Mental Health A long-term drug teatment plan for social anxiety?

silvermane

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After fifteen years of struggling with social anxiety, I've started sobering up to the realization that a successful treatment plan -- in my case, at least -- requires the life-long administration of legal and/or illicit drugs. I should be explicit that this is an adjunctive treatment that I'm pursuing in conjunction with an already consistent regimen of exercise, nutrition, and psychotherapy (namely, mindfulness-integrated CBT). Essentially, I'd like to know how you would design a drug treatment plan for social anxiety if you knew in advance that you would need to be on it for the rest of your life. Clearly, the drugs used should produce a potent anxiolytic and/or pro-social effect. However, it's also important that they can be taken over many years, and without incurring rapid tolerance or neurological damage.

After much research and personal experimentation, I've become fairly convinced that cannabis and Phenibut are more effective than benzodiazepines and SSRI's. Mind you, the anxiolytic/anti-depressant benefits of cannabis are only apparent hours after the high itself has run its course. Accordingly, I take 2-3 grams of Phenibut twice per week, and 0.3 grams of cannabis three times per week. Remarkably, I've been enjoying the benefits of these drugs without any obvious negative side effects and without too much tolerance. The problem I have right now is that I still have two days during the week and several hours between cannabis and phenibut use where I'm not under the effects of any drug. I'd like something else that can be taken intermittently for these specific occasions. Ethanol might do the trick, but I don't feel entirely comfortable using it in a professional work environment. I'd rather not give any indication that I'm actually on anything. My current candidates, then, are kava, and possibly a microdose of amphetamine, mescaline, or psilocybin. These might be a complete waste of time, but as you can probably tell, I have no qualms about using illicit drugs provided they can produce the desired effects. That said, I'm equally willing to reconsider benzodiazepines or pharmaceutical grade drugs so long as they can be used long-term with relative safely. Happy to receive any suggestions or criticisms on this.
 
The problem I have right now is that I still have two days during the week and several hours between cannabis and phenibut use where I'm not under the effects of any drug

Why is this a problem?

"The best laid plans of mice and men..."
 
Low dose SSRIs (2.5-5 mg of Escitalopram or 12.5-25 mg of Sertraline). Lots of exercise, sleep, and low dose benzos no more than 3x a week.
 
Why is this a problem?

"The best laid plans of mice and men..."

I'm merely trying to be comprehensive by attacking this issue from as many angles as possible. I have no illusions about any of this being a complete solution.
 
This is too self serving to be a good ADD thread. "what drug should I take" threads don't fly around here.

It's unwise to use long-term pharmacotherapy for social anxiety - it's a band-aid that fixes the symptoms without treating the underlying cause. No matter the agents, eventually you will find they lose efficacy. CBT really works well for phobias…well, best of anything we have.

The real trap is that drugs like ethanol, barbiturates, benzos & other GABAergics work way better in the short term and don't require people to do anything difficult.

People want this in TDS so... add--->tds
 
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Be careful with the Phenibut. Even if you haven't felt much (yet) in terms of a physical dependency, we've seen several cases in TDS of people getting dependent on it after thinking it to be a rather benign and harmless friend of benzos. I think for long-term treatment, less is more with it, and if you can, I'd limit it to once a week, perhaps twice if you don't notice any physical withdrawal symptoms over an extended time using it.

If you do want to add anything in, I'd add an herbal mixture of mostly legal stuff. Kava is a great core supplement. Around this, add some l-theanine, hops, blue lotus, skullcap, catnip, passionflower, valerian, etc. If this is a bit on the drowsy side, have it alongside some green or black tea, or some yerba mate.

In fact, given that none of these substances are physically harmful if taken daily, I'd say that it would be okay to take a combination similar to this everyday, or even twice a day, and use that as your foundation.

