Dopaminergic drugs for social phobia?

[emjay]

I'm reading a lot of anecdotal reports, and a very small bit of clinical evidence to support the use of selectively dopaminergic drugs to treat social phobia, avoidant behavior, and concomitant depression.

Looking through the list of meds I've been through, there's only 1 drug that had a considerable amount of action on the dopamine transporters and this was wellbutrin, which my psychiatrist took me off of immediately because she felt it could only worsen anxiety. The reason that's a concern for her is that I get panic attacks that can't really be called panic disorder because it's directly caused by my social phobic response to social situations.

For a few reasons I definitely feel that if anything, it's my dopamine system that is less active than it should be, and looking into all of the drugs she's given me so far, I've noticed they really only target the serotonin and noradrenaline transporters, with even the TCA I'm on (Nortriptyline) seemingly selected for its low dopamine activity.

What's worse is... she keeps trying to push me onto anti-psychotics, which, if I indeed do have a somewhat lethargic dopamine system, is clearly only going to make things worse.

I should also mention that I'm pretty certain I have inattentive-type ADHD. Problem is, since I was maybe 9 years old I was placed in a "gifted" program and that's not exactly where they look for kids with learning disabilities, even despite the fact that, although intellectually on par with my peers, my schoolwork lagged far behind.

It didn't go totally unrecognized though. For instance in my final year of high school, I had the highest calculus grade in the class, and this was only possible because the teacher was giving me extra time - sometimes up to double the time allotted - to finish tests, as even though I understood the material very well, I'd be nowhere near finished when everybody else was.

So I'd like to see what the brains have to say regarding this. Recently my psychiatrist has also put me on klonopin, and I'm thinking that the clonazepam plus modafinil might be a good place to start that shouldn't catapult my anxiety.

I'd like to know what some of you knowledgeable biochem guys think of this whole situation, and hopefully give me a bit fodder to use next time I meet with my psychiatrist. Of course, if I'm way off base here, I'd welcome some insight into that as well

 

[daddysgone]

Well, let me first say that I have ZERO doubt that dopaminergic drugs will alleviate many of the symptoms of social phobia.
However, this by no means suggests that this is a good course to pursue. If you take dopaminergic drugs, you will be high, euphoric, in a good mood (at least initially), and when one feels this way, they will almost certainly feel much more social and far less anxious.
It is analogous to someone asking if they should take opiates for depression. Sure, if you take a big old dose of oxy, you are going to be high and euphoric, and your depression will magically disappear....for awhile.
The problem with this of course, is that you will become totally reliant on these drugs, and unable to function without them. Plus, the positive effects you get from them will fade over time, and you will just be left with an addiction.

So in your case, taking a dopaminergic drug will simply temporarily change your state of mind, allowing you to be social and less anxious while under the influence of the drug. But Im sure you know must know that this is no way to effectively deal with your problems in the long run. good luck

 

[emjay]

So in your case, taking a dopaminergic drug will simply temporarily change your state of mind, allowing you to be social and less anxious while under the influence of the drug. But Im sure you know must know that this is no way to effectively deal with your problems in the long run. good luck

I don't know, I've been dealing with social phobia for as long as I can remember, since I was maybe 9 or 10 years old. It's difficult for me to even place the goalposts because this is what is "normal" for me. Even if you're correct, I would at the very least think that being on a dopaminergic drug for an intermediate term would give me some level of functioning to anchor onto, no? Because I've never been at a point in my life where I could call myself functional.

As for the opiates for depression, I was abusing them for a while and that kind of detachment only made things noticeably worse for me. Even under the acute effects of the drug... while I enjoyed the high, it only made me less sociable and highly irritable. If my psychiatrist suggested it (unlikely, I know), I'd probably be open to the idea, as I've been pretty open to the dozen or so medications she's thrown at me (until now, obviously.) But I'd be very skeptical.

I understand it's not a realistic long-term treatment plan, definitely not something I want to be on for the rest of my life. And by no means am I relying on medication alone. I've been seeing a CBT therapist for just as long as I've been seeing a psychiatrist. But so far the efforts from both of them have been to little avail.

Most importantly though... am I wrong in thinking that she's batshit insane for trying to put me on drugs that BLOCK dopamine receptors?

I took TWO cracks at university and living on my own, but each time it ended very grim. My goal is to be able to go back to school, get my degree, and maybe build a little confidence in the process. I just don't see how treatment with antipsychotics, which make me both emotionally numb AND intellectually slow, is compatible with that goal. I need to find a better solution.

