QUESTION:
Dear Dr. Heller,
I'm a male, 30 years old. I would like to explain my problem to you: I suffer from worry, blushing so much, social phobia, social anxiety, panic attack, and obsessive compulsive disorder. During my school life I was shy and I didn't participate in any sort of social life with any student. I hate to go to any occasion or any place full of people because I always feel anxiety, phobia and fear, even if I face familiar people. I cannot do any thing - I feel that I'm standing in my place without doing my thing; so for that reason, also, I'm fearing and can't speak in front of people.
I 've been to a doctor before (8 months) and they prescribed a medicine: Faverin - "Fluvoxamine" 100mg 3 tables daily for period from 6 to 12 months. But now I 'm not feeling very well after using that medicine and I suffered from a side effect, weight gain, so I stopped using the medicine. Two years ago I used a medicine called "Nardil" 15 mg 4 tablets daily and "Xanax" 1mg 3 tablets daily. I felt somewhat better than other medicines. But I used them for six months only. I expected with the doctor's opinion that for using that medicine (a 9 months to 12 months period), I would feel much better in my situation.
Now, in addition to relaxation exercises, a month ago I began to use a medicine called Aurorix - "Moclobemide", 150 mg, 2x3 daily, with "Inderal" 10 mg 4 tablets daily, but I'm wasn't feeling better until now. Will you advise me for the best treatment, for the case described above?
ANSWER:
People like yourself with multiple anxiety disorders need many medications, often in the correct sequence. Usually the generalized anxiety disorder is present, which requires BuSpar. Once the BuSpar is working, SSRI medications like fluvoxamine, Prozac and others can be used without much difficulty. If BuSpar causes increased anxiety, Remeron may be necessary for a while. Once all these anxiety disorders are successfully treated - including any obsessive compulsive disorders - the individual can respond to counseling and desensitization therapy. Oftentimes high doses of SSRI medications may be necessary.