I would take Phenibut and/or benzos "as needed," and not get yourself on a schedule where you take them X days per week. The latter only leads to mental pressure and self-control when it might not even be needed in the first place. Keeping a bottle of Phenibut or a bottle of a benzo around, even without always taking them, can have a calming effect just in the security that they are there if you need them. Nothing's worse than an anxiety attack and knowing that you don't have anything to calm yourself down if you need it.

I'd say away from alcohol. It's not the cleanest of substances, and it's actually going to make your anxiety worse in the long run. If you have good self-control, then you can drink at social or professional settings where just having the drink in your hand might help you as a social lubricant (I'd suggest also carrying a lighter and a few spare smokes, even if you don't smoke, to use as an opportunity to meet new people). But as soon as you start seeing these as medications that you are to take as part of a health-care regime, then you're misusing these substances and it will only possibly go in a bad direction.

An occasional (as in once per month max) low-dose mushroom trip can be great at helping you remain in contact with the grander concepts in life. If you're comfortable with them, then slowly increase your doses if you want the occasional more humbling experience. As well, I find that using things I learned from my mushroom trips within social dialogue (implicitly, not "hey, so I was tripping once and...") can help you seem like a more interesting person. If you have access to mescaline, then you can proceed in a similar fashion with it. I'm not going to straight-up tell you to trip, as in TDS we don't try and encourage people to take medication/drugs without a doctor's advice, but personally I see a lot of potential in psilocybin and if you've tripped on it before and it's taken you to good places, I see no reason why it wouldn't continue to do so.

I think my underlying point, though, is to not bite off more than you can chew with taking medications/drugs for mental health. When I've tried to do this, I have ended up putting too much pressure on myself to do a huge list of things at the right times, to journal it all, etc. It's best to keep with a simple core-base of earth-based supplements to go along with a healthy diet, daily exercise and proper sleep. Trip every now and then at a dose that is comfortable to you, find ways to meet new people that are comfortable to you, be helpful and treat others as you'd like to be treated, and you will be well ahead of most people in your culture. :)
 
This is too self serving to be a good ADD thread. "what drug should I take" threads don't fly around here.

It's unwise to use long-term pharmacotherapy for social anxiety - it's a band-aid that fixes the symptoms without treating the underlying cause. No matter the agents, eventually you will find they lose efficacy. CBT really works well for phobias…well, best of anything we have.

The real trap is that drugs like ethanol, barbiturates, benzos & other GABAergics work way better in the short term and don't require people to do anything difficult.

People want this in TDS so... add--->tds

Alright, there may be some confusion around what it is I'm trying to accomplish here. The treatment plan I have in mind has many more moving parts than the administration of drugs. As I mentioned earlier, I've already incorporated intensive exercise, balanced nutrition, and psychotherapy (mindfulness meditation and CBT). I already apply these as the primary means of managing the social anxiety, but they're simply not enough. Again, I've been working through this condition for 15+ years. It's very clear to me that these softer or more humanistic treatments, while potentially effective long-term, are not cutting deep enough into the condition. This is what has lead me to conclude that the issue is rooted more in genetic than environmental/social factors; an aspect of the condition that drug therapies are especially well-adapted to handle. I'm not looking for a quick fix based around careless drug use. Keep in mind that 1 gram of cannabis and 5-6 grams of phenibut per week is well within the responsible and non-toxic range for these specific drugs. What I'm hoping to find is a more effective, well-rounded, and sustainable solution to the one I already have.

In response to Ho-Chi-Minh: I've already seen many psychologists, psychiatrists, and doctors about this. Obviously, you should get medical advice where appropriate. However, if your condition is serious enough, then you owe it to yourself sit down and do your due diligence and research. I really hope no one is such a mindless drone that they entrust their lives to a person who clearly has no first-hand knowledge or genuine sympathy for the conditions they're afflicted with.

