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Social interaction problems / Depression


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#1 Declmem

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Posted 29 December 2008 - 03:16 PM


I have a complex problem I thought maybe a few people could relate to, or may have solved, and could offer me some advise.

I often have problems interacting with others, except the rare people in the small group of friends I've got. The main problem is that my screwed up mind decides to dwell on quips, sarcasm and friendly insults, making me quite depressed when around most people, and for days afterward. The depression also leads to me becoming a bit too introspective, quiet, or generally making a further ass of myself if I start drinking.

To clarify, I wouldn't call this social anxiety. I have no anxiety toward interacting with people. I also wouldn't call it depression, since if I go a few days without interacting with people I'm perfectly happy.

I've thought of calling it the Zach Braff disorder, but even he doesn't seem to get too depressed about his constant social blunders.

Anyway-

So far, the only drug I've taken that helped me with this is Lexapro, one of the newer SSRIs. It more or less solved the entire social problem for me. I even tested it by going out with some acquaintances who are more than a little overloaded on testosterone and take competition and oneupsmanship to an extreme level. Thanks to Lexapro, no problems: I held my own, took insults in stride, left happy, and didn't give the encounter a second thought.

OK, so Lexapro is great. Oh, you know, except for the fact that it basically renders all sexual functions useless. If I wasn't in a relationship I wouldn't care, except for fear of permanent damage (lookup PSSD).

So now I'm trying Tianeptine (Stablon). I've been off the Lexapro for a month, and on the Stablon for a week. So far, nothing. I feel like I'm holding back the floodgates of my social dysfunctions in an attempt to appear normal to anyone who hasn't seen me sans Lexapro.


To sum up this big post:

- Socially I have Zach Braff / foot-in-mouth disease and get depressed about it

- Lexapro solved the problem, but also decided to destroy any hope of normal sexual function

- Now I'm on Tianeptine which doesn't appear at first glance to be working.

- I'm looking for advise on other things to try



I'm also trying DLPA and small amounts of modafinil, but only for the last few days. I love modafinil for the energy, but it has never helped with this problem.

Any pointers guys? Gals?

Anyone relate to my screwed up social problems? ;)

Edited by Declmem, 29 December 2008 - 03:18 PM.


#2 Colli

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Posted 29 December 2008 - 05:34 PM

Hi Declmem.

I'm not a regular poster here, but your post really caught my attention.

You described your problem as "my screwed up mind decides to dwell on quips, sarcasm and friendly insults, making me quite depressed when around most people, and for days afterward. The depression also leads to me becoming a bit too introspective, quiet, or generally making a further ass of myself if I start drinking."

That was me to a tee. I would do exactly the same things as you. If someone took a good-natured "dig" at me or teased me (as friends do!) I would analyse it for days afterwards. If I said something that wasn't even commented upon by anyone else but after later investigation in my own mind didn't appear to make sense, I would torture myself for ages. I constantly felt that I had to explain myself for everything. And yes, like you, it made me withdraw into myself for fear of saying something silly.

I have news for you. It is social anxiety. You may not be nervous about talking to people as such. You may not tremble or blush when interacting with others. However, social anxiety is about a lot more than the actual symptoms of anxiety. Sufferers also adopt a particular way of thinking that causes them to analyse every part of a conversation. They become experts at extracting the worst out of their own social performances leading them to develop safety strategies and behaviours so as to help them avoid perceived social dangers.

I have been officially diagnosed with social anxiety. My doctor initially put me on citalopram, which didn't do much to help me. I am currently on Effexor (venlafaxine). This has been of some help although I am going to be exploring other medications with my doctor as Effexor has really blunted my emotions and has negatively affected my short-term memory.

As it happens, I am going to be going for my very first session of CBT (cognitive behavioural therapy) tomorrow. AFAIK, it is the "standard" psychological treatment for social anxiety. Medication will only get you so far - and you certainly don't want to be at the mercy of the side-effects said medications can produce - and so you really need to change your way of thinking around people. I'm just about to make that journey.

As for Stablon, from what little I've read it's great for depression but not so useful for anxiety issues. You should speak to your doctor about trying another anti-depressant. It may take a bit of experimentation to find what works best for you (I'm still trying to find that out!), but you will get there. You also need to speak to your doctor about referral to a psychologist for CBT.

It was my social anxiety issues that led me to this forum as I was questing to find something that would make me "socially smarter". While nootropics may provide a crutch, they're not a long-term solution. Please speak to your doctor. Ask him/her about CBT. I'm hoping it will help me and hopefully it'll help you too.

Take care and good luck,
Colette

Edited by Colli, 29 December 2008 - 05:39 PM.


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#3 NDM

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Posted 29 December 2008 - 07:37 PM

our common problem has a name: atypical depression - the key symptom of which is hypersensitivity to rejection; social anxiety would be being afraid to start a conversation; I am more than sociable and love speaking with people - but if in the conversation I receive the slightest negative remark, that one little thing can screw my whole day (actually it happened on Christmas day). I opened up a thread in the supplements section on coping with aversive stimuli - it discusses some of the issues. I am not aware of good supplements for this - but am experimenting with Lysine, Rhodiola, Gotu Kola (hopefully Nicholas is right), Tryptophan, and soon with Resveratrol (for his anti-interleukin 6 activity).

A good cognitive technique for this is disputation: If x says that you are y, try to remember if you can find in your memory people who have said that you are the non-y (or other kinds of evidence that would contradict or at least qualify x). However, this technique helps only at a shallow intellectual level. The problem is much more visceral than this, I'm afraid.

