Misc Best antidepressant for Social Anxiety

[Vagabond696]

Ever tried Valdoxan? It did wonders for me when I was on it.

 

[telepathetic]

Tbh this is the only antidepressant I have any interest in these days. Gonna ask for it next time.

To answer OP I've never in my life found a non-addictive and effective anxiolytic other than exercise. Slightly pessimistic about it, but that is my experience.

Watch out, the wds are no joke

 

[telepathetic]

gabapentin or phenibut im surprised hasn't been mentioned.. or even lower-dose K

 

[telepathetic]

I think psilocybin takes the cake though.. although it can at times make social anxiety much worse, it can also be a cure

 

[December Flower]

gabapentin or phenibut im surprised hasn't been mentioned.. or even lower-dose K

Bit of a danger zone

Gabapentin is quite similar to benzos when it comes to side effects, and especially in combination with opioids can cause death-related symptoms. There's also a high withdrawal risk, said to be one of the most unpleasant WDs

As Phenibut is just another gabapentinoid I'm not going to list the same dangers again.

There's also a risk of an allergic reaction, I really wouldn't just throw them in the mix without consulting a knowledgeable and empathetic doctor.

Ketamine has massive bladder damage long-term, and I think OP is looking for a long-term solution. None of these are good long-term

The only true long-term solution is sports, hands down.

 

[December Flower]

I think psilocybin takes the cake though.. although it can at times make social anxiety much worse, it can also be a cure

microdosed LSD, psilocybin and mescaline have shown to be very effective at micro-dosage, but should never be underestimated, and are only truly effective with cognitive therapy to go with it, otherwise you might stray in the entirely wrong direction.

But much better solution than antidepressants :D haha

 

[negrogesic]

Watch out, the wds are no joke

I didn't think they were that bad but the bar for withdrawal syndromes are pretty high for me given past heroin, methadone and benzo addictions. (Although i feel more sensitive to any sort of withdrawal as time goes on.)

 

[negrogesic]

You are going to have to do some shopping, nobody but you knows how they will make you feel. That being said fluoxetine does increase gabargic neurosteroid production in the brain which gives it an edge against anxiety over other ssris. That being said, I know somebody who prozac made horribly anxious, so again, your mileage will (not may) vary.

Interesting ive never heard of this. Which neuroactive steroids? Pregnanolone? Desoxycorticosterone? Got a citation?

 

[pally pete]

gabapentin or phenibut im surprised hasn't been mentioned.. or even lower-dose K

I've been on 600 mg Pregabalin per day for 5 years solid and I'm currently tapering off. Ketamine is one of my least favourite drugs in the world.

Bit of a danger zone

Gabapentin is quite similar to benzos when it comes to side effects, and especially in combination with opioids can cause death-related symptoms. There's also a high withdrawal risk, said to be one of the most unpleasant WDs

As Phenibut is just another gabapentinoid I'm not going to list the same dangers again.

There's also a risk of an allergic reaction, I really wouldn't just throw them in the mix without consulting a knowledgeable and empathetic doctor.

Ketamine has massive bladder damage long-term, and I think OP is looking for a long-term solution. None of these are good long-term

The only true long-term solution is sports, hands down.

You've mentioned sports/exercise in most of your posts, but have not highlighted the fact that I've always gotten plenty of exercise, eaten a well balanced nutritional diet, once had a very healthy social life (I was never one for sitting home alone stuffing my face watching movies etc..) I was always out and about going places, meeting people, partaking in various physical/social activities. None of this stopped/helped the crippling anxiety/depression that has taken hold of my life.

I agree - much of peoples negative emotional/psychological well-being stems from their inactive/mundane lifestyles. But I can assure you that is not the case with me, nor many other. Exercise/healthy diet isn't the be all, and end all, for everybody suffering mental torment. I wish it were that simple. If that were the case I'd be the happiest person alive.

I have listed all the meds I've tried since I reached desperation in 2011. My troubles began in 1997/1998. I battled on believing a chemical solution was not the way to go. I lived that healthy lifestyle that you and so many others are lucky enough for it to work for.

I didn't think they were that bad but the bar for withdrawal syndromes are pretty high for me given past heroin, methadone and benzo addictions. (Although i feel more sensitive to any sort of withdrawal as time goes on.)