Be careful with the Phenibut…

Lots of great points and advice here. Thanks for this. About the phenibut, it’s hard to know exactly the right dosage since there are so many contradictory reports about it. I’m a relatively stocky guy, around 200 lbs. I’ve tried smaller amounts in the past, approx. 500mg-1,500mg, and the therapeutic benefits weren’t too perceptible. It takes about 2-3 grams to produce the desired effect, which might be the amount needed to agonize the GABAa receptors (which explains its similarity to benzos), rather than just GABAb receptors (which I've read is a muscle relaxant channel). The question I’m left with, as you point out, is how many days I need to wait between dosings. I’ve seen reports where people were doing moderate dosages on a daily basis without too many complications. I’ve also seen Russian studies that claimed a high dose was upwards of 12-14 grams. On the other side, I’ve heard the same stories as you about dependence and withdrawal with superficial usage. Once a week would clearly maintain the benefit of phenibut long-term, but this seems almost too severe a limitation on what is otherwise an incredibly useful GABAergic drug for those of us unwilling to get on the benzo bandwagon. In any case, I’m going to maintain a bi-weekly schedule, leaving 3 days in-between for detox and recovery. If I start to find diminishing returns, I’ll likely follow your advice.

If you do want to add anything in, I'd add an herbal mixture of mostly legal stuff. Kava is a great core supplement. Around this, add some l-theanine, hops, blue lotus, skullcap, catnip, passionflower, valerian, etc. If this is a bit on the drowsy side, have it alongside some green or black tea, or some yerba mate. In fact, given that none of these substances are physically harmful if taken daily, I'd say that it would be okay to take a combination similar to this everyday, or even twice a day, and use that as your foundation.

Some kind of herbal cocktail could work. I’m really just wondering how it would measure up to the cannabis and phenibut. I can’t help getting the impression that it would be too mild to be effective. Am I underestimating these alternatives? Is kava even practical? I mean, is it even worth taking the time to prepare the stuff for its effects? Maybe an extract would work better? I didn’t mention this before since this is included in my nutrition plan, but I drink a lot of green tea, around 5-6 cups per day, which supplies a lot of natural l-theanine in my diet. I’ve also bought some l-theanine supplements, but for some reason, this hasn’t worked nearly as well. I’ll confess to being almost completely ignorant of hops, blue lotus, skullcap, catnip, passionflower, valerian, etc. None of my research turned these up as being effective. Perhaps in combination as you say? I don't seem to have too many alternatives here, so I might have to go down this herbal remedy road eventually. I'd be very pleased if I could use something like this on a daily basis.

I would take Phenibut and/or benzos "as needed," and not get yourself on a schedule where you take them X days per week…

This would definitely be ideal, I agree. The only problem I have with this is that “as needed,” might become “every day.” I really don’t think I have the self-control to manage my medicines in this way. A schedule I can follow because I just know ahead of time what my limits are. If the phenibut weren’t so central to my current stack, I could see how it might be nice to have as a fallback. I’d entertain this option if I could find something to supplement the phenibut. Benzos would be perfect, but I’m paranoid that they’re going to slowly destroy my mental performance and eventually exacerbate the social anxiety.

I'd say away from alcohol. It's not the cleanest of substances, and it's actually going to make your anxiety worse in the long run. If you have good self-control, then you can drink at social or professional settings where just having the drink in your hand might help you as a social lubricant (I'd suggest also carrying a lighter and a few spare smokes, even if you don't smoke, to use as an opportunity to meet new people). But as soon as you start seeing these as medications that you are to take as part of a health-care regime, then you're misusing these substances and it will only possibly go in a bad direction.

The amount of alcohol I have in mind is only about 3-4 beers or 2 cups of red wine per week. In the right setting, this would be perfectly acceptable, if only for the recreational effects. It’s when I’m in a professional context that I need to be a little bit more creative. The cigarettes are definitely out since I quit these and the smoking culture that went with them some time ago. Given my past history, it would be truly masochistic if I were to carry them around with me ;-) I actually have no intention of abusing these or any other drugs. I’ve gone down that dark road, and I’m done with it.