 

[seep]

For this very reason I'm conniving ways of convincing my shrink to write Adderall scripts for all 5 of my identities.

 

[emjay]

For this very reason I'm conniving ways of convincing my shrink to write Adderall scripts for all 5 of my identities.

I hope you're not trying to imply I'm looking to score stims for the purposes of recreation... I'm really not. Besides, I get major anxiety on ritalin and adderall (I WAS in university at one point) so it's not something I'm looking to take. I wasn't talking about anything more serious than bupropion or modafinil.

That being said... after much reading I think I'm going to talk to my doctor about an MAOI. We discussed the idea of taking Nardil at one point, but then all of a sudden she changed her mind and went with a TCA and never really explained why.

The diet restrictions are kind of a crappy prospect, but it seems to me that I had better chances of success with an MAOI from the start... although I do realize it'd be foolish to prescribe MAOIs as a first line treatment.

 

[seep]

I'll PM when I'm not sedated (if I figure out how to PM). I work for psychiatrists and I've been trying to whip social phobia for like 2 decades. I have a lot to say about what you bring up, but it's heavily psychoanalytic and not exactly ADD material.

 

[emjay]

I'll PM when I'm not sedated (if I figure out how to PM). I work for psychiatrists and I've been trying to whip social phobia for like 2 decades. I have a lot to say about what you bring up, but it's heavily psychoanalytic and not exactly ADD material.

Sure, I would really appreciate that.

 

[daddysgone]

Oh
If you are just thinking about using something like modafanil, then I dont really see the harm, When you said dopaminergic, I thought you were referring to something like amphetamines.
I dont see a problem with modafanil, but I also highly doubt it would alleviate any of your phobias. The reason I am not concerned about monadanil is that it is in no way recreational nor does it lead to compulsive use. My concern with something like amphetamines is that it would likely (temporarily) help with your phobias, but then you would soon feel that the ONLY way you could survive social situations would be by using Amps.

Modafanil is a totally different animal. It really does not provide any noticeable effects, aside from the sort of "mellow" energy and concentrations felt by some. It does NOT provide the confidence and desire to engage in conversation that amphetamines do.
It is for these reasons that I think that modafanil would be safe to use for your purposes...but unfortunately will also not be useful for your purposes.

 

[emjay]

Well the modafinil itself isn't really for the social phobia per se. Depression, anxiety and reality of my situation have me way too fatigued to do anything, even if I felt like I could. In the initial post I mentioned that I've recently been prescribed klonopin, which has been good in a few instances, but I'm otherwise feeling too tired and lacking the motivation to really get myself functioning in the real world. I was also thinking about it to offset the loss of focus I seem to get on klonopin. I don't know how effective it might be but it would be better than doing nothing at all.

Also as previously mentioned a few posts up, I think I'm going to discuss trying an MAOI before I give up just yet. The only thing I DO know for sure is that I'm not taking any more damn anti-psychotics.

 

[daddysgone]

Well the modafinil itself isn't really for the social phobia per se. Depression, anxiety and reality of my situation have me way too fatigued to do anything, even if I felt like I could. In the initial post I mentioned that I've recently been prescribed klonopin, which has been good in a few instances, but I'm otherwise feeling too tired and lacking the motivation to really get myself functioning in the real world. I was also thinking about it to offset the loss of focus I seem to get on klonopin. I don't know how effective it might be but it would be better than doing nothing at all.

Also as previously mentioned a few posts up, I think I'm going to discuss trying an MAOI before I give up just yet. The only thing I DO know for sure is that I'm not taking any more damn anti-psychotics.

The MAOI route is not a bad thought, but i would strongly suggest something like selegiline, as it is selective for MAO-B, as opposed to something that also inhibits MAO-A. With something like selegiline, as long as you dont go much beyond 5mg per day, you should not have to worry about all the dietary restrictions, and you should still experience the positive, mood lifting effects. Good luck-DG

 

[ebola?]

I have/had moderate social anxiety (since successfully treated). Basically, there are a number of inebriant-type drugs that are immediately effective, but none will prove sustainable in the long run (this includes doctor-issued benzos). Sure, if you're gacked/opiated/benzo'd/rolling balls, whatever, you'll experience reduced inhibition and anxiety, but regular use points toward disaster. SSRIs are just marginally effective, and the tricyclics aren't much better. Heterocyclics appear to perform similarly. MAOIs are the best bet of the lot, but they're not terribly effective either. Buspar works for pretty much no one.