The withdrawal from Mirtazapine isn't something that overly concerns me. Having been through countless long-term high dose cold turkey poly drug Benzo/Opiate withdrawals.

 

[Skorpio]

Interesting ive never heard of this. Which neuroactive steroids? Pregnanolone? Desoxycorticosterone? Got a citation?

Here's a review. It is PTSD centric, but papers cited in it that show the increase in neurosteroid are not PTSD centric. The authors focus on allopregnanolone (GABAergic). Citation 26 in the review seems to be the earliest in human experiment where they found fluoxetine and fluvoxamine both increased allopregnanolone in csf.

Unfortunately they don't have a mechanism that is tested experimentally, they kind of talk about the different bottlenecks of neurosteroid synthesis as potential points of action.

Upregulation of neurosteroid biosynthesis as a pharmacological strategy to improve behavioral deficits in a putative mouse model of PTSD - PMC

Benzodiazepines remain the most frequently used psychotropic drugs for the treatment of anxiety spectrum disorders; however their use is associated with development of tolerance and dependence. Another major hindrance is represented by their lack of ...

www.ncbi.nlm.nih.gov

 

[pally pete]

microdosed LSD, psilocybin and mescaline have shown to be very effective at micro-dosage, but should never be underestimated, and are only truly effective with cognitive therapy to go with it, otherwise you might stray in the entirely wrong direction.

But much better solution than antidepressants :D haha

I've been down the LSD, Psilocybin/Psilocin, DMT, 4-AcO, 2-CB route.

They helped whilst under the influence, but the positives didn't last (I wish they did!)

Thanks for your continued imput.

 

[Skorpio]

Here's a review. It is PTSD centric, but papers cited in it that show the increase in neurosteroid are not PTSD centric. The authors focus on allopregnanolone (GABAergic). Citation 26 in the review seems to be the earliest in human experiment where they found fluoxetine and fluvoxamine both increased allopregnanolone in csf.

Unfortunately they don't have a mechanism that is tested experimentally, they kind of talk about the different bottlenecks of neurosteroid synthesis as potential points of action.

Upregulation of neurosteroid biosynthesis as a pharmacological strategy to improve behavioral deficits in a putative mouse model of PTSD - PMC

Benzodiazepines remain the most frequently used psychotropic drugs for the treatment of anxiety spectrum disorders; however their use is associated with development of tolerance and dependence. Another major hindrance is represented by their lack of ...

www.ncbi.nlm.nih.gov

Wasn't satisfied with the lack of mechanism. The paper below from 2014 finds that fluoxetine changes the red ox balance of 3α-hydroxysteroiddehydrogenase activity by decreasing it's propensity for oxidative action.

Allopregnanolone requires a final reductive step by 3α-HSD, so this is a likely mechanism.

Interestingly enough they mention a paper that states that mirtazepine and imipramine also alters allopregnanolone levels in the brain (although imipramine had conflicting data which they explain away by saying it was tested at too low of a level to see the effect previously).

Makes me wonder if this is a direct mechanistic thing or is some cog in depression/antidepressant effects that occurs downstream of a more fundamental process (such as say Trkb activation or even something as simple as the reuptake of serotonin itself).

Fluoxetine elevates allopregnanolone in female rat brain but inhibits a steroid microsomal dehydrogenase rather than activating an aldo-keto reductase - PMC

Fluoxetine, a selective serotonin reuptake inhibitor, elevates brain concentrations of the neuroactive progesterone metabolite allopregnanolone, an effect suggested to underlie its use in the treatment of premenstrual dysphoria. One report showed ...

www.ncbi.nlm.nih.gov

 

[pally pete]

Wasn't satisfied with the lack of mechanism. The paper below from 2014 finds that fluoxetine changes the red ox balance of 3α-hydroxysteroiddehydrogenase activity by decreasing it's propensity for oxidative action.

Allopregnanolone requires a final reductive step by 3α-HSD, so this is a likely mechanism.

Interestingly enough they mention a paper that states that mirtazepine and imipramine also alters allopregnanolone levels in the brain (although imipramine had conflicting data which they explain away by saying it was tested at too low of a level to see the effect previously).

Makes me wonder if this is a direct mechanistic thing or is some cog in depression/antidepressant effects that occurs downstream of a more fundamental process (such as say Trkb activation or even something as simple as the reuptake of serotonin itself).