An occasional (as in once per month max) low-dose mushroom trip can be great at helping you remain in contact with the grander concepts in life…

I couldn’t be in more agreement. I’m actually very well acquainted with psylocybin and have a deep respect for the psychedelic experience in general; at least, at a philosophical level. What I’m less sure of is if there’s any reason to take it for the treatment of social anxiety. I do know of a few studies supporting the idea that psilocybin can improve depression and anxiety, but it’s still a very under-researched area. Once a month sounds almost right, I might even say every 2-3 months depending on the intensity of the experience. Relatedly, I’d be curious to know if there’s any benefit in taking very small, sub-threshold doses of psilocybin. If anyone can weigh in on that question I’d be happy to learn more about it.

I think my underlying point, though, is to not bite off more than you can chew with taking medications/drugs for mental health. When I've tried to do this, I have ended up putting too much pressure on myself to do a huge list of things at the right times, to journal it all, etc. It's best to keep with a simple core-base of earth-based supplements to go along with a healthy diet, daily exercise and proper sleep. Trip every now and then at a dose that is comfortable to you, find ways to meet new people that are comfortable to you, be helpful and treat others as you'd like to be treated, and you will be well ahead of most people in your culture. :)

All well said, and very sober advice. I share a very similar approach and I actually do have many of these other areas well-handled; diet, exercise, sleep, social life, etc. There’s just this irrational uncertainty and nauseating paranoia at the root of it all, which can make the most mundane aspects of daily living a nightmare. Fifteen years is just an absurd and unbearable amount of time to be facing the same issue over and over again. This might be why it sounds like I’m being a little more extreme than some people in attacking this condition.
 
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Kava definitely works, but it takes a bit of experimentation and shopping around before you have your first really good experience with it. I tried it a few times around '06 and wrote it off completely as something that tasted horrible and didn't do much, if anything. But then recently I gave it another try, having read about kavalactones and how many are needed even for a threshold experience (a lot more than anything you can buy in a health food store, that's for sure!). But I took a heavy dose a few months ago and definitely noticed a feeling of well-being and happiness, and then had a good night of sleep afterward. I did notice some annoying side-effects, though, and something of a "kavangover." I then tried a different preparation and it was more of the good and less of the bad. I imagine that ordering some of the stuff from the South Pacific that really gives you the bang for your buck would lead to a much better and "pure" kava experience, and it's something I plan to do down the road. The kava high does not last that long, and it's not all that intense, so one who is used to intense recreational drugs might find this one a bit too tame. It's something that has to be respected for what it is, which is a traditional beverage that can be taken daily to help one calm down and transition into sleep-mode after a long day, and can be done on a regular basis without turning one into an out-of-control addict. So ya, if you're going to try kava, do some research and order some top-of-the-line kava and take the time to prepare it right. It's worth it in the end. Just whatever you do, don't take 60 capsules bought in a health-food store to try and get as many kavalactones in you at once. This might give you some fleeting euphoria, but you're going to get a mighty stomach ache as well!

As for the other supplements and your comment about it all being too mild, well I think that if you mix them all together you'll find that the parts as a whole will definitely come together with the strength of a benzo or a few drinks. Only it will feel much better the next day, and it's something that can be done on a regular basis and won't really hurt your body or get you addicted. Sure, it's not going to be that intense, but it is calming and once you get into the habit of doing it daily, you do kind of mellow out as a person, and it gives you something to look forward to after a long day or work, school or whatever you do. As well, I find the whole idea of getting into herbs and natural therapies to be in and of itself rather therapeutic, and the idea of getting to know what grows on the planet and respecting these things for what calming effects they do give us is something that gives us this mature calming effect. Those things I listed are just a starting point, as the most well-known herbs out there for these effects. But trying a little bit of this, or a little bit of that can be a lot of fun when you know that the things you're dabbling with aren't that serious and things aren't going to go wrong if you don't happen to like a particular thing. For me, the idea of coming home each night and mixing and matching different herbs in a tea is much more gentle on me than going to the bottle shop and sampling different beers, or ordering exotic benzos off of the net and doing the whole "benzo rotation" thing. My personal anxiety doesn't like the idea that the thing I'm taking for anxiety will actually give me more anxiety in the long-run, or that the medication that is treating the anxiety will, cyclically, start to create the anxiety that it's treating. Alcohol and benzos will do this, but herbs won't. So I just feel a lot calmer about the whole effort, if you know what I mean.