Here's what worked for me: careful cognitive behavioral therapy coupled with directed exposure therapy (in my case, mainly teaching undergrads and conducting ethnographic research). Benzos were useful as adjuncts to exposure therapy, for situations that would otherwise be intolerable, but never to be used as exclusive aids ('crutches').

It is the most difficult route, but pretty much the only one effective in the long term.
...
The only dopaminergics suitable for maintenance therapy are selegiline (at levels selective for MAOB) and buproprion (but never combined!). However, these will likely prove ineffective.

ebola

 

[daddysgone]

I have/had moderate social anxiety (since successfully treated). Basically, there are a number of inebriant-type drugs that are immediately effective, but none will prove sustainable in the long run (this includes doctor-issued benzos). Sure, if you're gacked/opiated/benzo'd/rolling balls, whatever, you'll experience reduced inhibition and anxiety, but regular use points toward disaster. SSRIs are just marginally effective, and the tricyclics aren't much better. Heterocyclics appear to perform similarly. MAOIs are the best bet of the lot, but they're not terribly effective either. Buspar works for pretty much no one.

Here's what worked for me: careful cognitive behavioral therapy coupled with directed exposure therapy (in my case, mainly teaching undergrads and conducting ethnographic research). Benzos were useful as adjuncts to exposure therapy, for situations that would otherwise be intolerable, but never to be used as exclusive aids ('crutches').

It is the most difficult route, but pretty much the only one effective in the long term.
...
The only dopaminergics suitable for maintenance therapy are selegiline (at levels selective for MAOB) and buproprion (but never combined!). However, these will likely prove ineffective.

ebola

You will not find better advice then this. Using techniques such as these, which gradually get you to the point where you can function, and even be comfortable in social situations, is clearly the better route, as opposed to using drugs which just temporarily "allow" you to handle such situations.

 

[emjay]

I have/had moderate social anxiety (since successfully treated). Basically, there are a number of inebriant-type drugs that are immediately effective, but none will prove sustainable in the long run (this includes doctor-issued benzos). Sure, if you're gacked/opiated/benzo'd/rolling balls, whatever, you'll experience reduced inhibition and anxiety, but regular use points toward disaster. SSRIs are just marginally effective, and the tricyclics aren't much better. Heterocyclics appear to perform similarly. MAOIs are the best bet of the lot, but they're not terribly effective either. Buspar works for pretty much no one.

Here's what worked for me: careful cognitive behavioral therapy coupled with directed exposure therapy (in my case, mainly teaching undergrads and conducting ethnographic research). Benzos were useful as adjuncts to exposure therapy, for situations that would otherwise be intolerable, but never to be used as exclusive aids ('crutches').

It is the most difficult route, but pretty much the only one effective in the long term.
...
The only dopaminergics suitable for maintenance therapy are selegiline (at levels selective for MAOB) and buproprion (but never combined!). However, these will likely prove ineffective.

ebola

I don't really disagree. As mentioned I've been doing CBT for about a year now, I'm just looking for a little more help, not a magic pill. My therapist is also trying to facilitate exposure therapy in very small steps but it's proving to be difficult. That's pretty much what I need help with, and sort of what I meant when I've never been a functional person and need some sort of level of functioning to anchor onto.

My GP actually had me on bupropion for a while, as I waited for my referral to a local mental health outpatient clinic, where I started seeing my psychiatrist and therapist around the same time . It had me feeling a bit more motivated but my psychiatrist took me off of it immediately, telling me it was only going to make me more anxious, so I've never really had the chance to combine it with any sort of therapy.

 

[PetersKeys]

I'm reading a lot of anecdotal reports, and a very small bit of clinical evidence to support the use of selectively dopaminergic drugs to treat social phobia, avoidant behavior, and concomitant depression.

Looking through the list of meds I've been through, there's only 1 drug that had a considerable amount of action on the dopamine transporters and this was wellbutrin, which my psychiatrist took me off of immediately because she felt it could only worsen anxiety. The reason that's a concern for her is that I get panic attacks that can't really be called panic disorder because it's directly caused by my social phobic response to social situations.

For a few reasons I definitely feel that if anything, it's my dopamine system that is less active than it should be, and looking into all of the drugs she's given me so far, I've noticed they really only target the serotonin and noradrenaline transporters, with even the TCA I'm on (Nortriptyline) seemingly selected for its low dopamine activity.

What's worse is... she keeps trying to push me onto anti-psychotics, which, if I indeed do have a somewhat lethargic dopamine system, is clearly only going to make things worse.

