# Topamax has helped



## arkwelder (May 10, 2010)

I wanted to say a few words about my experience with Topamax, since it hasn't received a lot of attention here so far (not a lot of positive first-hand experience anyway). You can consider this a treatment review.

*Social Anxiety Background*:
I've had SA my entire life but was diagnosed in my mid-twenties. I am extremely non-competitive and non-confrontational, and most people would describe me as unmotivated and lacking ambition. I also think it's worth noting that my relationships with other people tend to deteriorate over time rather than strengthen. Also worth noting is that I don't generally have anxiety problems outside of SA.

*Other Treatments*:
I've been on Nardil, and it helped immensely. My SA was utterly annihilated for the first four or so months I was on it, then the effects tapered off, but it still remained somewhat effective. My theory is that the gabaergic qualities of Nardil crap-out long before the dopaminergic ones. I ultimately went off Nardil because I was having intense hypomanic episodes. "What's wrong with hypomania?" some ask. For one, I kept having these intense mystical "God" experiences. But even so, that wasn't why I went off. Rather, I went off it because I was starting to have fits of rage. In other words, it wasn't the prolonged hypomania of the first four months that made me go off of Nardil, but the subsequent rapid-cycling between hypomania and rage that ensued. That was when things became intolerable.

*Treatment Experience*:
Topamax comes with a lot of unwelcome side effects. Most of them subsided with time, or were easy to manage, but the worst side effect, and the one that never quite goes away completely, is the toll it takes on memory and cognition. I could barely string a sentence together at first. For SA sufferers who are already painfully aware of their crappy communication skills, this is a real problem. Nevertheless, Topamax miraculously cured my DPSD (Delayed Phase Sleep Disorder), and it also gave me the motivation to eat healthier (and eat less) and ultimately lose 35 lbs.

The reason I wanted to review Topamax, however, is because its GABAergic effects felt identical to those of Nardil. Admittedly, I don't have a lot of experience with GABAergic drugs, but with both, I felt a profound sense of what I call "human connectedness". The feeling was unmistakable. I didn't feel "cut off" anymore. I wanted to call or hang out with people who I hadn't seen in months or years. It was also nearly impossible to make me angry. Relationships were easy all of the sudden.

Now, I can't say for sure that this was a GABA thing, but whatever it was, I strongly believe that it's one half of curing my SA (the other half would involve increasing dopamine, I believe). Unfortunately, tolerance built up, and the feeling subsided after a few months. Nevertheless, Topamax was very effective at treating my SA for a period of time, and so I believe it deserves mention here. I am currently taking a short break to combat tolerance, but I will go on the drug again soon.

I don't think Topamax will work for everyone, perhaps not even most people on here. I happen to think SA has a handful of causes. That said, I think Topamax could be helpful to _some_ SA sufferers, so I want at least to put it on the radar.


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## roadwarrior48 (Jun 23, 2013)

arkwelder said:


> I wanted to say a few words about my experience with Topamax, since it hasn't received a lot of attention here so far (not a lot of positive first-hand experience anyway). You can consider this a treatment review.
> 
> *Social Anxiety Background*:
> I've had SA my entire life but was diagnosed in my mid-twenties. I am extremely non-competitive and non-confrontational, and most people would describe me as unmotivated and lacking ambition. I also think it's worth noting that my relationships with other people tend to deteriorate over time rather than strengthen. Also worth noting is that I don't generally have anxiety problems outside of SA.
> ...


*********
Okay- so you're talking Secondary Disorders here, and in essence, the added benefit of the drugs that you are taking for ANOTHER health issue (depression or other psych. things) is an added BONUS for helping your SA as well.

Your post somewhat freaked me out, as I thought it was treatment JUST for your SA and I don't believe any Dr. would treat SA with MAOI's or Topamax.

Nardil and Parnate are almost last in line for treating Major Depression when much else or all else has failed, aren't they? They wouldn't give a person with only SA, an MAOI.

If someone with SA being their ONLY diagnosis, it is my opinion that TOPAMAX would be EXTREME treatment for social anxiety. My gosh- topamax can knock people out. Very powerful drug, even at a low dose. When I was first being treated for shock and PTSD years ago (that is- when my PTSD hypervigilance was OFF-THE-WALL-eg:- my body literally vibrated day and night) I was given a miniscule dosage of topamax. I took 1/4 of what the Dr. prescribed me. I was on my side drooling like a dog- yes - drooling. Went off that ASAP.

It is not humanly possible for the body to even generate anxiety when one is in that condition, so no wonder it worked for SA! I think it would work for MANY things, as it almost shuts the body and mind right down! And as far as thinking goes- I researched it a bit before I took a trial of it- and what I read said 'be prepared to be dumber than a box or rocks'. I could barely speak while on it, and I'm sure I couldn't have added 1 + 1.

(I lost 25 lbs. after going off of Parnate/Nardil/MAOI. But I could see the Topamax making someone want to eat...)

I wouldn't be messing with or 'recommending' Topamax (or Nardil) unless someone needed help with something more severe than SA. (Believe me, I know severe SA. Been there- to the worst degree.Don't need to be admonished by anyone.) I don't think Top. needs mentioning as you said, or .... we could say that all MAJOR tranquilizers need be mentioned.