For me, I like to keep benzos around for nights when I just cannot otherwise sleep. When I get worked up about something, I have a lot of non-drug ways of calming myself down and stopping panic attacks, but I still do suffer from insomnia related to stress and anxiety. And this makes things worse for me the next day, because I always get anxious when I am tired (and am chugging coffee to stay awake, which makes me even more anxious). Benzos help me regulate my sleep schedule, and I try and strictly keep them for this use only. I understand what you mean about "as needed" turning into "all the time," and this really does come down to self-control. I can see your argument for a strict schedule and why this will help you not overdo it. To this, all I can really say is "good luck." I tried this time and time again with opiates and each time I broke the schedule, rewrote it to allow me to take them just a bit more often, and eventually was using daily. Like opiates, benzos are physically and psychologically addictive, so you gotta be strong enough to tell yourself NO when you feel like it could be getting out of control.

Like for me, if I say that I can use a substance once a week - let's say on Friday night - I can use every Friday for a few weeks and not get physically addicted, but what happens is that I spend the other six days wishing it was Friday again. So the quality of my life goes downhill, not because I'm physically addicted and acting like a classical drug-addict, but because I'm torturing myself wishing for that day to come faster, and my week soon turns into one fun day and six sub-par days. I'll then tell myself that I can use another drug on one of those six days, and pretty soon I'm getting high on X each monday, Y each Tuesday, Z each Wednesday, and so on. I'm a poly-drug addict, even if not physically addicted to anything, and my life still very much revolves around drugs and using them to calm my anxious mind. This is how I am, I dunno about you. But for me, I have to use them "as needed" because the schedules drive me crazy at the end of the day way more than the self-control of "as needed" does.

For cannabis, I haven't smoked in a very long time due to legal restraints. But I used to love MJ, especially indicas. Again, this is TDS so we cannot really suggest drugs on people without being doctors, but MJ never did anything too bad for me other than making me a bit more introverted. So ya, perhaps with the topic of your thread origianlly being social anxiety, and me saying that cannabis made me introverted and had me keeping to myself a lot, it probably wasn't the best thing for my social skills, now that I think about it. But it's also a very safe drug and didn't, over time, screw my mind and body up like alcohol, stimulants or opiates did. Cannabis did wonders for my creativity, made me very interested in learning new things, helped me sleep, helped me eat, helped me work out, helped me be a more caring and loving person, and it also tasted really good! So I definitely think that it can help a person keep a good balance in life, and it can satisfy a desire to "get fucked up" and at the same time won't turn your life upside-down like a lot of other things can.

As for low-dose psilocybin, I always liked threshold doses. I found them to be a lot more euphoric than regular doses. I used to love to take a threshold dose and then listen to music or take walks around the city at night. Those times were beautiful and I do hope that I can do them again sometime. In fact, I feel like I've had enough deep mushroom experiences and would be fine with threshold ones for the rest of my life. I don't know about doing them all of the time, as I feel like it might lose its novelty and I respect mushroom way too much to do this to them. But I could see myself doing them in low does as much as once per week. To be completely honest with you, years ago I stuck to cannabis and mushrooms with the occasional MDMA, and really trying out a lot of different herbs, and I was much happier than I am now. Due to some legal events and relocating to an area where I cannot find many psychedelics, I've kind of turned over to some bad drugs and it's really affected my mind, body and soul for the worst. But I would love to get back to that old place once again, because it definitely is the way to go, if you are going to choose using medicines/drugs over being sober.