#4 FunkOdyssey

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Posted 29 December 2008 - 08:22 PM

I've always heard that Nardil is the ultimate for social anxiety. It is side-effect prone but supposed to be the holy grail of that particular disorder, might be worth looking into. Check out dr-bob.org for more information.

#5 medicineman

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Posted 29 December 2008 - 08:33 PM

our common problem has a name: atypical depression - the key symptom of which is hypersensitivity to rejection; social anxiety would be being afraid to start a conversation; I am more than sociable and love speaking with people - but if in the conversation I receive the slightest negative remark, that one little thing can screw my whole day (actually it happened on Christmas day). I opened up a thread in the supplements section on coping with aversive stimuli - it discusses some of the issues. I am not aware of good supplements for this - but am experimenting with Lysine, Rhodiola, Gotu Kola (hopefully Nicholas is right), Tryptophan, and soon with Resveratrol (for his anti-interleukin 6 activity).

A good cognitive technique for this is disputation: If x says that you are y, try to remember if you can find in your memory people who have said that you are the non-y (or other kinds of evidence that would contradict or at least qualify x). However, this technique helps only at a shallow intellectual level. The problem is much more visceral than this, I'm afraid.


I am also a bit sceptical about CBT, but there is a wealth of literature to support it, while very, very few studies show any improvement in anxiety disorders or depression in Lysine, Rhodiola, or Gotu Kola (im not saying they don't work, im just saying there is no literature to support their use in mental disorders)...

And resveratrol, until some formulation comes out to increase bioavailibility, than it definitely will do nothing, although the interleukin-6 thing is interesting. To my knowledge, inhibiting interleukin-6 is a end result of biological treatment for diseases such as rheumatoid arthritis and inflammatory bowel disease, so i will look into that.

Tryptophan has been found to be, somewhat effective in mild depression.

Here are a couple studies on therapy in general:


TI Cognitive therapy vs medications in the treatment of moderate to severe depression. AU DeRubeis RJ; Hollon SD; Amsterdam JD; Shelton RC; Young PR; Salomon RM; O'Reardon JP; Lovett ML; Gladis MM; Brown LL; Gallop R SO Arch Gen Psychiatry 2005 Apr;62(4):409-16. BACKGROUND: There is substantial evidence that antidepressant medications treat moderate to severe depression effectively, but there is less data on cognitive therapy's effects in this population. OBJECTIVE: To compare the efficacy in moderate to severe depression of antidepressant medications with cognitive therapy in a placebo-controlled trial. DESIGN: Random assignment to one of the following: 16 weeks of medications (n = 120), 16 weeks of cognitive therapy (n = 60), or 8 weeks of pill placebo (n = 60). SETTING: Research clinics at the University of Pennsylvania, Philadelphia, and Vanderbilt University, Nashville, Tenn. PATIENTS: Two hundred forty outpatients, aged 18 to 70 years, with moderate to severe major depressive disorder. INTERVENTIONS: Some study subjects received paroxetine, up to 50 mg daily, augmented by lithium carbonate or desipramine hydrochloride if necessary; others received individual cognitive therapy. MAIN OUTCOME MEASURE: The Hamilton Depression Rating Scale provided continuous severity scores and allowed for designations of response and remission. RESULTS: At 8 weeks, response rates in medications (50%) and cognitive therapy (43%) groups were both superior to the placebo (25%) group. Analyses based on continuous scores at 8 weeks indicated an advantage for each of the active treatments over placebo, each with a medium effect size. The advantage was significant for medication relative to placebo, and at the level of a nonsignificant trend for cognitive therapy relative to placebo. At 16 weeks, response rates were 58% in each of the active conditions; remission rates were 46% for medication, 40% for cognitive therapy. Follow-up tests of a site x treatment interaction indicated a significant difference only at Vanderbilt University, where medications were superior to cognitive therapy. Site differences in patient characteristics and in the relative experience levels of the cognitive therapists each appear to have contributed to this interaction. CONCLUSION: Cognitive therapy can be as effective as medications for the initial treatment of moderate to severe major depression, but this degree of effectiveness may depend on a high level of therapist experience or expertise. AD Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA. derubeis@psych.upenn.edu PMID 15809408

TI A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: outcome of the first year. AU Lam DH; Watkins ER; Hayward P; Bright J; Wright K; Kerr N; Parr-Davis G; Sham P SO Arch Gen Psychiatry 2003 Feb;60(2):145-52. BACKGROUND: Despite the use of mood stabilizers, a significant proportion of patients with bipolar affective disorder experience frequent relapses. A pilot study of cognitive therapy (CT) specifically designed to prevent relapses for bipolar affective disorder showed encouraging results when used in conjunction with mood stabilizers. This article reports the outcome of a randomized controlled study of CT to help prevent relapses and promote social functioning. METHODS: We randomized 103 patients with bipolar 1 disorder according to the DSM-IV, who experienced frequent relapses despite the prescription of commonly used mood stabilizers, into a CT group or control group. Both the control and CT groups received mood stabilizers and regular psychiatric follow-up. In addition, the CT group received an average of 14 sessions of CT during the first 6 months and 2 booster sessions in the second 6 months. RESULTS: During the 12-month period, the CT group had significantly fewer bipolar episodes, days in a bipolar episode, and number of admissions for this type of episode. The CT group also had significantly higher social functioning. During these 12 months, the CT group showed less mood symptoms on the monthly mood questionnaires. Furthermore, there was significantly less fluctuation in manic symptoms in the CT group. The CT group also coped better with manic prodromes at 12 months. CONCLUSION: Our findings support the conclusion that CT specifically designed for relapse prevention in bipolar affective disorder is a useful tool in conjunction with mood stabilizers. AD Department of Psychology, Institute of Psychiatry, London, England. spjtdhl@iop.kcl.ac.uk PMID 12578431