Medication can be really good for SA if you find something that helps but I don't believe major tranquilizers are the answer. We cannot be heavily sedated through life or we will never be able to learn how to overcome situations.
Also you know how it made you feel- the side effects were enough for you to go off. That's like me saying a bottle of Smirnoff's made my SA better (which it would for SURE), but I didn't like the side effects (hung over as heck), but yet I mention it to others as an idea!

Well, I'm sure there ARE people with secondary disorders who can handle Topamax and need to be on it and it also helps their SA. But as like you, Topamax was not a good deal for this cowboy.

Arkwelder:- I am rather interested though, in how you felt after going OFF of Nardil and the anger... I was on it (Parnate, basically the same thing but the older version with more side-effects) for bad depression and PTSD.

This was a year ago that I went off (Parnate-MAOI)- and I think I have been angry since and it's no fun. Never felt this way before...have never been diagnosed with BP1 or 11 before....I'm not sure I've ever 'really' understood BP11 before....it's in question for me... It has never been a diagnosis for me because I don't do the 'happy dance' (mania).....but I am really experiencing rage for the 1st time in my life and it's not easing off...it's rather scaring me....so doc. and I are actually wondering if I may have BP11......

ARKWELDER or anyone else, IS RAGE COMMON FOR PEOPLE WITH BP11, when they're not doing well???? Could you PM me so I don't take up this thread by going off topic?

Thanks.:banana


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## basuraeuropea (Jul 25, 2012)

roadwarrior48 said:


> *********
> Okay- so you're talking Secondary Disorders here, and in essence, the added benefit of the drugs that you are taking for ANOTHER health issue (depression or other psych. things) is an added BONUS for helping your SA as well.
> 
> Your post somewhat freaked me out, as I thought it was treatment JUST for your SA and I don't believe any Dr. would treat SA with MAOI's or Topamax.
> ...


whoa, mean.

many who have anxiety-spectrum disorders or mental illnesses of various flavours alone or comorbid for that matter turn to a wide variety of medications in order to ameliorate their ailments. and while maois may not be first-line choice and only due to potential adverse reactions, they are damn good drugs whose efficacy is really unparalleled for many; the same can be said about the aeds. i take an aed myself - pregabalin - and it has been an absolute lifesaver. i have no doubt in my mind that she has been helped immensely by topiramate and topiramate is certainly no stranger to psychiatry.

p.s. the major tranquilisers refer to the atypical and typical antipsychotics, not the antidepressant or antiepileptic classes of drugs.


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## swim (Apr 4, 2011)

You make me want to try it ark.


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## CD700 (Apr 22, 2010)

It helps in the sense you cant think 
I didn't mind it for a short term relief


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## arkwelder (May 10, 2010)

roadwarrior48 said:


> *********
> I don't believe any Dr. would treat SA with MAOI's or Topamax.


You would be wrong. Nardil was the first thing my pdoc prescribed after I described my symptoms to him. Depression is not one of my diagnoses, thus I am a little confused by some of what you're saying.

You are making a few assumptions here, some of which are uncalled for, so I will try to clarify. I was prescribed Topamax by my GP (my relationship with my pdoc was short-lived) to treat the Nardil-induced hypomania, which had earned me a Bipolar type II diagnosis. I've actually been on Topamax twice, once while on Nardil, and a second time because--even without Nardil--I still experience some mood instability from week to week, known as Cyclothymia. Topamax is actually a decent treatment for it.

Topamax is not the boogeyman people make it out to be (nor is Nardil). For others reading this, you have to look at things in the proper perspective. Some people react very badly to Topamax; they are the ones who go on Internet forums and make the most noise about it (as well all like to vent on the Internet). For those who handle it well, you tend not to hear their stories. Thus, someone researching Topamax on the Internet is going to get an overwhelmingly bad view of it. But like I said, for me, most of the side effects either disappeared or were easily managed. For example, you need to drink lots of water to prevent kidney stones, and you should take Biotin supplements to prevent hair loss, etc. Like I already said, the worst side effects were cognitive. I would say my memory and concentration were only at 80%-90% even after a few months, which is unfortunate.

Topamax isn't for everyone. For some, the side effects are simply too much to bear. Furthermore, many people won't experience the positive aspects I've described. In fact, some people experience the exact opposite. All I'm saying is that Topamax has worked well for me, far better than I could have imagined. I'm currently taking a break from it, but I plan to go back on it soon.

I want to add that I don't believe Topamax helped because of its basic anxiolytic qualities, or because it's a mild sedative. I wish I knew how to articulate this better, but it made me feel more intimately connected to those around me. It went beyond making socializing easier in that it actually made me _want _to socialize. It wasn't a complete cure for SA, but I'm mentioning it because it was identical to how I felt on Nardil in the first few months. Granted, Nardil is a more complete treatment, having dopaminergic and serotonergic qualities, but my theory is that Topamax at least addressed the gabaergic component, although I will need to experiment further. I am thinking of trying some other gabaergic drugs (Lyrica, Gabitril, Phenibut, Baclofen, Klonopin, etc.) to see if they induce the same feelings. Nevertheless, without exactly knowing why, Topamax addressed aspects of my SA in a way that truly got to the root of the problem, so I think it's worthy of mention.