I think the benefit of low-dose mushrooms on a regular basis is that they help me see what really matters in life and what is synthetic happiness and fake positive energy created by a screwed up society. Mushrooms show me, for example, just how much better taking a stroll at night down by the river is than sitting in front of a television and watching violent shows while drinking beer and text-messaging meaningless stuff to people. It also helps me stay in close contact with my 5 senses, and how it really is as simple as properly stimulating those senses each day in order to feel good and stay happy. Good food, being around art (or making it), playing or listening to instruments, having a comfortable bed. On a really basic level, these are the types of pleasures that we seek, and I try and remember that it does not need to be as complicated as society wants us to think the stimulation needs to be. Our planet just as it is provides us with amazing sensual entertainment, but a lot of people pass this over. Like when I used to trip a lot, I could tell you the exact time of the sunrise and the sunset each day. Why? Because I was always watching it. Nowadays, with so much stupid shit being crammed into too little free hours I have, I couldn't even guess those things within 20 minutes. And that's sad, and it's something that I don't forget when I have that close connection to my planet. And these are the kinds of things I like to bring up in conversation with new people. Granted a lot of those people think I am a fucking madman, but at the same time it's great when someone chimes in that she/he has felt or thought the same way at times, and it really does help me know from an early time when I met someone who is going to become a great friend.
 
Lots of interesting food for thought here. I think you’ve basically keyed into the main problems I have with Kava. Even if you find the right supplier and expend the effort to prepare the stuff, the concentration of kavalactones needed to achieve a therapeutic dose is probably still too mild and short-lived for most practical purposes. I appreciate your point about the soothing effects found in the practice of herbal medicine itself, but I don’t see why you couldn’t just start gardening or learn a musical instrument to achieve those kinds of benefits. I don’t know, I’ve just had very few positive experiences with these things. On the other hand, I have observed some interesting effects from curcumin (I know, not an herb per se), which may be the result of its reported MAOI activity. So, perhaps one strategy along these lines is to concoct a highly bioavailable mixture of curcumin with other naturally occurring ingredients—e.g., Rhodiola rosea, syrian rue, etc.—to produce a potent MAOI tonic. I don’t know if this would work, but I do know MAOIs are a powerful, though rarely prescribed last line of defense in the treatment of depression and anxiety. If similar results can be produced purely by herbal means, I’d be strongly inclined to give this option a try.

To your point about playing favorites with certain days of the week because of your selection of drugs, I think you raise an interesting psychological issue. However, this would only be a problem if your selection of medicines were drastically disproportionate in their effects. For example, if I could only have phenibut once per week without having access to anything else, I agree that the overall quality of my life would go down. However, I don’t think my choices are really this limited. Personally, a cannabis day is pretty much on par with a phenibut day. Barring the obvious differences, I’d say the basic outcome of each drug is subjectively very similar. What I notice is when I have nothing at all to fall back on. It’s only in this case that I start craving something to take the edge off. Now, if I could expand my options a little further and develop a more sustainable treatment plan, I’d have no reason to make these kinds of comparisons since each day would afford me some kind of relief.

On this whole issue of drug cycling and being a poly-drug addict, I guess I just don’t share your concerns with the strategy. If you’re not on the same drugs long enough to become dependent or overly tolerant to their effects, what does it matter if you’re under the influence of a different drug each day of the week? Yes, I’m dependent on the drugs to an extent, but so what? I’m also dependent on my contact lenses to help me function as if I still had my complete vision. I don’t see any significant difference between this and the use of drugs to help me reach a healthier and more natural state of mental well-being. I don’t think any less of myself for using drugs—in a responsible way—as a kind of mental prosthetic. This is why sustainability is key. If I can’t count on the drugs years down the line, if their effects diminish, I’ll feel deficient without them. But if they’re reliable over the long-term, I can easily incorporate them into my life and make them a part of me without suffering any serious drawbacks or even realizing that I’m on them.

