much better on it.

Some of the AAPs really do have reasonable uses for that obsessional stuff. Funny you mention the reassurance stuff- my bipolar friend benefited from abilify I think (maybe it was seroquel as well, she was on some combos) with that. She used to call almost daily for some things but the AAPs really helped. Now we talk more without large amounts of the reassurances.

Yeah, we're still in the try and see phase for a lot.

Some of what you are saying here confuses me cause i have the least amount of knowledge regarding biochemistry and that kind of stuff known to man, but I'm copying and pasting everything everyone here says to a word doc to look up more later.

Abilify is sounding interesting though, and i will ask my psychopharmacologist about it.

I also heard it has the potential to strengthen other anti-depressants, so maybe along with something else it could be even better.

Thanks.

 

[Mycophile]

Go ahead and ask the person who probably knows what best to next try.

I am assuming you mean my psychopharmacologist lol....see you can actually say that you know...just seems like a bit of snarky sarcasm, though I'm sure you mean well...

Obviously every suggestion anyone makes will be something i will run by my psychopharmacologist as she will be the one prescribing it, but asking for suggestions from people who have tried certain things is IMO a reasonable form of research.

I talked to her last time and she only made a couple suggestions and did not know what Vortioxetine was for example, and just because she's a doctor does not necessarily mean that every possible medication that might be useful will occur to her, so if you are being snarky here then frankly that's a bit annoying.

I can and am building a list on a word document from these medications and posts suggested to me so that next time i go to see her i can go in armed with ideas i had not previously had and many of which she probably would not have considered.

I doubt she'd have ever thought of Abilify either, despite it being well known, or N-acetylstine or however it is spelled.

Doing outside research on this kind of stuff IS WORTHWHILE IMO rather than just walking into my doctor's office and saying ''ok, so what should i take?''

That's not my style.

I want to know some things about the meds that are out there ahead of time.

A younger me used to do that, just go into an office and ask what i should take, and i got some bad psychiatrists with bad ideas, and i think many others walk in to doctor's offices without any thoughts of their owns, and frankly i think that's being naive.

I'm always going to figure that a doctor knows better than random posters on the internet, but I prefer to have ideas of medications to ask about ahead of time rather than walking in their cold and just saying ''yeah, give me whatever''...

I mean, I am bad at detecting sarcasm/snarkyness even in person due to my non-verbal learning disability, so I have an even harder time online where i can't hear tone of voice or see facial expression, but if you are truly being snarky here, then why would you be a mod at all?

Why not just make a sticky for this sub-forum that says ''do not ask for any medication suggestions or info if you are actively seeing a doctor as they know better than us''?

Again, sorry if I am misreading you and i can't detect your tone, but i'd be silly not to take my doctor's opinion MUCH more seriously than anyone on here, and not have my decision of what to take to come down to a decision between the two of us, but I like walking into a doctor's office ahead of time with ideas.

I also found it odd that at one point you said ''we don't really know the specifics of your situation'' when in the post right before that I'd given you all the specifics as to why i didn't want to try another SSRI because i'd already tried lexapro and prozac.

I can understand it being a longer post than you probably wanted to read though, as i'm very long winded and need to work on that so more people will want to read what i write...