TI A pilot study of cognitive therapy in bipolar disorders. AU Scott J; Garland A; Moorhead S SO Psychol Med 2001 Apr;31(3):459-67. BACKGROUND: The efficacy and effectiveness of cognitive therapy (CT) is well established for unipolar disorders, but little is known about its utility in bipolar disorders. This study aimed to explore the feasibility and efficacy of using CT as an adjunct to usual psychiatric treatment in this patient population. METHOD: Subjects referred by general adult psychiatrists were assessed by and independent rater and then randomly allocated to immediate CT (N = 21) or 6-month waiting-list control, which was then followed by CT (N = 21). Observer and self-ratings of symptoms and functioning were undertaken immediately prior to CT, after a 6-month course of CT and a further 6-months later. Data on relapse and hospitalization rates in the 18 months before and after commencing CT were also collected. RESULTS: At 6-month follow-up, subjects allocated to CT showed statistically significantly greater improvements in symptoms and functioning as measured on the Beck Depression Inventory, the Internal State Scale, and the Global Assessment of Functioning than those in the waiting-list control group. In the 29 patients who eventually received CT, relapse rates in the 1 8 months after commencing CT showed a 60 % reduction in comparison with the 18 months prior to commencing CT. Seventy per cent of subjects who commenced therapy viewed CT as highly acceptable. CONCLUSION: Although the results of this study are encouraging, the use of CT in subjects with bipolar disorders is more complex than in unipolar disorders and requires a high level of therapist expertise. The therapy may prove to be particularly useful in the treatment of bipolar depression. AD Department of Psychological Medicine, University of Glasgow, Gartnavel Royal Hospital. PMID 11305854



TI Psychological therapies for generalised anxiety disorder. AU Hunot V; Churchill R; Silva de Lima M; Teixeira V SO Cochrane Database Syst Rev. 2007 Jan 24;(1):CD001848. BACKGROUND: Generalised anxiety disorder (GAD) is a highly prevalent condition, characterised by excessive worry or anxiety about everyday events and problems. The effectiveness and effectiveness of psychological therapies as a group has not yet been evaluated in the treatment of GAD. OBJECTIVES: To examine the efficacy and acceptability of psychological therapies, categorised as cognitive behavioural therapy (CBT), psychodynamic therapy and supportive therapy, compared with treatment as usual/waiting list (TAU/WL) and compared with one another, for patients with GAD. SEARCH STRATEGY: We searched the Cochrane Depression, Anxiety & Neurosis Group (CCDAN) Controlled Trials Register and conducted supplementary searches of MEDLINE, PsycInfo, EMBASE, LILACS and controlledtrials.com in February 2006. We searched reference lists of retrieved articles, and contacted trial authors and experts in the field for information on ongoing/completed trials. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials conducted in non-inpatient settings, involving adults aged 18-75 years with a primary diagnosis of GAD, assigned to a psychological therapy condition compared with TAU/WL or another psychological therapy. DATA COLLECTION AND ANALYSIS: Data on patients, interventions and outcomes were extracted by two review authors independently, and the methodological quality of each study was assessed. The primary outcome was anxiety reduction, based on a dichotomous measure of clinical response, using relative risk (RR), and on a continuous measure of symptom reduction, using the standardised mean difference (SMD), with 95% confidence intervals. MAIN RESULTS: Twenty five studies (1305 participants) were included in the review, of which 22 studies (1060 participants) contributed data to meta-analyses. Based on thirteen studies, psychological therapies, all using a CBT approach, were more effective than TAU/WL in achieving clinical response at post-treatment (RR 0.63, 95%CI 0.55 to 0.73), and also in reducing anxiety, worry and depression symptoms. No studies conducted longer-term assessments of CBT against TAU/WL. Six studies compared CBT against supportive therapy (non-directive therapy and attention-placebo conditions). No significant difference in clinical response was indicated between CBT and supportive therapy at post-treatment (RR 0.86, 95%CI 0.70 to 1.06), however significant heterogeneity was indicated, which was partly explained by the number of therapy sessions. AUTHORS' CONCLUSIONS: Psychological therapy based on CBT principles is effective in reducing anxiety symptoms for short-term treatment of GAD. The body of evidence comparing CBT with other psychological therapies is small and heterogeneous, which precludes drawing conclusions about which psychological therapy is more effective. Further studies examining non-CBT models are required to inform health care policy on the most appropriate forms of psychological therapy in treating GAD. AD Institute of Psychiatry, Section of Evidence Based Mental Health, Health Services Research Department, PO Box 32, De Crespigny Park, London, UK, SE5 8AF. v.hunot@iop.kcl.ac.uk PMID 17253466



TI Effectiveness of cognitive-behavioral treatment for panic disorder versus treatment as usual in a managed care setting: 2-year follow-up. AU Addis ME; Hatgis C; Cardemil E; Jacob K; Krasnow AD; Mansfield A SO J Consult Clin Psychol. 2006 Apr;74(2):377-85. Eighty clients meeting criteria for panic disorder and receiving either panic control therapy (PCT; M. G. Craske, E. Meadows, & D. H. Barlow, 1994) or treatment as usual (TAU) in a managed care setting were assessed 1 and 2 years following acute treatment. PCT was provided by therapists with little or no previous exposure to cognitive-behavioral therapies. Analyses of the full intent-to-treat sample revealed no significant differences between the treatments across the follow-up period. However, when treatment completer status was added as a moderator, those receiving PCT showed lower levels of panic severity and phobic avoidance and a greater likelihood of achieving and maintaining clinically significant change. Benzodiazepine use during follow-up was associated with greater panic severity for those clients who received PCT, but no such relationship was found for TAU clients. Results are discussed in relation to the dissemination and effectiveness of PCT as well as evidence-based psychotherapies more generally. AD Department of Psychology, Clark University, Worcester, MA 01610, USA. maddis@clarku.edu PMID 16649882


i would go for the CBT, might as well try the supplements since they have a clean side effect profile... The gentleman above mentioned Nardil,, which is a fantastic, but iffy side effect profile, drug.