It’s a shame you can’t get your hands on cannabis. Luckily for me, it’s extremely easy to find high quality bud in my neighborhood. I routinely have access to potent indicas and sativas. I definitely agree about the indicas; they’re amazing for combating stress and anxiety. A good hybrid can also work wonders, though (White Widow comes to mind). I should probably mention that I’m new to TDS, so if I’m breaking any rules in discussing these things, I apologize. More to the point though, I think you’re on to something about cannabis and introversion. I’ve always thought that cannabis was a solitary drug. I mean, when I’m high it’s just impossible for me to function socially without becoming freakishly paranoid. The method that works for me is to smoke a small joint in the morning and then sleep for an hour or two. After waking, there’s a very palpable afterglow that stays with me for most of the day, where I feel very open, empathetic, non-aggressive, and comfortable being around others. It’s a great feeling and the main reason I think cannabis has efficacy for social anxiety. Could be my own unique reaction to the drug, I don’t know. It’s useful for so many different things, as you’re well aware I’m sure :-)

About the psilocybin, I’ll actually be getting my hands on a few grams this week, so I’ll most definitely be experimenting with these threshold doses. I’ve been thinking 0.5-1 grams should be more than enough to produce the intended euphoria and mental fluidity to curb the anxiety. If this is successful, I imagine I could get away with a very small dose once or twice every week, which would nicely solve my earlier problem. Of course, all of this could backfire… I have read in a few places that low threshold doses can be anxiogenic in some cases, but this might only be what happens to people who have no first-hand experience with shrooms. I’ve personally taken doses as high as 4-5 grams and never had a bad trip. Hopefully, I’ll respond well. Come to think of it, it’s been a few years since I did a proper shroom trip. If I ever decide to go that high again I expect to have my mind blasted to cinders… I also like that combination by the way: cannabis, shrooms, and MDMA. I’m not surprised that you had good results with it. I’ve also had my share of MDMA trips, and I’ve never been happier; it’s incredible stuff, but a little bit too easy to abuse. Doesn’t really matter either way since I’d have no clue where to find it at this point. Amphetamines, on the other hand, are all over the place (very pure too). I suppose if all else fails, I’ll end up trying these… Of course, for obvious reasons, I’m cautious about introducing these into my life.

Excellent point about finding the simple pleasures in life as a means to promoting happiness. Yup, I’m on board with that too. It’s a sick world out there. It can be hard not to turn into a seething mess of a human being. Maybe I have the shrooms and all that other youthful drug use to thank for preserving my sanity, fragile as it is. Maybe… just maybe… this is why some us have social anxiety and a host of other mental disorders in the first place! Maybe certain kinds of drug use have a way of inoculating us from the norms of our society. Maybe that’s the price we pay to hold our individuality intact in the face of a coercive majority, and the reason we seek out even more drugs for a solution… I mean, that’s irony for you. See, with the right encouragement, we can all begin to sound like madmen ;)
 
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Taking tranquillisers will make your anxiety worse long term because your mind loses the ability to cope without drugs. As obvious as this might seem there are studies to confirm this. My psychologist was even kind enough to illustrate this with some interesting data during one of our sessions because I was adamant that benzos were the only truly effective treatment for social phobia even if they have to be taken long term.

There is evidence that phenylzine (Nardil) is very effective for the anxiety disorder and is is considered by many to be the gold standard in the pharmacological treatment of social phobia. As much as it is unsafe due to the risk of a hypertensive crisis if you consume tyramine or take many types of drugs that interact, I wish I could at least give it a go.

In the hopes that a reversible MAIO would be more effective than an SSRI, if less so than phenylzine, I ended upactually trying moclobemide. However unfortunately I honestly couldn't notice a difference at all.