Roadwarrior, I respect that you've been on Topamax and that your experience was largely negative, and that it certainly didn't help with your SA. However, you're experience does not negate my experience, nor does my experience negate yours. Ultimately, everyone's different, and I think we've all given up on finding some magic, universal cure for SA. That said, for those whose SA sounds similar to mine (I would characterize it as having some likeness to Avoidant Personality Disorder and even Schizoid Personality Disorder, not to mention the added Delayed Phase Sleep Disorder and Cyclothymia), then Topamax might help a great deal.


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## arkwelder (May 10, 2010)

roadwarrior48 said:


> *********
> Arkwelder:- I am rather interested though, in how you felt after going OFF of Nardil and the anger... I was on it (Parnate, basically the same thing but the older version with more side-effects) for bad depression and PTSD.


I forgot to address this but am happy to answer. My rage problems weren't a result of going off Nardil, but of being on Nardil. I attribute this to Nardil's dopaminergic qualities plus the fact that I am indeed mildly bipolar. Some people report experiencing rage/irritability on higher doses of Wellbutrin, and I have no doubt that this is the same phenomenon (i.e., Wellbutrin being dopaminergic as well).


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## A Sense of Purpose (May 8, 2011)

I had incredible fogginess with topiramate. I was unable to form complete sentences because i couldnt recall the words i was searching for, etc. It definitely reduces appetite too.


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## swim (Apr 4, 2011)

CD700 said:


> It helps in the sense you cant think


that's quite something!


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## arkwelder (May 10, 2010)

A Sense of Purpose said:


> I had incredible fogginess with topiramate. I was unable to form complete sentences because i couldnt recall the words i was searching for, etc. It definitely reduces appetite too.


That is indeed a major drawback, and I believe it's also a relevant concern for people with SA. To clarify, I'm not saying Topamax is an ideal treatment for SA. However, for one person (me), it did target my SA on a fundamental level. My theory is that its GABAergic qualities were a temporary and partial cure for my SA. However, I think complementing a GABAergic drug with dopaminergic drug is part two of the equation, at least in my case. That said, Topamax doesn't get a lot of attention here, and the attention it does get is largely negative. As you can see, I don't post here a lot, but I believe it has been worthwhile to share my _mostly_ positive experience with Topamax.


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## arkwelder (May 10, 2010)

CD700 said:


> It helps in the sense you cant think
> I didn't mind it for a short term relief


The first time I took it, or whenever I titrated, I felt somewhat "drunk", and found it quite pleasant. In the past I have described it as dipping my brain in a warm bubble bath. It was very soothing, but like you said, "you can't think", at least not very well. That said, if I believed that Topamax only helped my SA because it was sedating or because it made me "dumb", I probably wouldn't have posted the treatment review. I appreciate what you're saying though.


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## arkwelder (May 10, 2010)

A Sense of Purpose said:


> I had incredible fogginess with topiramate. I was unable to form complete sentences because i couldnt recall the words i was searching for, etc.too.


Unfortunately, this seems to be a nearly universal side-effect of the drug.


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## A Sense of Purpose (May 8, 2011)

arkwelder said:


> Unfortunately, this seems to be a nearly universal side-effect of the drug.


Its so strange that it affects word recall. Bizarre even. How can someone explain that pharmacologically. It must be active at Broca's area or have some kind of interference in association areas of the brain to block recall.


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## roadwarrior48 (Jun 23, 2013)

Wow, waaaaaay too much to respond to here.

(I'd like to make note to Ark- of how many comments (and perhaps more coming) how knocked out and loaded people felt on Topamax drug. Knocked out or loaded people generally don't experience a lot of anxiety when it that condition. I had ZERO anxiety when I tried Topamax.)

I did not say MAOI's were bad drugs.

I did not say that Topamax does not have it's place in the world, or that it's bad. 

I thought Tomapax WAS a major tranquilizer. Apparently I'm wrong. But it certainly has the side effects of the effect of a m.tranqilizer to just about everyone who's posted their experiences.

What I said in my 1st post- and I still think this is true- that if a person walked into a Dr.s office and said- 'Gee, I really am so nervous about social situations, sweating, panic attacks, I don't want to be around people anymore..." I do NOT believe that any Dr. would pull out an MAOI OR Topamax. This just would not happen, unless the person had other stuff going on as well.

I'm usually open minded, but I'd like to hear from one single person, who was given either drug when they ONLY have social anxiety. (When I say 'only', I am NOT minimizing social anxiety.) That means NO depression, no other secondary disorders or illnesses.

I think a lot of people on here have secondary disorders. But when it comes to just SA alone, the treatment I believe, is milder, it usually starts with an antidepressant or a benzo.... 