Edited by medicineman, 29 December 2008 - 08:40 PM.


#6 bgwithadd

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Posted 29 December 2008 - 11:28 PM

Here is a case where you really need a psychiatrist to figure out your issue. It sounds like more ocd than anything else, though, not really anxiety. Which explains why the lexapro works. As for supplements, not sure what would help (if anything). I think omega 3s will help you to at least some degree but they will not be anything approaching a cure. Your problem might also go away by treating the depression and for that there's lots of stuff that works.

@medicineman - there's been many studies on the antidepressive qualities of many supps, including ashwaghanda and bacopa and rhodiola rosea. If you can't find them you are not looking hard enough. There are fewer for anxiety, but for anxyolitics the effect is usually pretty obvious to someone who takes it if it's there.

#7 ajnast4r

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Posted 29 December 2008 - 11:53 PM

cognitive/behavioral therapy is the way to go imo

#8 NDM

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Posted 30 December 2008 - 12:37 AM

I think the thread may be going in the wrong direction because the guy is emphatically NOT anxious to initiate conversations with people --- the hell comes in the aftermath of social interaction, when nasty remarks & friendly "just teasing you's" penetrate deep down to one's gut and make one feel bad despite the fact that at the intellectual level one realizes only too well than one is overreacting. If there's any social anxiety, that is an effect of previous nasty interactions on one's feelings...it's like getting burned and staying away from the flame. It seems to me a clear case of hypersensitivity to rejection (I also have it, without the other symptoms of atypical depression - they appear only when the load and significance of rejections reaches a critical threshold).

Here's the original quote, with my added highlights.

"I often have problems interacting with others, except the rare people in the small group of friends I've got. The main problem is that my screwed up mind decides to dwell on quips, sarcasm and friendly insults, making me quite depressed when around most people, and for days afterward. The depression also leads to me becoming a bit too introspective, quiet, or generally making a further ass of myself if I start drinking.

To clarify, I wouldn't call this social anxiety. I have no anxiety toward interacting with people. I also wouldn't call it depression, since if I go a few days without interacting with people I'm perfectly happy."


As for the supps suggested, I am experimenting with them as a result of previous research, or of excellent anectodal accounts (eg Nicholas on Gotu Kola), or of my own inferences integrating different scraps of knowledge. An example of the latter:

I read online about a woman who detected after many years that she always got herpes outbreaks after rejections.
I read in a study posted by Lufega that overly anxious people have a deficit of lysine, which seems critical to the modulation of serotonin in the amygdala.
I know that herpes outbreaks prosper when there's an inbalance of arginine to lysine.

From the three above I speculate on the following mechanism:

rejection--->anxiety--->lysine depletion--->herpes outbreak + serotonin depletion--->depression




Edited by NDM, 30 December 2008 - 12:38 AM.


#9 Declmem

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Posted 30 December 2008 - 01:50 AM

Thanks everyone - for the advise and for personal stories. I'm glad people were able to relate ;)

Regarding Cognitive Therapy, I respect the therapy very much, have read about many of the studies, and have no doubt that it works for many people. Unfortunately, I'm very resistant to talk therapy of any kind. I went through a year with a psychologist and it just hasn't worked well for me in the past. Perhaps I'm not interacting enough with the therapist, am resistant to authority in general, am a control freak, or some other such excuse. I have studied and actively engaged in many mental techniques ranging from visualization, affirmations, aspects of cognitive therapy (countering irrational thoughts, etc), meditation, self-hypnosis, etc. While these have serendipitously helped me with a large array of other problems, this social problem remains. As NDM mentioned, they only help me on a very superficial level. Consciously, I realize how irrational it is to dwell on normal conversation and social interactions - constantly parsing them out to figure out where I went wrong, what the person was actually thinking, and so on. I know that is ridiculous. But my subconscious doesn't much care what I think, it does it anyway - in the background, you could say.

Still, maybe I'll give Cognitive Therapy another try, and I appreciate the suggestions and posts of the studies.

For now I'm led to believe it is a neurological issue / chemical imbalance of some kind. The Lexapro really did solve it quite nicely. But, sexual dysfunction just isn't acceptable.

Though nobody has touched on this subject yet, I am also very physically active. I do both cardio and weight lifting 6 days of the week. This no doubt helps with my depression problems - but, for these social issues physical activity has proved only marginally helpful.

I've got some ashwaghanda and bacopa lying around, so maybe I'll give them another try. Reseveratrol had fantastic mood-lifting properties for me, but I also experienced the not uncommon joint/tendon issues which took months to recover from. I was using an "impure" extract, however. I didn't note any effects on social interaction, but I didn't take it long.

I do also take Omega-3's. I have been for years. I couldn't tell you whether they've done anything or not, but they certainly haven't hurt. Currently I'm experimenting with higher DHA formulations.

@Colli - thanks very much for your story and I hope you'll return and let me know how the CBT goes, or if you have any other suggestions.

@NDM - thanks for your advise. I hope you'll let me know how your regimen works out. Have you tried CBT?

@medicineman - I really appreciate the time you put into posting those studies. But, have you heard of CBT being used for anything similar to my case? I don't have generalized anxiety, bipolar, or really even mild depression. It is really only specifically relegated to these social interaction problems.