I should also mention that I'm pretty certain I have inattentive-type ADHD. Problem is, since I was maybe 9 years old I was placed in a "gifted" program and that's not exactly where they look for kids with learning disabilities, even despite the fact that, although intellectually on par with my peers, my schoolwork lagged far behind.

It didn't go totally unrecognized though. For instance in my final year of high school, I had the highest calculus grade in the class, and this was only possible because the teacher was giving me extra time - sometimes up to double the time allotted - to finish tests, as even though I understood the material very well, I'd be nowhere near finished when everybody else was.

So I'd like to see what the brains have to say regarding this. Recently my psychiatrist has also put me on klonopin, and I'm thinking that the clonazepam plus modafinil might be a good place to start that shouldn't catapult my anxiety.

I'd like to know what some of you knowledgeable biochem guys think of this whole situation, and hopefully give me a bit fodder to use next time I meet with my psychiatrist. Of course, if I'm way off base here, I'd welcome some insight into that as well

I think the only anti-pshycotic that is a dopamine agonist is Abilify. Hence it is unique in nature and now given for unipolar and bi-polar depression too.

I am in a very similar situation though. Wellbutrin and selegiline unfortunately didn't work. My doctor is scripting me mirapex(a pure dopamine agonist) for the anhedonia issues.

 

[Smyth]

The MAOI route is not a bad thought, but i would strongly suggest something like selegiline, as it is selective for MAO-B, as opposed to something that also inhibits MAO-A. With something like selegiline, as long as you dont go much beyond 5mg per day, you should not have to worry about all the dietary restrictions, and you should still experience the positive, mood lifting effects. Good luck-DG

I've experimented with a fair amount of tranyl and someone who posts here was also on Nardil recently.

His experiences with Nardil tended to be quite negative although my experiences with tranyl are generally positive.

For example, on tranyl I was able to lift my dose up >50mg per day, whereas to do that on selegiline bought over the internet would be far too pricey.

When I see the psyc on the 15th I plan on maybe just having more tranyl. In addition I have some Soma in the post to hopefuly dampen a few of the negatives I get from using the tranyl.

 

[seep]

Here's what worked for me: careful cognitive behavioral therapy coupled with directed exposure therapy (in my case, mainly teaching undergrads and conducting ethnographic research). Benzos were useful as adjuncts to exposure therapy, for situations that would otherwise be intolerable, but never to be used as exclusive aids ('crutches').

Exposure therapy for me has always led to addiction to this or that drug (usually cocaine or heroin). This is especially prominent in group therapy. The problem lies in the fact that for addicts with social phobia, the original addiction often came about by desensitization and subsequent involvement (read mentoring) with/by other addicts.

 

[emjay]

I've experimented with a fair amount of tranyl and someone who posts here was also on Nardil recently.

His experiences with Nardil tended to be quite negative although my experiences with tranyl are generally positive.

For example, on tranyl I was able to lift my dose up >50mg per day, whereas to do that on selegiline bought over the internet would be far too pricey.

When I see the psyc on the 15th I plan on maybe just having more tranyl. In addition I have some Soma in the post to hopefuly dampen a few of the negatives I get from using the tranyl.

After reading up on "tranyl" (took me a while to find out you meant parnate/tranylcypromine), it definitely seems preferable to Nardil.

However... there doesn't appear to be a generic available here in Canada. I it generic where you live? I thought all the MAOIS were supposed to be old!

 

[Smyth]

I found this: http://www.socialanxietysupport.com/forum/f30/nardil-versus-parnate-65760/#post952827

^^Yeah, in the uk the scripts I get have got "Goldshield Pharmaceutical" on it, im certain that it is a generic.

 

[emjay]

I found this: http://www.socialanxietysupport.com/forum/f30/nardil-versus-parnate-65760/#post952827

^^Yeah, in the uk the scripts I get have got "Goldshield Pharmaceutical" on it, im certain that it is a generic.

geez... now I'm really not sure. Just did a check and Nardil doesn't seem generic here either. I thought it was supposed to be old... anybody know if this is true?

In Canada we have "universal healthcare" but drugs aren't covered outside of a hospital. Crossing my fingers hoping it's just so cheap that generics have no reason to be in the market

I guess I'll ask my pharmacist about the prices next time I see him, because my psychiatrist really doesn't pay any heed to the costs of what she prescribes me

 

[emjay]

Just did a search. They are indeed both very old, but it seems that generics have stayed out of the market due to low demand.