There are many many drugs that we can be given for our secondary disorders (which are usually 'worse' or more difficult disorders or illnesses than SA), and as an ADDED BONUS-the drug we're using for that other disorder, happens to work in helping our anxiety. Which of course is awesome.

OR- with our 'other disorder' (meaning not SA), maybe we are suffering anxiety as PART OF that disorder. I think some people have SEVERE anxiety, not necessarily social anxiety, but anxiety that encompasses so much... and that too can be part of the 'other' disorder/illness.

If I'm on Topamax or Quetiepine or powerful stuff, no kidding the social anxiety is going to be better. But Dr.s don't prescribe this stuff for people who just have (even hellish) anxiety.

Again people- hear my message- MAOI's and Neuropleptics and Antipsychotics, etc.- can be LIFE-SAVERS. I just wouldn't 'recommend' them to a 'newbie' who just has SA. (Not that we're dr's.) That's what I was thinking about- the newbies who are reading these threads. A 'newbie' trying Topamax for SA? Of COURSE it's going to help! But they don't do this to begin with- it's not the appropriate course of action.

I knew there were 2nd diagnoses (or more) going on- but that's what those drug/s were prescribed for- the OTHER disorders in mind, they were not trying to target the anxiety and oh- by the way- it just might help the cycling. Do you see where I'm coming from? It was the other way around. As eventually stated.

And if your experience (arkwelder) was so good on Topamax, I don't see why you would go off of it. It was so effective. I agree, it really IS affective. If you're on enough of it, your SA will be fine. Maybe you needed a higher dosage.

Like I said usually I'm more open-minded, but I responded to the original message of this thread. I did not say these were 'bad' drugs or 'ineffective' drugs, nothing of the sorts.

What I DID assume- and I was correct, that those drugs were being prescribed originally for a secondary (or primary) disorder/s. 

******I just had concerns that a newcomer to SAS would read that and think "Oh, how come my dr. hasn't tried that with me???" When in fact the newbie might ONLY have SA. Not even depression or anything else. I just felt like the message was misleading. (NOT misleading on purpose). Those of us with secondary disorders can see it, but not newcomers who have anxiety.

The 'cured anxiety' was a by-product of being treated with drugs for another disorder. Seriously.

My opinion. Just my opinion. I've experienced it myself, where my anxiety was helped by drugs that were not given to me for anxiety, but for depression or PTSD, whatever.

I just think we need to be careful about what we 'advertise' or 'recommend' or whatever because there are a lot of new, and a lot of young people around-

JUST MY OPINION!

That's all! Wasn't and am not looking for an argument.


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## arkwelder (May 10, 2010)

roadwarrior48 said:


> That's all! Wasn't and am not looking for an argument.


I'm not looking for an argument either. I'm enjoying the discussion in fact.



> (I'd like to make note to Ark- of how many comments (and perhaps more coming) how knocked out and loaded people felt on Topamax drug. Knocked out or loaded people generally don't experience a lot of anxiety when it that condition. I had ZERO anxiety when I tried Topamax.)


It's important to note that I've had a fair amount of experience on Topamax, and I'm one of those few people who have stuck with it. The key is to titrate slowly. Start at 25mg, wait a week, titrate to 50mg, etc. I've heard of people being on 400mg to 800mg, which I think is crazy. As a mood stabilizer and anxiolytic, the 100mg to 200mg range is about right. I don't know how much you were taking, but it sounds like you may have been on either too much or titrating too quickly.



> ...it certainly has the side effects of the effect of a m.tranqilizer to just about everyone who's posted their experiences.


It is definitely anxiolytic and somewhat calming, but I do not feel tired or less energetic on it at all. In fact, when I say "calming", I mean that it calms the brain. My body doesn't feel fatigued whatsoever, and ironically, my days tend to be more productive while on the med.



> What I said in my 1st post- and I still think this is true- that if a person walked into a Dr.s office and said- 'Gee, I really am so nervous about social situations, sweating, panic attacks, I don't want to be around people anymore..." I do NOT believe that any Dr. would pull out an MAOI OR Topamax.


...Which is unfortunate. I think you and I and everyone here has a responsibility to create awareness and change that. Now, that doesn't mean I think either MAOIs or Topamax should be a first-line approach for SAD (MAOIs do carry a fair amount of risk), but that said, MAOIs are WAYYY too difficult to acquire as it stands. When SSRIs fail--and they quite often do--MAOIs and/or anticonvulsants (i.e., gabaergic drugs, of which Topamax is one) should be the "second" line, with stims and benzos being the "third" line. Too many doctors are bull****ing their patients by making them take SSRI after SSRI (or SNRI) and ultimately leaving them untreated. The problem is that the medical community and society in generally doesn't take this disorder seriously. They think its enough just to think positively and change your outlook. You even get well intentioned people on these forums saying that all you need to do is exercise more or masturbate less or some absurd thing and you'll be cured. I'm not about feeling sorry for myself, but I do take the disorder seriously, and I know that it takes serious drugs to treat it, even ones that carry a fair amount of risk.



> I'm usually open minded, but I'd like to hear from one single person, who was given either drug when they ONLY have social anxiety. (When I say 'only', I am NOT minimizing social anxiety.) That means NO depression, no other secondary disorders or illnesses.


