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Suggest most effective social anxiety and depression drugs available

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Posted on Sat, 10 May 2014
Question: Hello, I hope you can help me today. First of all, allow me to provide you with some background information. I have suffered from severe social anxiety disorder and depression for approximately 10 years. I first saw a doctor for treatment for my social anxiety approximately 3 years ago. And I currently am now seeing a psychiatrist. The drugs that I have tried so far (that I can remember) include: Escitalopram, Sertraline, Citalopram, Propranolol (a low dose), Venlafaxine and Mirtazapine. None of these had any effect on my social anxiety or depression at all! Lately, I have been seeing a psychiatrist, and I have been taking Nardil. (I specificially asked the psychiatrist if I could have Nardil as I had read extensively on the internet how Nardil was the “gold standard” for social anxiety disorder. And I also hoped it would help my depression.) I currently am in my second week of taking 105mg Nardil daily, and so far have not felt any benefit from it (for my social anxiety or my depression). As I hope you can understand, I feel very annoyed that I cannot find a drug that seems to help me with my social anxiety or depression. If I had my way (and I have asked my doctor and psychiatrist for this), I would be taking a benzodiazepine. Benzos seem to be the only drugs that are guaranteed to provide a person with social anxiety disorder with any relief. From what I remember, my doctor and psychiatrist did not want to prescribe me with a benzo due to the fact they can be addictive and you build tolerance to them. Due to the fact that I am not a expert in pharmacology, I don’t know what to say to them in return, but I am sure that there must be ways around tolerance and addicitiveness! Unless I am wrong and everybody in the World that takes a benzo for anxiety is addicted and has built up a high tolerance (which I doubt!). Am I not correct in saying that it IS possible to take a benzo without you building up tolerance and becoming addicted? (For example, can’t you cycle a benzo with a different drug to prevent tolerance, and if you only take a benzo pill once per week, you won’t build tolerance - right?) At the moment, it looks as if Nardil isn’t going to help me (and it will prove to be yet another drug that hasn’t helped me). Should I bother to continue taking Nardil for a few more weeks and possibly increase the dose to the maximum of 120mg when I haven’t noticed any benefit from it so far? In other words, if I haven’t experienced any benefit from it by now, am I wasting my time sticking with it and increasing the dose to the maximum? I have been looking on the internet lately for other drugs that I could take that are supposed to be effective for social anxiety and depression. I want to find the most effective social anxiety and depression drugs available for myself and then specifically ask my doctor/psychiatrist for them because I do not have any faith in the competance of my doctor or psychiatrist. I believe that if I allowed them to decide what drugs I should take, I would never get cured from my mental problems! So, having looked on the internet, I notice there a lot of different drugs available for my mental problems, including: Parnate, Clonidine, Inderal, Adderall, Lyrica, Wellbutrin, Vyvanse, Symbyax, Serzone and TCA’s. Are you familiar with any of these drugs, and would you recommend any of them for social anxiety or depression? And aside from these drugs, please tell me what drugs you would recommend that I take to get rid of my social anxiety and depression? Apologies for writing so much. Thank you in advance.
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Answered by Dr. Ashish Mittal (1 hour later)
Brief Answer: Hi Detailed Answer: Hello, Thanks for your query. I appreciate your efforts for medical consultation in so much distress. Important aspects of your query are: • 24 year old male • Known case of social anxiety and depression. • Poor response history with: Escitalopram, Sertraline, Citalopram, Propranolol (a low dose), Venlafaxine and Mirtazapine You are already on nardil 105 mg per day which is a effective dose. It is indicated in treatment resistant cases of social anxiety and depression. But it may takes 3-8 weeks to show its effect. In my opinion it is better to continue it in current doses for weeks before changing to other medicine. For immediate relief of anxiety benzodiazepines group of medicines are used for short duration (due to risk of dependence and tolerance) only. These medicine can not used daily (even by alternating salt type/brand) due to presence of cross tolerance, as they act by same mechanism. If a person use them only 1-2 times per week in prescribed doses, then there is negligible chance to develop dependance). As you are having poor response to treatment then some of the following steps will be helpful for you: -To rule out any medical condition leading to existing symptoms -Detection and correction of vitamin deficiency (especially vitamin D/B12): Get vitamin assay done and take vitamin supplement and fruits/milk in diet. -Screening of thyroid dysfunction: Get serum T3/T4 and TSH level done -Use the medicine in maximum doses. Hope you have used Escitalopram (20-30mg), Sertraline (200mg), Venlafaxine (300mg) and Mirtazapine (45mg) in maximum doses, as these are safer medicines for social anxiety and depression. Medicine used to show effect after 4-6 weeks of continuous use. Hope in your case medicine had been used for sufficient duration (6 week) in maximum doses before changing to other medicines. -Addition of other medicine, so medicines will have synergistic action: Following combination will be helpful for you: Escitalopram+Mirtazapine or Escitalopram+Wellbutrin. I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups. Wish you good health. Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Ashish Mittal

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Practicing since :2004

Answered : 1858 Questions

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Suggest most effective social anxiety and depression drugs available

Brief Answer: Hi Detailed Answer: Hello, Thanks for your query. I appreciate your efforts for medical consultation in so much distress. Important aspects of your query are: • 24 year old male • Known case of social anxiety and depression. • Poor response history with: Escitalopram, Sertraline, Citalopram, Propranolol (a low dose), Venlafaxine and Mirtazapine You are already on nardil 105 mg per day which is a effective dose. It is indicated in treatment resistant cases of social anxiety and depression. But it may takes 3-8 weeks to show its effect. In my opinion it is better to continue it in current doses for weeks before changing to other medicine. For immediate relief of anxiety benzodiazepines group of medicines are used for short duration (due to risk of dependence and tolerance) only. These medicine can not used daily (even by alternating salt type/brand) due to presence of cross tolerance, as they act by same mechanism. If a person use them only 1-2 times per week in prescribed doses, then there is negligible chance to develop dependance). As you are having poor response to treatment then some of the following steps will be helpful for you: -To rule out any medical condition leading to existing symptoms -Detection and correction of vitamin deficiency (especially vitamin D/B12): Get vitamin assay done and take vitamin supplement and fruits/milk in diet. -Screening of thyroid dysfunction: Get serum T3/T4 and TSH level done -Use the medicine in maximum doses. Hope you have used Escitalopram (20-30mg), Sertraline (200mg), Venlafaxine (300mg) and Mirtazapine (45mg) in maximum doses, as these are safer medicines for social anxiety and depression. Medicine used to show effect after 4-6 weeks of continuous use. Hope in your case medicine had been used for sufficient duration (6 week) in maximum doses before changing to other medicines. -Addition of other medicine, so medicines will have synergistic action: Following combination will be helpful for you: Escitalopram+Mirtazapine or Escitalopram+Wellbutrin. I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups. Wish you good health. Regards,