Any other suggestions are always welcome :)

Edited by Declmem, 30 December 2008 - 01:55 AM.


#10 Colli

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Posted 30 December 2008 - 02:54 AM

I appreciate that many of you don't think this is a social anxiety issue, and I can understand why you think this is the case. The OP may have little or no anxiety in interacting with people, but he certainly has a degree of apprehension around people which in turn leads to feelings of depression. Social Anxiety is more than just being anxious in a social situation: if that was simply the case, it could be argued that the OP (or any SA sufferer, for that matter) is just painfully shy.

It is true that many sufferers of social anxiety do experience feelings and symptoms associated with anxiety. However, that is just one aspect of the condition and isn't necessarily applicable to all sufferers; in fact, there are a number of victims who experience feelings of extreme self-conciousness rather than actual anxiety. Thus a huge part of the social anxiety "experience" runs much deeper, and as I'm not eloquent enough to put it into my own words, I've borrowed a quote from the Social Anxiety UK website to try to convey the processes underlying the disorder: "At a deeper level, sufferers often experience chronic insecurity about their relationships with others, hypersensitivity to criticism, and deep-rooted fears of being judged negatively, mocked, or rejected by others." So while anxiety is a usual occurrence in sufferers, it is not a necessary and sufficient criterion for a diagnosis of the disorder. The superficial manifestation of anxiety is a typical (but not always evident) feature resulting from these deeper issues at the core of social anxiety.

Take my own experience. I still wanted to be around others, to talk and interact like any other "normal" person. I would feel nervous approaching people I didn't know - I'm sure that this is something we've all experienced to varying degrees during the course of our lives - but this didn't deter me. I would talk to people and genuinely make the effort to engage them in conversation. For me, the horrific part was after the conversation. I would conduct an internal "post-mortem" of the interaction, picking out anything that my mind would construe as being remotely nonsensical, stupid or ignorant. From this I would conclude that the person that I was talking to thought I was an idiot. I would subsequently avoid them or become quiet in any further dealings with them. This led to feelings of depression and inadequacy which stayed with me wherever I went.

I know I'm no expert on the subject. Even as a past student of psychology, it took me a long time to realise that I had a problem and that I wasn't just some socially inept weirdo. Since that realisation, I've seen several doctors and have been assessed by psychologists who have all provided a diagnosis of social anxiety. So what's my point? OK, I don't know the OP. There may very well be others issues at play here. But please don't write off the possibility of social anxiety. Like many mental disorders, there isn't a hard and fast checklist of criteria for SA, so just because someone doesn't experience anxiety doesn't mean they're not suffering from social anxiety to some degree.

Anyway, that's my two cents. I'm hoping that whatever the problem, Declmem can get the help he/she needs.

Colette

#11 Lufega

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Posted 30 December 2008 - 04:11 AM

This sounds like social anxiety to me. I should know :(

Anything that boost dopamine will help..tyrosine, deprenyl..

Check out this forum, some good info. on the supplements section.

http://www.socialanx....com/forum/f11/

#12 NDM

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Posted 30 December 2008 - 02:16 PM

@ Colli This thread is really getting interesting: for one thing, my mental model of what counts as social anxiety seems to be narrow (ie. specifically fear of approaching people & visible unease when talking with them). But if psychologists define it to include ex post facto hypersensitivity to rejection, so be it...I'm willing to update my model. But then the new issue arises as to the nature of the relationship between social anxiety and atypical depression. Are they psychologists' failure to properly cut nature at its joints? Is there really only one condition? Are they comorbid (and to what extent)? Is the latter an outgrowth of the former? etc

@ DecImen I don't take any prescription medication and don't plan to (my friends would laugh if they knew I'm on this forum because they always ask me how come that i'm so confident). Glad to know resv works as a mood booster - will start on it Jan 1st.

@ Lufega - thanks for the tip on dopamine boosters - I take sometimes some phenylalanine - however, I was told that too much dopamine can make one irritable and nasty (that's why i didn't went straight for tyrosine). Also, I fear of upregulating my dopamine system and then being dependent on supps. But the idea of dopamine boosters might work especially well in the day after the "rejection", preventing one from a deep plunge in the valley.

#13 Declmem

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Posted 30 December 2008 - 03:25 PM

This sounds like social anxiety to me. I should know :(

Anything that boost dopamine will help..tyrosine, deprenyl..

Check out this forum, some good info. on the supplements section.

http://www.socialanx....com/forum/f11/


I've considered trying Deprenyl - it is talked about a lot on here. My only concern is that it is a MAO inhibitor, and you have to be real careful on those. Even something as safe as melatonin isn't recommended while using a MAOI.

What's your experience with it? Worth the risk?

#14 HereInTheHole

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Posted 30 December 2008 - 06:01 PM

I have a decades-long history with a similar problem and have tried a number of anti-depressants and even more supplements. For many months now, what's been working for me consistently are ashwagandha and rhodiola, exercise, and not becoming sleep-deprived. These knock down the problem enough that when the nasty thoughts creep up, I can use some brief mindfulness meditation (focus on the sensation of breathing and not on thinking) to send them away.

Edited by NarrativiumX, 30 December 2008 - 06:01 PM.


#15 smithx

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Posted 01 January 2009 - 01:37 PM

I've always heard that Nardil is the ultimate for social anxiety. It is side-effect prone but supposed to be the holy grail of that particular disorder, might be worth looking into. Check out dr-bob.org for more information.



Please avoid Nardil.

My good friend died of it.

Nardil can cause catastrophic hypertension if the patent eats any of a huge list of foods including (as I remember) cheese and mushrooms. Or if they forget and take any allergy pills. etc.