Fair enough. I will reiterate, however, that depression is not one of my diagnoses. My pdoc prescribed me Nardil specifically for social anxiety disorder. It was the first and only thing that particular pdoc prescribed me. The Topamax was prescribed for Nardil-induced hypomania. The fact that Topamax treats my SAD is a happy accident, but it's good news worth sharing nonetheless. That said, I do have mild bipolar, known as cyclothymia, even without the Nardil, so I guess you've got me there. I don't see how it invalidates my experience however.



> I think a lot of people on here have secondary disorders. But when it comes to just SA alone, the treatment I believe, is milder, it usually starts with an antidepressant or a benzo....


I have nothing against benzos and have no doubt regarding their efficacy. They are not without their drawbacks however. Tolerance builds fast, they're addictive, and withdrawal can be a challenge. I would personally take an anticonvulsant over a benzo for mild to moderate SA. Then perhaps I would supplement with a benzo for severe SA (mine is moderate, not severe, however). Recognizing that everyone responds differently to different medications, I think SSRIs are only useful in treating mild cases of SA. Generally speaking, if you want to treat moderate to severe SA with an antidepressant, you will need an MAOI (preferably Nardil).



> There are many many drugs that we can be given for our secondary disorders (which are usually 'worse' or more difficult disorders or illnesses than SA), and as an ADDED BONUS-the drug we're using for that other disorder, happens to work in helping our anxiety. Which of course is awesome.


Topamax is gabaergic. People here who have done their homework know that gabaergic drugs play a big role in treating SA. I've said multiple times that, in my personal experience, I believe Topamax's gabaergic effects were similar to those of Nardil. My opinion is that Topamax targeted my social anxiety directly, at its very core. Correct me if I'm wrong, but you are saying that Topamax basically knocked you on your *** and made you incapable of feeling anxiety of any kind. Fair enough, but you have to realize that we are articulating two fundamentally different experiences here. Again, mine does not negate yours, and yours does not negate mine.



> Again people- hear my message- MAOI's and Neuropleptics and Antipsychotics, etc.- can be LIFE-SAVERS. I just wouldn't 'recommend' them to a 'newbie' who just has SA. (Not that we're dr's.)


No. I wouldn't recommend an antipsychotic either. That's likely to make things much, much worse. However, an MAOI like Parnate or Nardil is very likely to make their SA better, so I would in most cases recommend it, perhaps not as a first line approach, but certainly as a second or third. Same goes for an anticonvulsant like Lyrica, and maybe Topamax. Lyrica gets high marks as a treatment for SA on these forums. No, we're not doctors, but there is no doubt in my mind that many of us know more about SA than your typical GP or even pdoc. Lets not kid ourselves. Doctors have to be "experts" on a gazillion different disorders, conditions, and illnesses. I'm only trying to be an expert on one--one which I've had personal, firsthand experience with from the time I was a small child. In fact, the term "newbie" just doesn't apply here, to any of us.



> I knew there were 2nd diagnoses (or more) going on- but that's what those drug/s were prescribed for- the OTHER disorders in mind, they were not trying to target the anxiety and oh- by the way- it just might help the cycling. Do you see where I'm coming from? It was the other way around. As eventually stated.


I don't get your point. You seem to put an awful lot of faith on doctors. I do for some things, but not for SA. I'm not saying Topamax is a complete treatment for SA, or that it will work for everyone, but if you want my honest opinion, I think it would probably work better than, say, an SSRI like Paxil. You're probably starting to notice that I have no faith in SSRIs to treat moderate to severe SA, and since most doctors will just try to treat SA with SSRIs, I have limited faith in their ability to treat SA at all. MAOIs, anticonvulsants, stimulants, benzodiazepines, and a few supplements (like phenibut) are what work best. You seem to be saying that SSRIs are best for vanilla SA, but I think the opposite. If someones SA was effectively treated with SSRIs, then they probably didn't have SA in the first place, but something else that only looked like SA (or just mild SA).



> And if your experience (arkwelder) was so good on Topamax, I don't see why you would go off of it.


I didn't go off of it. I said I took a break from it to combat tolerance. I started it again recently I can definitely attest to helping my SA.



> What I DID assume- and I was correct, that those drugs were being prescribed originally for a secondary (or primary) disorder/s.


Actually, you were half incorrect. The Nardil was not prescribed for a secondary disorder. I've been very upfront about that. As for Topamax, IT IS ABSOLUTELY WORTH A TRY for someone who has tried a few different meds for SA already and maybe is a little on the heavy side (since most other drugs cause weight gain).



> The 'cured anxiety' was a by-product of being treated with drugs for another disorder. Seriously.


I don't agree with that at all, and again, you are making assumptions, but that's okay because I'm still enjoying the discussion. I have been diagnosed by a psychiatrist as having Social Anxiety Disorder. I did an evaluation that must have been a hundred pages long. If I come on here and say Topamax is treating my disorder, that doesn't mean it's going to work for you, but it's still worth something. Your experience is valid on its own, but it certainly doesn't invalidate mine.



