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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 10643
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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I have been diagnosed with social anxiety and depression.

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Hi
I have been diagnosed with social anxiety and depression. For the last couple of years I have tried antidepressants celexa lexapro affexsor and now I am taking 90mg of cymbalta. I have been working with a CBT doctor and I have concluded that I have ruminating thoughts constantly. It's always negative thoughts and most of the time they are completely pointless but I still obsess over them. I also get very irritated and it causes me to be in a bad mood and very unsocial. The only med that I have taken that has helped ease the rumination is 30mg of vivance. My parents have described me as being aloof and they get very frustrated when I am like that.
I currently take 30mg vivance 90mg cymbalta and 300 mg of gabapentin any suggestions?
Thanks
DoctorZ :

Hello I believe I can help you with your concerns

DoctorZ :

So how long have you been on your current medication regimen?

Customer: Affexsor for about 4 months but I just started taking 90mg this week. I was taking 60mg before. Vivance for about 2 years and gabapentin for about 6 months
DoctorZ :

Okay, well the Vyvanase is orginally intended for individuals with ADHD, but I see how it can work with ruminating thoughts.

DoctorZ :

The gabapentin at 300mg is not a particularly high dose and can be increased to help with anxiety

DoctorZ :

Has your prescribing physician considered using a benzodiazepine, it is specifically designed to help with symptoms of anxiety including ruminating thoughts

DoctorZ :

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?

DoctorZ :

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

DoctorZ :

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.

Customer: I have tried 600 mg of GABA but it would make me tired. The thing with benzo, aren't they more for quick and temporary relief.? I feel my rumination is constant through out the day. By taking a benzodiazepine in the morning how long would that last?
Customer: I started CBT not to long ago but I am aware of the thought record technique. At this point I am totally aware when I get anxious I always question it and try to shoot it down. So I know what I got to do its just been frustrating not seeing improvements. I guess I should be a little more patient with the CBT. Overall I just wanted to get a second opinion on my meds and to make sure the meds I am taking are good for social anxiety and rumination. Just another quick question, is the anxiety and depression causing the rumination or vice versa ?
DoctorZ :

Yes the gabapentin is a hypnotic that can make you sleepy. Sometimes people up the dose gradually to get used to the side effects

DoctorZ :

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

DoctorZ :

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.

DoctorZ :

All thought records are different, but this is the one I use for my patients.

DoctorZ :

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.

DoctorZ :

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.

DoctorZ :

These are some good relaxation techniques I use with patients to help manage severe anxiety attacks that can occur with your diagnosis.

DoctorZ :

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.

Dr. Z and other Mental Health Specialists are ready to help you