What meds should I go for?

[Maarten]

I have an appointment with the psychiatrist who can prescribe medication for me. Its not yet sure that he will even prescribe any for me so my first question becomes how can I convince him to do so? In Holland we are insured for these things so I will get meds for free which means that he will probably be more hesitant to prescribe them.
And second, what kind of medication should I try to get? I just want to feel more relaxed in social situations. I suffer mostly from anxiety in social situations, pretty severe anticipatory anxiety and sometimes a pounding heart.
I understand that if I tell him that I am depressed (which I am sometimes) he will probably prescribe anti-depressants. But I would prefer benzodiazepines, from what I read Clonazepam is the most effective drug against SA. Is this true? How do I get him to prescribe me Clonazepam?

All help is appreciated,

Maarten

 

[frizboy]

Benzodiazepines are recommended only for short-term relief. They work quickly, but physical dependence can be a problem with them. Most psychiatrists will not prescribe them for SA; they're more used for stress related to life events and are prescribed for about 4 weeks maximum (if they are prescribed for longer, you should probably find a new psychiatrist!).

Most likely, your psychiatrist will want to prescribe you an SSRI. Paxil is the most commonly prescribed drug for SA (and it should also help with your depression). Paxil has side effects, including sexual dysfunction, and your psychiatrist should fully disclose the risks to you, as they are very common. Another option is Buspirone (BuSpar), but I think that's more prescribed for generalized anxiety rather than SA. I say it's an option though because it's fairly inexpensive (your doctor has incentive to prescribe the cheapest medicine possible), it has few side effects, and it's been used to treat anxiety for many, many years. You will probably want to drink a lot of grapefruit juice if you get on BuSpar, because it increases the drug's availability in your bloodstream.

If you can swing it, get on Cymbalta or one of the other dual-action antidepressants. It has a very good side effect profile, and there is evidence that it is effective against anxiety and depression. I think it's usually prescribed for depression and especially depression with painful symptoms, but anxiety may be an off-label use.

As far as actually convincing your doc goes, I would think as long as he understands your condition, he will prescribe you something. There has been a trend to underprescribe for SA lately though, because people are becoming more and more aware of it and are self-diagnosing. So he may want to suggest other options, like CBT.

 

[Maarten]

Thx frizboy, its good to have someone with your expertise in the forum. I'll tell him that I suffer from depression as well so that he will prescribe me antidepressants. I understand prozac's side effects are more friendly towards males but I guess I'll just have to figure out what works for me by trial and error.

Regards,

Maarten