> My opinion. Just my opinion. I've experienced it myself, where my anxiety was helped by drugs that were not given to me for anxiety, but for depression or PTSD, whatever.


Yes, but Topamax is gabaergic and gabaergic drugs, particularly anticonvulsants, are known to help with SA. Benzos help with SA for the same reason, i.e., they gabaergic. I'm not saying anything terribly outlandish here.



> I just think we need to be careful about what we 'advertise' or 'recommend' or whatever because there are a lot of new, and a lot of young people around-


I'm not too worried about it. There are hundreds, if not thousands, of treatment reviews here. Mine is just a drop in the bucket.


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## roadwarrior48 (Jun 23, 2013)

arkwelder said:


> I'm not looking for an argument either. I'm enjoying the discussion in fact.
> 
> It's important to note that I've had a fair amount of experience on Topamax, and I'm one of those few people who have stuck with it. The key is to titrate slowly. Start at 25mg, wait a week, titrate to 50mg, etc. I've heard of people being on 400mg to 800mg, which I think is crazy. As a mood stabilizer and anxiolytic, the 100mg to 200mg range is about right. I don't know how much you were taking, but it sounds like you may have been on either too much or titrating too quickly.
> 
> ...


Wow, just ain't got the time bud. Good luck with that.


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## arkwelder (May 10, 2010)

roadwarrior48 said:


> Wow, just ain't got the time bud. Good luck with that.


I think you're under the impression that we're arguing when really I'm only giving you the benefit of the doubt that you're not purposefully trying to misrepresent me or condescend to me. You've made some unfair assumptions here, and I've merely tried to clarify things, both for your sake and for others.

However, if you want the condensed version of what you're doing that I take objection to: You are not in a position to tell me that Topamax is not effectively treating my SA based on your own experience with the drug. And while it would be irresponsible for me to say it _will_ help others SA, it is not irresponsible for me to say it _might _help. On the other hand, you have been too dismissive in saying that it _won't _help others, or that it will only help in roundabout ways, i.e., by treating secondary disorders or simply knocking a person out. My point stands: Your experience does not invalidate mine, nor does mine invalidate yours. Let them stand side by side, and people can make up their own minds, whether they be "young" or "new" or whatever.

That said, if you've lost interest in this discussion (which I was enjoying up to this point), then just stop talking to me.


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## arkwelder (May 10, 2010)

Stumbled upon this: http://www.ncbi.nlm.nih.gov/pubmed/15641873

"This study suggests that topiramate [Topamax] may be effective in the treatment of generalized social phobia. These results also suggest the possibility that the neurotransmitters glutamate and GABA may be involved in the neurobiology of generalized social phobia."

I'm wondering if this thread can be moved to the "Treatment Reviews" section of the forum.

Also, crazymeds.us has a decent write-up of the drug: http://www.crazymeds.us/pmwiki/pmwiki.php/Meds/HowTopamaxWorks

Of note: "Topamax inhibits the voltage-gated (dependent) sodium and calcium channels, inhibits glutamate and carbonic anhydrase, and promotes the reception of GABA and/or increases the amount of GABA..."

It's affect on glutamate and GABA would explain why it has been helpful in treating my SA, and would suggest that it may be helpful in treating others.


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## roadwarrior48 (Jun 23, 2013)

Let's just Jello wrestle instead! :banana The he__ with anxiey.


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## arkwelder (May 10, 2010)

The more research I do, the more I'm convinced the Topamax could be a major player in treating SA:



> Topiramate is a very potent anticonvulsant that is structurally different from other AEDs. It is derived from D-fructose and initially was developed as an antidiabetic drug. In animal models, it was found to have potent antiepileptic effects. Topiramate has multiple mechanisms of action. It exerts an inhibitory effect on sodium conductance, decreasing the duration of spontaneous bursts and the frequency of generated action potentials, *enhances GABA by unknown mechanisms, inhibits the AMPA subtype glutamate receptor*, and is a weak inhibitor of carbonic anhydrase.


Quote taken from here.

Some abstracts to give some context to the above quote and the possible role of the AMPA receptor in SA:

http://www.ncbi.nlm.nih.gov/pubmed/18363046: "...non-competitive AMPA receptor antagonists can profoundly block anxiety-like behavior in rodents..."

http://www.ncbi.nlm.nih.gov/pubmed/9610933: "...the putative AMPA/glutamate receptor antagonist, LY326325, produces anxiolytic-like effects..."


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## basuraeuropea (Jul 25, 2012)

out of the aeds, i think pregabalin may have the greatest potential in treating anxiety-spectrum disorders with perhaps the exception of obsessive-compulsive disorder.

while topiramate may have its merits, i feel as though pregabalin may help a great deal more people who suffer.


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## arkwelder (May 10, 2010)

basuraeuropea said:


> out of the aeds, i think pregabalin may have the greatest potential in treating anxiety-spectrum disorders with perhaps the exception of obsessive-compulsive disorder.
> 
> while topiramate may have its merits, i feel as though pregabalin may help a great deal more people who suffer.