Fluoxetine elevates allopregnanolone in female rat brain but inhibits a steroid microsomal dehydrogenase rather than activating an aldo-keto reductase - PMC

Fluoxetine, a selective serotonin reuptake inhibitor, elevates brain concentrations of the neuroactive progesterone metabolite allopregnanolone, an effect suggested to underlie its use in the treatment of premenstrual dysphoria. One report showed ...

www.ncbi.nlm.nih.gov

I have a medication review with my GP/Psychiatrist this Friday. I may actually go for Vortioxetine as this has brought me some success in the past...But then again, so has Fluoxetine...

 

[SKL]

Also, I was meaning to mention, while not an antidepressant, BuSpar (buspirone) is better for anxiety than people give it credit for.

 

[evo4ever]

Pregabalin is good for social anxiety, the only problem is it can be addictive like benzos.

 

[Keif' Richards]

This is really a tough one OP. We all want to do anything possible to help you feel better, but the reality is, that it can be a long and difficult road to truly get out of depression. There is sadly, much trial and error involved typically. I would have to say that it's a rare event when someone is put on a random medication and it meets all of their needs. You might require multiple medications to truly get where you want to be.

The only thing that you can do, is make an appointment with a prescriber of some shape or form and conduct some good research while you're waiting for your appointment. Bluelight exists in the age of information. There is a treasure trove of information available to all of us regarding drugs and medications that previous generations couldn't have even dreamed of.

Be mindful of your symptoms. How do you truly feel. Think about your thought process. Think about your emotions. Do your research. What works for other people? What similarities do other people have that you can effectively relate to? What medications worked for them?

It is still likely to be a trial and error type of thing. That doesn't mean that you can't arm yourself with the knowledge required to make an informed decision at your appointment. There are so many medications out there, but I'm sure we'd be happy to advise if you can give us a little more information about yourself?

How does all of that sound?

 

[Subfish]

did the mirtazapine work out? Especially during a flare up, any noticeable negative effects when IV sumatriptan? I went almost 5 years with only a couple cluster headaches and about 5 weeks ago they came back full swing “life is literally on pause” so back to getting my battle chest together so I don’t do anything I can’t come back from with this unimaginable pain. Looking into Botox this time “wasn’t and affordable option last time”

 

[negrogesic]

When i think back on this the real answer, perhaps on a technical level, would be tianeptine perhaps. Then again its the only opioid that has been used in the course of the normal practice of medicine, at least in modern psychiatry

Not a great choice really though, do not recommend it.

 

[supersonic89]

I'm surprised your doctor hasn't started treating you with Paroxetine. I think it's the best SSRI to treat social anxiety. In extreme cases, I advocate the use of benzodiazepines.

I suffer from social anxiety and, as someone said, sport is an excellent remedy. In my case, it helped me a lot, it raised my self-esteem when I saw how my body changed completely. I think diet also has something to do with it, when I ate little or no carbohydrates I felt very little anxiety.

 

[pally pete]

did the mirtazapine work out? Especially during a flare up, any noticeable negative effects when IV sumatriptan? I went almost 5 years with only a couple cluster headaches and about 5 weeks ago they came back full swing “life is literally on pause” so back to getting my battle chest together so I don’t do anything I can’t come back from with this unimaginable pain. Looking into Botox this time “wasn’t and affordable option last time”

Just would like to say a massive thanks to everybody who posted on this thread.

Sorry to hear your cluster headaches have come back. At least I know you understand the pain... unreal pain from another planet is how I describe it! I started Verapamil as a cluster headache prophylactic 9 weeks ago and have only had one attack in that time. Luckily when I used the Sumatriptan it had no interaction with the Mirtazapine.

I tried the Mirtazapine for 8 weeks, starting with 15 mg then going up to 30 mg - it didn't do a thing for my depression/anxiety/agoraphobia, so I stopped taking it. 3 weeks ago today I started 10 mg of Vortioxetine alongside 5 mg of Aripiprazole, so I'm waiting for that to really start working fully. Although I'm going to stop taking the Aripiprazole - see here - Harm Reduction - Aripiprazole discontinuation | Bluelight.org

Have you got access to Subcutaneous Sumatriptan injections? They are extremely effective for me - usually aborting the cluster attack within 5 minutes.