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I Suffer From Anxiety. I Have Social Phobia And I
Question: I suffer from anxiety. I have social phobia and I was told by a psychiatrist that I have generalized anxiety also.
The best medication that I took, without considering the side-effects, was escitalopram. On the other hand, considering the side-effects, this medication would not be an option, especially because of the terrible insomnia that it causes. In the past, I was able to deal with the insomnia (caused by the escitalopram) by taking seroquel. But seroquel caused cramps in my legs/feet/toes and even a permanent cramp in one of my toes, which wakes me up in the middle of the night.
I also tried other types of SSRIs and also Effexor and all these also caused severe insomnia. Other medications that I tried unsuccessfully include: desyrel, imipramine, mirtazapine, amitriptyline and buspar.
The medications that are relatively good for me are:
1. Bromazepam: I used it as needed. It is very effective for episodes of acute anxiety, but I can’t take it on a day-to-day basis.
2. Trazodone: I use it for sleep and I may use it during the day, as needed for anxiety, but the effect is not very strong and not long enough.
3. Hydroxizine: it has a very nice calming effect that starts almost immediately and lasts for most of the day. This medication also almost completely eliminate my hyperhidrosis. On the other hand, this medication is not strong enough for my social phobia.
What recommendations would you give me in regards to medications, even off-label, that I could take individually or in combination with the three options above that would be strong enough to relieve my social phobia? Please keep in mind that I wouldn’t want to take medications that have the potential to negatively affect memory. In addition to, or as a substitute for medications, what alternative treatments would you recommend (other than talking to psychologists)?
Thanks.
The best medication that I took, without considering the side-effects, was escitalopram. On the other hand, considering the side-effects, this medication would not be an option, especially because of the terrible insomnia that it causes. In the past, I was able to deal with the insomnia (caused by the escitalopram) by taking seroquel. But seroquel caused cramps in my legs/feet/toes and even a permanent cramp in one of my toes, which wakes me up in the middle of the night.
I also tried other types of SSRIs and also Effexor and all these also caused severe insomnia. Other medications that I tried unsuccessfully include: desyrel, imipramine, mirtazapine, amitriptyline and buspar.
The medications that are relatively good for me are:
1. Bromazepam: I used it as needed. It is very effective for episodes of acute anxiety, but I can’t take it on a day-to-day basis.
2. Trazodone: I use it for sleep and I may use it during the day, as needed for anxiety, but the effect is not very strong and not long enough.
3. Hydroxizine: it has a very nice calming effect that starts almost immediately and lasts for most of the day. This medication also almost completely eliminate my hyperhidrosis. On the other hand, this medication is not strong enough for my social phobia.
What recommendations would you give me in regards to medications, even off-label, that I could take individually or in combination with the three options above that would be strong enough to relieve my social phobia? Please keep in mind that I wouldn’t want to take medications that have the potential to negatively affect memory. In addition to, or as a substitute for medications, what alternative treatments would you recommend (other than talking to psychologists)?
Thanks.
Brief Answer:
Fluoxetine can be useful medication
Detailed Answer:
Hello sir, thank you for choosing healthcare magic. You have given a detailed account of your medication I appreciate it. You may discontinue escitalopram by slowly tapering rather than abruptly stopping. You can take prozac (fluoxetine) 20 mg daily once for social phobia. It's a long acting drug and is effective in anxiety disorders.
The following are my recommendations:
1)You may discontinue bromazepam and consider taking only if it's absolutely necessary.
2)prozac 20 mg must be taken on a daily basis.
3) trazodone can be continued.
4)hydroxicine may be discontinued.
5)Alprazolam(xanax) 2mg once daily at night can be taken for acute anxiety and insomnia.
6)Alprazolam may have addictive potential. So it is to be taken as prescribed.
7)medications must not be stopped abruptly.
8) I would like to mention few side effects of fluoxetine :
Nausea
Headache
Insomnia
Somnolence
Diarrhoea
Dry mouth
Anorexia
Dizziness
Sweating.
It takes few weeks to show the therapeutic effect so you need to wait to see the effect. In the meantime, if you get any adverse effect, please let me know.
Hope I have answered your question. Please let me know if you need any further assistance.
Thank you.
Take care.
Fluoxetine can be useful medication
Detailed Answer:
Hello sir, thank you for choosing healthcare magic. You have given a detailed account of your medication I appreciate it. You may discontinue escitalopram by slowly tapering rather than abruptly stopping. You can take prozac (fluoxetine) 20 mg daily once for social phobia. It's a long acting drug and is effective in anxiety disorders.