You could be right. All I know for now is that Topamax works for me, and the research suggests to me that I am not experiencing a placebo effect.

You have to consider the sequence of events here: 1. Patient goes on Topamax for cyclothymia. 2. Realizes it is treating his SA. 3. Wonders why the heck that is. 4. Starts doing all the research he can on it. 5. Research suggests that Topamax could, in theory, treat SA.

Problem is, nobody that I know of here has given it a fair chance but me. They either avoid it altogether or go off it prematurely because they find the side effects intolerable. The fact is, it's a powerful drug, and nobody should start on more than 25mg, nobody should titrate more than 25mg per week, and I doubt anybody here needs more than 100mg. It's anxiolytic effect can be easy to miss, because it's more specifically psychological than physiological (I happen to think SA is mostly _in the head_ anyway). It can also be somewhat of a tempermental drug. Somebody mentioned uncontrollable crying spells. That happened to me for a short while. It just does weird stuff sometimes.

To tell you the truth, I would like to try Lyrica _just to see_. It has an established track record for treating SA and anxiety in general, and I would like to see, personally, if it is better, worse, or the same for treating SA as Topamax. I believe I will ask my doctor for it the next time I see him.

In the meantime, help me understand your statement that reads "While topiramate may have its merits, i feel as though pregabalin may help a great deal more people who suffer." I follow your posts quite closely and am intelligent enough to know when someone is more intelligent than me in a particular area. You seem to know a lot more about psychopharmacology than I do (I know virtually nothing, actually, because I only started learning when I got serious about understanding my disorder). So what makes it better? Is it the established track record, something to do specifically with its mechanism of action, the fact that it has fewer side effects? I assure you I genuinely want to know.

I realize I'm advocating for Topamax but don't personally have much to compare it to. However, I have been on Nardil, which is considered the "gold-standard" by some.

Ultimately, there is no doubt in my mind that Lyrica is an effective SA treatment, probably one of the best, in fact. If I hadn't already been on Topamax, I probably would have turned to Lyrica first. That said, I have been on Topamax, I know that it works, I'm vaguely starting to understand why it works, and now I want to know how it stacks up against Lyrica. If my doctor will prescribe it, I'll absolutely volunteer as guinea pig.


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## CD700 (Apr 22, 2010)

Started taking this again today
I'm just going to stay at 100mg this time and not ramp it up so high
It was just sitting there and I'm feeling crapola so why not....plus I took my first dose of luvox today and it felt like a tic tac


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## arkwelder (May 10, 2010)

Fascinating account by someone who has tried Lyrica. Fascinating because it's almost exactly how I would've described Topamax. These drugs may not be all that different from each other, after all. Sure, their mechanisms of action are different, but the results they yield may be very similar. After all, they both raise brain GABA levels while lowering glutamate levels, albeit by poorly understood means.


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## arkwelder (May 10, 2010)

CD700 said:


> Started taking this again today
> I'm just going to stay at 100mg this time...


Which?

If you're talking about Topamax, then dear Jeezus Almighty!! don't start at 100mg. Start at 25mg and titrate slowly.


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## CD700 (Apr 22, 2010)

arkwelder said:


> Which?
> 
> If you're talking about Topamax, then dear Jeezus Almighty!! don't start at 100mg. Start at 25mg and titrate slowly.


I only have the 100mg 
For some reason I have a high tolerance for meds and only started getting cognitive issues at 300mg.

For anyone else then yeah this can be useful for SA I believe but start off at lower doses


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## basuraeuropea (Jul 25, 2012)

arkwelder said:


> You could be right. All I know for now is that Topamax works for me, and the research suggests to me that I am not experiencing a placebo effect.
> 
> You have to consider the sequence of events here: 1. Patient goes on Topamax for cyclothymia. 2. Realizes it is treating his SA. 3. Wonders why the heck that is. 4. Starts doing all the research he can on it. 5. Research suggests that Topamax could, in theory, treat SA.
> 
> ...


i don't doubt that the effects are anything but the result of the placebo effect at all. i'm absolutely positive that the drug has worked wonders for you - i think i stated that earlier in the thread.

anyhow, though, and perhaps most importantly is that once one knows which drug works, i've learned, and with an immense amount of difficulty at that, that one should stick to what works rather than experimenting just for sake of satisfying guinea-pig curiosity. you may very well relapse/destabilise yourself in the interim, or not be prescribed a high enough dose of pregabalin by your physician, or not be able to tolerate pregabalin for some reason, or, or, or - and all the while make yourself more resistant to effective treatment; that compounded by scholarly documentation that certain psychotropics aren't apt to work as well during subsequent administration makes for it all a bit scary - scary in my eyes, at least.


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## arkwelder (May 10, 2010)

basuraeuropea said:


> i don't doubt that the effects are anything but the result of the placebo effect at all. i'm absolutely positive that the drug has worked wonders for you - i think i stated that earlier in the thread.
> 
> anyhow, though, and perhaps most importantly is that once one knows which drug works, i've learned, and with an immense amount of difficulty at that, that one should stick to what works rather than experimenting just for sake of satisfying guinea-pig curiosity. you may very well relapse/destabilise yourself in the interim, or not be prescribed a high enough dose of pregabalin by your physician, or not be able to tolerate pregabalin for some reason, or, or, or - and all the while make yourself more resistant to effective treatment; that compounded by scholarly documentation that certain psychotropics aren't apt to work as well during subsequent administration makes for it all a bit scary - scary in my eyes, at least.