My friend died of a cerebral hemorrhage caused by catastrophic hypertension as a result of forgetting she couldn't eat certain foods.

She was in a coma for 8 days and then died.

Nardil is not a drug that's worth taking. It's too easy to mess up and too easy to die from it.

#16 djmmm

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Posted 02 January 2009 - 08:13 PM

I've always heard that Nardil is the ultimate for social anxiety. It is side-effect prone but supposed to be the holy grail of that particular disorder, might be worth looking into. Check out dr-bob.org for more information.



Please avoid Nardil.

My good friend died of it.

Nardil can cause catastrophic hypertension if the patent eats any of a huge list of foods including (as I remember) cheese and mushrooms. Or if they forget and take any allergy pills. etc.

My friend died of a cerebral hemorrhage caused by catastrophic hypertension as a result of forgetting she couldn't eat certain foods.

She was in a coma for 8 days and then died.

Nardil is not a drug that's worth taking. It's too easy to mess up and too easy to die from it.


I couldn't DISAGREE more.
Nardil SAVED my life. The MAOIs have been the only medications that worked for me. Hypertensive reactions do happen, but are generally rare (8% with NO dietary restrictions, and 3% with dietary restrictions) (Rabkin J, Quitkin F, Harrison W, et al (1984). Adverse reactions to monoamine oxidase inhibitors, part 1, a comparative study. J Clin Psychopharmacol 4.270-78. )

As far as the food restrictions, the list is modified almost yearly. Generally, you must avoid aged meat and cheese. Personally, I have no dietary restrictions, and have been taking either Nardil, Parnate or Selegiline for 15 years.

MAOIs are safe and extremely effective drugs. They have been used since the 1950's, predating all other antidepressants. Not many drugs are supported by nearly 60 years of post developmental research.

#17 imarobot

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Posted 03 January 2009 - 12:43 AM

I've always heard that Nardil is the ultimate for social anxiety. It is side-effect prone but supposed to be the holy grail of that particular disorder, might be worth looking into. Check out dr-bob.org for more information.



Please avoid Nardil.

My good friend died of it.

Nardil can cause catastrophic hypertension if the patent eats any of a huge list of foods including (as I remember) cheese and mushrooms. Or if they forget and take any allergy pills. etc.

My friend died of a cerebral hemorrhage caused by catastrophic hypertension as a result of forgetting she couldn't eat certain foods.

She was in a coma for 8 days and then died.

Nardil is not a drug that's worth taking. It's too easy to mess up and too easy to die from it.


I couldn't DISAGREE more.
Nardil SAVED my life. The MAOIs have been the only medications that worked for me. Hypertensive reactions do happen, but are generally rare (8% with NO dietary restrictions, and 3% with dietary restrictions) (Rabkin J, Quitkin F, Harrison W, et al (1984). Adverse reactions to monoamine oxidase inhibitors, part 1, a comparative study. J Clin Psychopharmacol 4.270-78. )

As far as the food restrictions, the list is modified almost yearly. Generally, you must avoid aged meat and cheese. Personally, I have no dietary restrictions, and have been taking either Nardil, Parnate or Selegiline for 15 years.

MAOIs are safe and extremely effective drugs. They have been used since the 1950's, predating all other antidepressants. Not many drugs are supported by nearly 60 years of post developmental research.


How did Nardil save your life? Suicide ideation? Quality of life improvements don't count toward saving your life unless you were about to kill yourself or someone was about to kill you or a pack of Nardil in your breast pocket stopped a bullet.

If Nardil didn't truly save your life, then I'd say 8% sounds like bad odds. Even 3% doesn't sound great. Smithx's warning seems like good advice.

#18 medicineman

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Posted 03 January 2009 - 02:51 AM

I've always heard that Nardil is the ultimate for social anxiety. It is side-effect prone but supposed to be the holy grail of that particular disorder, might be worth looking into. Check out dr-bob.org for more information.



Please avoid Nardil.

My good friend died of it.

Nardil can cause catastrophic hypertension if the patent eats any of a huge list of foods including (as I remember) cheese and mushrooms. Or if they forget and take any allergy pills. etc.

My friend died of a cerebral hemorrhage caused by catastrophic hypertension as a result of forgetting she couldn't eat certain foods.

She was in a coma for 8 days and then died.

Nardil is not a drug that's worth taking. It's too easy to mess up and too easy to die from it.


I couldn't DISAGREE more.
Nardil SAVED my life. The MAOIs have been the only medications that worked for me. Hypertensive reactions do happen, but are generally rare (8% with NO dietary restrictions, and 3% with dietary restrictions) (Rabkin J, Quitkin F, Harrison W, et al (1984). Adverse reactions to monoamine oxidase inhibitors, part 1, a comparative study. J Clin Psychopharmacol 4.270-78. )

As far as the food restrictions, the list is modified almost yearly. Generally, you must avoid aged meat and cheese. Personally, I have no dietary restrictions, and have been taking either Nardil, Parnate or Selegiline for 15 years.

MAOIs are safe and extremely effective drugs. They have been used since the 1950's, predating all other antidepressants. Not many drugs are supported by nearly 60 years of post developmental research.


How did Nardil save your life? Suicide ideation? Quality of life improvements don't count toward saving your life unless you were about to kill yourself or someone was about to kill you or a pack of Nardil in your breast pocket stopped a bullet.

If Nardil didn't truly save your life, then I'd say 8% sounds like bad odds. Even 3% doesn't sound great. Smithx's warning seems like good advice.



life isnt just about being metabolically functional. there are more things to life than just being alive in the sense you put it. while being alive to you might mean breathing and shitting, it obviously is something more to him.

people are resorting to much more harmful ways to get by their depression or social anxiety.... you dont need to be critical in such a negative way. your opinion would have been good enough without the attempted mockery.