The following are my recommendations:
1)You may discontinue bromazepam and consider taking only if it's absolutely necessary.
2)prozac 20 mg must be taken on a daily basis.
3) trazodone can be continued.
4)hydroxicine may be discontinued.
5)Alprazolam(xanax) 2mg once daily at night can be taken for acute anxiety and insomnia.
6)Alprazolam may have addictive potential. So it is to be taken as prescribed.
7)medications must not be stopped abruptly.
8) I would like to mention few side effects of fluoxetine :
Nausea
Headache
Insomnia
Somnolence
Diarrhoea
Dry mouth
Anorexia
Dizziness
Sweating.
It takes few weeks to show the therapeutic effect so you need to wait to see the effect. In the meantime, if you get any adverse effect, please let me know.
Hope I have answered your question. Please let me know if you need any further assistance.
Thank you.
Take care.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thanks for your answer.
I tried to convey in my question that I can’t take SSRIs or any of these “reuptake inhibitors” mainly due to the severe insomnia that they cause. I actually have insomnia even when I’m not on any medication, but the SSRIs/SNRIs make it almost impossible for me to sleep. Because of this, I’m currently not taking any SSRI medication. A few questions:
Why SSRIs cause insomnia?
What could counteract the insomnia caused by SSRIs?
As I mentioned in my original message, when I was taking escitalopram, I was also taking seroquel to help with sleep (and seroquel did it relatively well). But after a few years, seroquel caused a permanent cramp in one of my toes, which wakes me up in the middle of the night.
Given my explanation here, and the details in my original message, including the history of medications that I tried, my next question is:
What other medications or treatments, should be worth a try?
Thanks.
I tried to convey in my question that I can’t take SSRIs or any of these “reuptake inhibitors” mainly due to the severe insomnia that they cause. I actually have insomnia even when I’m not on any medication, but the SSRIs/SNRIs make it almost impossible for me to sleep. Because of this, I’m currently not taking any SSRI medication. A few questions:
Why SSRIs cause insomnia?
What could counteract the insomnia caused by SSRIs?
As I mentioned in my original message, when I was taking escitalopram, I was also taking seroquel to help with sleep (and seroquel did it relatively well). But after a few years, seroquel caused a permanent cramp in one of my toes, which wakes me up in the middle of the night.
Given my explanation here, and the details in my original message, including the history of medications that I tried, my next question is:
What other medications or treatments, should be worth a try?
Thanks.
Brief Answer:
Benzodiazepines in combination with tricyclic antidepressants can be used.
Detailed Answer:
Hello sir, thank you for choosing healthcare magic. Following are my recommendations :
1) benzodiazepines can be used in adjunct to tricyclic antidepressants.
2)tricyclic antidepressants include imipramine, amitriptyline,clomipramine
3) Benzodiazepines are lorazepam, alprazolam, clonazepam.
4) This will help your insomnia.
5)only drawback is residual sedation next morning.
6) benzodiazepines can be used for 12 weeks and then tapered.
7)cognitive behavioural therapy is very helpful treatment option.
8)clonazepam can be started as 0.25 mg twice daily. Then 1mg/day after 3 days.
9)clomipramine 25mg /day once daily can be increased to 50mg/day once daily.
10)please avoid or reduce caeffine containing foods and beverages.
11) benzodiazepines can counteract the insomnia caused by SSRIs.
Hope i have answered your question. Please let me know if you need any further assistance. Thank you. Take care.
Benzodiazepines in combination with tricyclic antidepressants can be used.
Detailed Answer:
Hello sir, thank you for choosing healthcare magic. Following are my recommendations :
1) benzodiazepines can be used in adjunct to tricyclic antidepressants.
2)tricyclic antidepressants include imipramine, amitriptyline,clomipramine
3) Benzodiazepines are lorazepam, alprazolam, clonazepam.
4) This will help your insomnia.
5)only drawback is residual sedation next morning.
6) benzodiazepines can be used for 12 weeks and then tapered.
7)cognitive behavioural therapy is very helpful treatment option.
8)clonazepam can be started as 0.25 mg twice daily. Then 1mg/day after 3 days.
9)clomipramine 25mg /day once daily can be increased to 50mg/day once daily.
10)please avoid or reduce caeffine containing foods and beverages.
11) benzodiazepines can counteract the insomnia caused by SSRIs.
Hope i have answered your question. Please let me know if you need any further assistance. Thank you. Take care.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Saisudha Kotla
Answered by
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