I've actually been researching Lyrica a fair bit. This isn't to prove a point to you or anyone else that Topamax is better than Lyrica at all. Rather, I suspect that both and maybe others may be great for SA. The point is that I'm starting to build a great deal of faith in this unique group of anxiolytic, mood stabilizing, GABAergic anticonvulsants. I'm starting to think they're the best alternative to benzos for longterm use. However, its hard to advocate for them if I've only ever tried one. My problem is almost the exact opposite of a lot of people's here: I haven't been on one med after another with no success. The first med my pdoc ever prescribed to me for SA was Nardil. I had been on Paxil and Prozac in the past, but those are distant memories now. The second med was Topamax. My doctors rationale was that we needed to treat the mood instability first (that was his main concern, because the hypomania from Nardil had landed me in the hospital), then we could treat the SA. But lo and behold, it treated the SA, too.

So I'm going to experiment a little. I am, however, zeroing in on stimulants on one hand and anticonvulsants on the other. Everything I've read and experienced points me in that general direction, so I don't expect to deviate too far from that. And so...Sure, I'm on Topamax, but what if Lyrica's slightly better? And by the same token...sure, I'm currently on Dexadrine, but what if Adderall's slightly better? It's these small questions that I want answered. As I've said elsewhere, I believe there are "good", "better", and "best" treatments for SA. How do I know I have the best one for me if I don't experiment? Believe me when I say a lot of research goes into these "experiments". I'm not going to be haphazard about it.

And I know you certainly never suggested that Topamax wasn't working for me, and I appreciate that.


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## Emma Ruiz (Jul 25, 2013)

Topamax works by calming the nerve cells in the brain that have been known to create migraines when overly excited. This same process also works for anxiety disorders by calming the active nerve cells similar to the way anti-convulsive medication stops a seizure. When used as a cure for anxiety, there is a possibility of increased depression and suicidal thoughts similar to many antidepressants out on the market. Topamax will not cure depression and anxiety overnight and may take up to two months for the effects to be seen. Patient responses to the drug as a migraine reducer have been favorable, but results are mixed with its use as an anxiety medication. Some patients said they had hallucinations and confusion. Also this drug can work differently between women and men, or for people of different ages. Superdrugsaver clearly defines that it is used in migraine, migraine with aura, epilepsy, headache, migraine without aura. Commonly reported side effects of Topamax include convulsion, nausea, headache, fatigue, pain.


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## arkwelder (May 10, 2010)

Uhh...you just quoted a bunch of stuff off the Internet. You probably should have made that clear. That said, do you have any personal experience with this drug?


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## arkwelder (May 10, 2010)

CD700, I'm curious to know if you've stuck with the Topamax and, if so, how it's been working out for you. I've recently concluded that less is definitely more with Topamax. I've settled on 50 mg and, with no noticeable cognitive impairment, that definitely appears to be the sweet spot.


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## CD700 (Apr 22, 2010)

Not at the moment 
I stopped taking everything because I got first appointment with a P doc coming up


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## basuraeuropea (Jul 25, 2012)

CD700 said:


> Not at the moment
> I stopped taking everything because I got first appointment with a P doc coming up


pdoc appt.

pt: cd700, the artist formerly known as blakeyz.

dx: everything

rx: nothing

sx: crunchy niplz


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## CD700 (Apr 22, 2010)

basuraeuropea said:


> pdoc appt.
> 
> pt: cd700, the artist formerly known as blakeyz.
> 
> ...


:afr


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## basuraeuropea (Jul 25, 2012)

CD700 said:


> :afr


don't worry! i still :heart you!


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## CD700 (Apr 22, 2010)

You just luv me for my crunchy niplz


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## Margot06 (Mar 21, 2014)

Just dropping this note in here for posterity. I live by my wits. I have bipolar, not SA. I pushed my doc to put me on topomax. He put me on 100mg to start. I've had no mental foggiest so far, but I admit to headaches and a bit unreal feeling. We cut my dosage of Geodon from 120 to 60mg simultaneously, which I consider fast titrating but I'm all for it. Geodon required 500 calories each night. Topomax may bring weight loss. I'll put up with other side effects to get that. I believe he'll up the Topomax to 195mg eventually and get me off Geodon if it looks like it is functioning. I'll post about it for any bipolar brethren using the forum. You guys are so great about meds insights, so I hang out here. Thanks for being here and letting me be here. I'm also on Lamictal, and I'm hoping it will safeguard me from sliding into an episode.


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## JR2891 (7 mo ago)

Roadwarrior are you male or female?


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## WillYouStopDave (Jul 14, 2013)

JR2891 said:


> Roadwarrior are you male or female?


 This thread is very old and the person you mentioned here hasn't been online since 2015.


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