#19 TheFountain

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Posted 03 January 2009 - 03:34 AM

I have a complex problem I thought maybe a few people could relate to, or may have solved, and could offer me some advise.

I often have problems interacting with others, except the rare people in the small group of friends I've got. The main problem is that my screwed up mind decides to dwell on quips, sarcasm and friendly insults, making me quite depressed when around most people, and for days afterward. The depression also leads to me becoming a bit too introspective, quiet, or generally making a further ass of myself if I start drinking.

To clarify, I wouldn't call this social anxiety. I have no anxiety toward interacting with people. I also wouldn't call it depression, since if I go a few days without interacting with people I'm perfectly happy.

I've thought of calling it the Zach Braff disorder, but even he doesn't seem to get too depressed about his constant social blunders.

Anyway-

So far, the only drug I've taken that helped me with this is Lexapro, one of the newer SSRIs. It more or less solved the entire social problem for me. I even tested it by going out with some acquaintances who are more than a little overloaded on testosterone and take competition and oneupsmanship to an extreme level. Thanks to Lexapro, no problems: I held my own, took insults in stride, left happy, and didn't give the encounter a second thought.

OK, so Lexapro is great. Oh, you know, except for the fact that it basically renders all sexual functions useless. If I wasn't in a relationship I wouldn't care, except for fear of permanent damage (lookup PSSD).

So now I'm trying Tianeptine (Stablon). I've been off the Lexapro for a month, and on the Stablon for a week. So far, nothing. I feel like I'm holding back the floodgates of my social dysfunctions in an attempt to appear normal to anyone who hasn't seen me sans Lexapro.


To sum up this big post:

- Socially I have Zach Braff / foot-in-mouth disease and get depressed about it

- Lexapro solved the problem, but also decided to destroy any hope of normal sexual function

- Now I'm on Tianeptine which doesn't appear at first glance to be working.

- I'm looking for advise on other things to try



I'm also trying DLPA and small amounts of modafinil, but only for the last few days. I love modafinil for the energy, but it has never helped with this problem.

Any pointers guys? Gals?

Anyone relate to my screwed up social problems? :)


First of all, why are you attributing this to a problem within yourself and not in society? It is a noble gesture, but if your own nature is not to be happy in large groups, maybe you are just chemically different than these people you believe you wish to associate with. I am not saying that a chemical variation should condemn an individual to a dungeon as a suffering nocturnal, depressed soul. I am saying I think most psychiatrists estimates of what 'depression' or 'social anxiety' is, is really based on an abstract statistic that never really existed to begin with. It's almost as if there is a prototypical model human being the psychiatric community is trying to mold everyone into, the only problem is that person never actually existed because people are not chemically identical when it comes to brain functioning/lifestyle choices/diet etc. So Instead of making it easier for the brute type to like you, why not just be your true chemical self and let them either adapt or walk away. Because in truth we, as a species, are not going to get anywhere unless we accept and live by a philosophy of diversity, including psychiatric diversity. That is not to say that we must integrate psychotic killers into society and accept their acts of barbarism on the basis that it is part of the diversification factor, there are indeed limits to this principle, as when one attempts to block diversity by murdering or silencing someone else. My major point here is happiness ought to come in more than one form, or else it is a watered down trampled on abstraction of emptiness based on whatever the manufacturers of the latest antidipressant say it is. That said, have you heard of a natural product called 'relagen' yet? I will be trying this supplement myself soon.

Edited by TheFountain, 03 January 2009 - 03:37 AM.


#20 medicineman

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Posted 03 January 2009 - 11:49 AM

has this turned into a scientology forum??? psychiatrists using abstract statistic about models that never exist????

let me just give you a tiny tour about the abstract statistic...... psychiatrists use tests such as the mini mental state exam and such, not because they are trying to model the perfect human being. As you know, living in this modern day and age, THERE ARE NO imaging techniques or a simple blood test that will tell you what is mentally wrong with you. it is not as if i pull out your blood and check your potassium levels and then titrate your potassium dosage and sort you out. cut these psychiatrists some slack...

THERE HAS TO BE SOME SORT OF TEST BASED ON WHAT WE OBSERVE AS THE NORM. otherwise we wouldnt be able to treat, or give any form of prognosis.... and we obviously can't leave people depressed or with ADHD and such.... not because they are different or ABNORMAL, because this society functions one way, and we have been taught and conditioned like animals to function such way, and any deviation casts you OUT, hence the high suicide rates and self harm rates among the mentally ill. psychiatrists are a product of this money driven society, just like most professions. the only difference is psychiatry is more philosophical rather than just pure numbers, because we are not developed enough to obtain numbers in order to determine what condition ails someone.

#21 medicineman

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Posted 03 January 2009 - 12:01 PM

my apologies, i have swayed from the main topic again.....

#22 Declmem

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Posted 04 January 2009 - 12:38 AM

I purchased some Phenibut from RI, got it today, and took some earlier. I'm very impressed - it actually has many similarities to Lexapro for me, in the anti-anxiety area. It did make me depressed at first, but some 5-HTP, Tianeptine, DLPA and other supplements took care of that.

Also, I've been regularly using cognitive tests and recording the results for 6 months now, and my scores dropped a bit using this, so it certainly isn't nootropic, at least at first glance.

For relaxation it is also far superior (IMO) to valium. I'm honestly surprised this isn't a controlled substance.

Anyway, too bad I can't take it often for risk of dependence, and because of the rapid tolerance that builds up.

On to the next substance(s)...

Edited by Declmem, 04 January 2009 - 12:41 AM.


