Hello I believe I can help you with your concerns
So how long have you been on your current medication regimen?
Okay, well the Vyvanase is orginally intended for individuals with ADHD, but I see how it can work with ruminating thoughts.
The gabapentin at 300mg is not a particularly high dose and can be increased to help with anxiety
Has your prescribing physician considered using a benzodiazepine, it is specifically designed to help with symptoms of anxiety including ruminating thoughts
Also I think it is great that you are seeing a CBT therapist. CBT has a great track record with helping individuals diagnosed with social anxiety. Do you use the thought record technique in CBT?
I also think the Cymbalta is at a good dosage right now for anxiety. It used to be thought that increasing the Cymbalta to 120mg would be effective for anxiety, but studies show that keeping the dosage at 60mg or 90mg is just as effective without any increased chance of side effects
Some studies show that adding a second anti-depressant can increase the effectiveness of your Cymbalta, so that may be a consideration to ask you prescribing physician.
Yes the gabapentin is a hypnotic that can make you sleepy. Sometimes people up the dose gradually to get used to the side effects
The benzodiazepine can be used for longer term to manage your anxiety better. Some psychiatrists will start you off on 1mg or 2mg and split it evenly twice a day (e.g. 1mg in the morning and 1mg at night). The biggest downside to benzodiazepines are that you can develop a physical and psychological dependence to them, so ti requires you to taper off slowly so that you do not get any severe withdrawal effects
The CBT does take time and you have to be diligent writing in your thought record to keep it tangible so that you see the negative thoughts and then see your corrective pattern.
All thought records are different, but this is the one I use for my patients.
According to CBT theory it would be the rumination and the negative thoughts that are causing the anxiety, because thoughts are a precursor to emotions like anxiety and depression. So according to CBT theory and practice if you change the thought pattern to more positive thoughts then your symptoms of anxiety and depression should lessen.
CBT is more concentrated on how you are doing in the present so that you become more stable int he future, and that the symptoms you experience are not effecting as much or at all.
These are some good relaxation techniques I use with patients to help manage severe anxiety attacks that can occur with your diagnosis.
In addition, Paxil and Zoloft have been shown to be good medications for social anxiety if you feel the Cymbalta is not working well for you.