I truly believe that psychological treatments have the best chance of really working. If you really are determined and do all that's required of you then it should work for most people. Although the treatment is different in a way it's similar to any other phobia, such as of spiders. Most people know that you can overcome these phobias with things like systematic desensitisation if you are committed and this is also the case with social phobia. If you are dedicated you most likely will see an improvement. It is not a quick fix but it really works.
 
Taking tranquillisers will make your anxiety worse long term because your mind loses the ability to cope without drugs. As obvious as this might seem there are studies to confirm this. My psychologist was even kind enough to illustrate this with some interesting data during one of our sessions because I was adamant that benzos were the only truly effective treatment for social phobia even if they have to be taken long term.

That's a fair criticism, but I'm not sure it applies in this case. Neither phenibut or cannabis are conventional tranquilizers. They're more like mild sedatives. Also, they have wildly different mechanisms of action, which means I'm not becoming dependent on any particular effect; each is curtailing the anxiety through a different set of pathways. So, I just don't see how it can be true that my mind will lose its ability to cope without these drugs. Social anxiety is a multifaceted and highly complex condition and, as such, can be treated with a number of different strategies; only one of these involves the use of tranquilizers or sedatives. Alternatively, one could use beta-blockers to mediate adrenal hyperactivity, or any of a number of euphoriants or CNS depressants to attenuate the negative aspects of mood that accompany social anxiety. Another option would be to use performance enhancers and/or nootropics since SA tends to have something to do with a perceived lack of capability in social contexts. Another point is that the goal of these different drugs should be to create a psychological stopgap in relation to the anxiety so that the individual can learn new coping skills, which would be impossible to develop in the absence of those drugs. Presumably, the gains made during treatment would stay with the person even if they decided to stop using the drugs.

There is evidence that phenylzine (Nardil) is very effective for the anxiety disorder and is is considered by many to be the gold standard in the pharmacological treatment of social phobia. As much as it is unsafe due to the risk of a hypertensive crisis if you consume tyramine or take many types of drugs that interact, I wish I could at least give it a go.

In the hopes that a reversible MAIO would be more effective than an SSRI, if less so than phenylzine, I ended upactually trying moclobemide. However unfortunately I honestly couldn't notice a difference at all.

I'm no expert on phenalzine or moclobemide, although from reading their wiki entries it does sound like these could be very effective. However, like most pharmaceuticals, the number of potential negative side-effects for these drugs makes me uncomfortable. I'm also unclear about how much mileage you can get out of them before they die out on you. Would it even be possible, or medically advisable, to take reversible MAOIs for more than a few years at a time?

I truly believe that psychological treatments have the best chance of really working. If you really are determined and do all that's required of you then it should work for most people. Although the treatment is different in a way it's similar to any other phobia, such as of spiders. Most people know that you can overcome these phobias with things like systematic desensitisation if you are committed and this is also the case with social phobia. If you are dedicated you most likely will see an improvement. It is not a quick fix but it really works.

I used to believe this too... I guess I've just grown jaded and pessimistic about the prospects of psychotherapy after years of lukewarm results trying different modalities. For example, I've been practicing mindfulness meditation and CBT for nearly 5 years to promote desensitization and non-reactivity to the interoceptive sensations (and self-destructive thought patterns) involved in social anxiety... however, even on my best days, I've seen only a 20-30% decrease in symptoms. In combination with a very intensive cardiovascular, nutrition, and supplement regimen I might be able to eke out a 50-60% reduction. So, even when I'm doing everything right, I'm still 40% incapacitated by the condition., which is unacceptable to me. This is also the main reason I continue to suspect that something is amiss at a more fundamental biochemical level; a belief that's only reinforced from my success with different drugs... e.g., in addition to everything else, cannabis and phenibut makes me feel almost entirely cured. The problem, of course, is that I just can't depend on these specific substances 100% of the time. I know I'm close to beating this thing. I just need a little something more that I can use long-term, for years at a time.
 
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