Reading all these experiences has been interesting.
I wonder if SSRIs primarily work through mood-blunting to decrease anxiety. Of course, that would translate to lower ratings on social anxiety, but also lower quality of life for those of us with social anxiety but lacking generalized anxiety.
I have seen anecdotal reports of increased sexual functrioning when combining an SSRI/SNRI with mirtazapine. The latter inhibits some of the serotonin receptors that are thought to reduce sexual functioning when using SSRI/SNRIs alone.
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I think the take-away is that these are some serious drugs and should not be prescribed as life style drugs.
Mirtazapine is interesting to me. Unfortunately, it pretty strongly antagonizes DRD4, which is heavily implicated in attention.
I am wondering if there is anything that SSRIs can do that other things can't do better, in fact. They seem to help with a lot of problems "safely", but it doesn't seem like they help directly, really.
For depression, they help, but it may just be because of increased BDNF, in which case, there is a LOT of medicine that could be more helpful/direct.
For generalized anxiety, they seem to work primarily by blunting, which may or may not be the best solution. MAOIs may be better tolerated with a proper diet.
For social anxiety, MAOIs have better clinical response and lack long term negative effects, even having positive 2ndary effects while on them a lot of the time. Unfortunately, they are pushed to the back of the line because of the deitary restrictions. Amphetamine would also be a potential treatment, but would need to be further studied in combination with something like memantine. Inositol may be great for someone with social anxiety but no ADHD. I feel as though it strongly helped my social anxiety, but the ADHD problems that came with it were just too much. Maybe for an otherwise normal person, it would have been very effective. I am thus wondering if amphetamine/ritalin, memantine(both for stim tolerance and to reduce the Ca+ activity by inositol), high dose piracetam(countering excess choline side-effects by inositol and for memory), and inositol would be the perfect cure. The effects seem like they could either counter each others negatives and create the perfect mental state or could just end up canceling each other out and leaving no positive effect. Conisdering my own reaction to inositol and the general reaction to MAOIs, I wonder if social anxiety has universally low monoamine activity.
In cases of OCD or obsessive anxiety, inositol would be a better 1st line treatment, I think. It is safer and should have fewer side effects to people who are not ADHD.
The only thing were I actually see as risk is beer/wine but even there, if I don't have time to drink, I won't miss it. It's more of way to kill time, I guess (also, while I do get drunk, I sadly derive very little (social) disinhibition from booze, mainly it causes me to drink some more on the same evening..).
I can't say that I have tried many euphoric drugs, but I tend to be slightly more resistant to compulsive redosing of euphoric substances than most people, and even seem to be less pleasure-reinforcing in general. However, taking piracetam(750mg), phenibut(~500mg), and a few glasses of wine really killed my social inhibitions, fully. To be honest, it strangely felt a bit like an improved version of ritalin. That combination was the best I have had so far, increased concentration and social ability. Don't know how I feel about that. Several people in my family on my mothers side have been alcoholics (the same part of my family that tends to have social anxiety/avoidance traits), so it is something I have to be careful about.
A single beer does nothing much at all, though, and I don't have access to alcohol often. It may have acutally just been the combination of the three.
I can somewhat relate to this. In the past couple of months, something has turned off my libido completely; it's just been nonexistent. I suspect eszopiclone (Lunesta) I take for sleep. What's interesting is that I can't get worked up about it.
As a result (I think), I haven't had the desire to do anything but staying home reading, and that's how I've spent all my free time. No social impulse at all. Going out to bars or clubs has always been a negative experience for me, but at least previously I would force myself to go in the hope of maybe one day meeting someone attractive, but that motivation is gone; I wouldn't even be able to get aroused enough to get it up with a supermodel. I can't even be bothered to call anybody back to keep up the little social life I had. I know intellectually I should be bothered with this and that I may have regrets later that I have been wasting my life, but I can't seem to get emotionally bothered by it. Normally I would be bothered by it, so I'm pretty sure it's the pill talking. When night comes and I get to the point where I have to choose between being able to sleep or having a life, I just take the damn pill.
I know it is not an SSRI but my point here is that I think sexual motivation and social motivation are two sides of the same coin.
That is kinda strange. Normally benzos have a positive, dopaminergic after-effect when used for sleep, right? Maybe something about eszopiclone is different. Or, like nupi said, maybe it is depression, which I think can be caused by GABA-acting substances.
Have you tried other benzos or z-drugs? Maybe there would be something that didn't cause this. Etizolam, in particular, has a low half-life and low incidence of tolerance and side-effects, so it might be helpful for sleeping.
I agree with the sexual motivation and social motivation being interlinked, and it does make a lot of sense. In more schizoid phases, when I have almost no social motivation, I also tend to have no sexual motivation. However, porn and similar things remain as pleasurable. If the social aspect is removed, the actual sex and porn still entertains/arouses me. I just lose interest in people and thus in any thought of having sex with them. Don't mean to get too side-tracked, but do you notice the same thing? Do you find yourself averse to the idea of sex itself or just to the interactions of people and social aspect of it?
It could also be a form of atypical depression... Did you try switching Eszopiclone for another sleeping medication?
In my case, the reading is partially replaced by watching movies but the point stands (I was never much of a fiction reader and usually can't be bothered to get started with books although if I do, I generally do finish them). But the "I know intellectually I should be bothered with this" or wasting my life part sounds pretty familiar. Unfortunately, choosing between being depressed and anxious (and not really doing anything productive with live, either with all motivation coming from anxiety) and being in a sort of SSRI lull that at least takes care of the anxiety to some degree, the SSRI clearly does win out. It of course does not help that I have pinched nerve in my neck that prevents me from doing sports since 2 months and typing quite painful (physiotherapy is slowly making it better but it will be a while still)...
Have you considered the possibility that you may have a mild form of ADHD? It is possible for this sort of thing to occur because of depression, but the fact that it gets WORSE with SSRIs means you should maybe at least look into it.
I just created a new thread about this, maybe I shouldnt have.. i didnt see this one first. Anyway. Just wondering did anyone experience long term or permanent issues from dosing with low doses of escitalopram? 2.5 mg doses or less. Thanks.
I don't know about escitalopram, but my step-dad has taken zoloft(Sertraline) at about 12.5mg/day for most of my life for OCD/Generalized anxiety, and he hasn't had any problems with congnition as far as I can tell. Of course, I can't speak for sexual side effects, but it is highly unlikely considering any side-effects of anything makes him immediately quit the medicine. Similar to your 2.5 of escitalopram, it is 1/4 of the commonly effective dose.
However, he doesn't like the way it makes him feel, and he complains about it, and goes off of it for a year or so every few years because of that. Currently, he is taking inositol with some success. Protoject, if you have not tried inositol, I would recommend it before SSRIs, especially if you don't have any summer classes/major responsibilities. I had a bad experience with it, but I plan to retry it when I get attention problems under control. For now, however, it messes with my attention too much for me to be functional on it. Maybe you will have better luck with it.