#23 graatch

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Posted 04 January 2009 - 02:43 PM

In its mechanisms, Nardil (phenelzine) is quite unique (it's not just an MAOI ...) among currently available pharmaceutical agents indicated for depression, and it is also tremendously helpful for many, many people; these are often people who were not able to achieve helpful results with any of a wide spectrum of other drugs and drug combinations -- Nardil is almost never a first-line med, for some good reasons -- e.g. a profile of highly annoying side effects (although these usually fade with time or can be helped via various strategies), a long period and slow titration before it starts helping, and the necessity of unique considerations -- the MAOI diet; in fact the necessity of a caring, INVOLVED doctor who will do things like prescribe rescue BP medication to take in the event of hypertensive reaction ... also a few not-good reasons: marketing, hype, ignorance.

However, many veteran psychiatrists, researchers, and patients with experience with phenelzine note its sometimes amazing effectiveness, some even going so far as to call it a "gold standard" for, particularly, those struggling with the combination (symptom clusters) of social fear (i.e. social phobia, social anxiety, and/or avoidant personality disorder) and atypical depression unresponsive to the typical lineup of serotonergics and odd noradrenergics.

I generally agree with djmmm's post. I am more in the habit of calling almost no medicine "safe", rather approving of a earnest attempt to understand each medicine's risks, benefits, special considerations, without shortcuts ... however his points are good, and, again, he is not the only one to have found that Nardil (or Parnate) was the only medication that ever really made a big difference. The dr-bob forums are one easily acccesible vast body of anecdote and reports ... just off the top of my head, three posters "Chairman MAO", "Jedi", and "ace" are people who wrote about their experiences at length, an interested party might do well to search through them.

On safety:

"An approximation of the risk to benefit ratio of NSAIDs compared with MAOIs will place things in perspective. This is especially topical and pertinent in view of the recently recognised association between SSRIs and GI bleeding. NSAIDs are mostly used for arthritis which rarely has a fatal outcome. In major depression there is a 10-15% life-time risk of suicide as well as a greatly increased standardised mortality ratio (SMR). Consider the number of deaths from GI bleeds associated with NSAIDs (the figure is 1,200 deaths every year in the United Kingdom (2), not to mention cases of Stevens-Johnson syndrome/toxic epidermal necrolysis (3). Most doctors will have seen quite a few cases. Compare that to the rarity of cerebral bleeds from MAOIs. Most doctors will never ever see, or even hear of, a single case in their entire career. Deaths from MAOI induced hypertension are very rare. It is hard to find many reported in the last 50 years. A search of the whole Pubmed data base returns 67 hits for the keywords ‘fatal’ + ‘monoamine oxidase inhibitor’. Many of these relate to serotonin toxicity, older reports to hepatic toxicity, but not one single report of intra-cranial bleeding ...

Monoamine oxidase inhibitors are, for a significant proportion of patients, the most effective but least used drugs in the therapeutic armamentarium of psychiatrists. Despite substantive evidence of their superior effectiveness for various groups of patients (1) research shows that many specialists never use monoamine oxidase inhibitors. The more one contemplates that finding the more regrettable and inappropriate it appears ..."

Above passage from the following website of a psychopharmacologist who treats patients with MAOIs (he prefers Parnate):

http://www.psychotro...diet_full.shtml
http://www.psychotro...aois_full.shtml

Nardil and treatment-resistant social fear:
http://www.ncbi.nlm....7?dopt=Abstract

A good page someone has up:
http://www.socialfear.com/

smithx, I'm very sorry to hear about what happened to your friend. Truly horrible. It would be stupid of me to claim to know how you feel. I too have lost friends to medication accidents.

Edited by graatch, 04 January 2009 - 02:44 PM.


#24 graatch

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Posted 04 January 2009 - 02:49 PM

With all that said, something to consider (since lexapro already helped you) could be augmentation agents to relieve the sexual dysfunction. Early pharmaceutical ideas would include anything from PDE-5 inhibitors to D2/D3 agonists like ropinirole or pramipexole (which can have their own efficacy as antidepressants, and -- I would suspect -- in social fear as well.)

#25 Declmem

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Posted 04 January 2009 - 04:14 PM

Thanks, I've definitely considered it. I've heard Welbutrin is good in combination with SSRIs, and I've been on Welbutrin before.

If I can't find a better solution, I will definitely try that. Honestly, if I can't find a solution near what Lexapro did, I am willing to accept the side effects and use Levitra for the rest of my life. :)

#26 bgwithadd

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Posted 04 January 2009 - 11:28 PM

Nardil has its place, and so do other MAOIs, but that place isn't to be taken at the drop of the hat. It's a last line defense for the desperate, not first line, and for a reason. You can pretty much throw out all you know about supplements and OTC meds let alone rx drugs if you take this stuff because you could get unpredictable results.

But more to the point that was somehow sidetracked with talk about nardil, MAOI is not something to mess around with on your own on a supplement basis which is why it's recommended to be careful with your dose on deprenyl.

#27 medicineman

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Posted 05 January 2009 - 08:51 AM

Nardil has its place, and so do other MAOIs, but that place isn't to be taken at the drop of the hat. It's a last line defense for the desperate, not first line, and for a reason. You can pretty much throw out all you know about supplements and OTC meds let alone rx drugs if you take this stuff because you could get unpredictable results.

But more to the point that was somehow sidetracked with talk about nardil, MAOI is not something to mess around with on your own on a supplement basis which is why it's recommended to be careful with your dose on deprenyl.


definitely.

#28 TheFountain

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Posted 05 January 2009 - 05:51 PM

has this turned into a scientology forum??? psychiatrists using abstract statistic about models that never exist????

let me just give you a tiny tour about the abstract statistic...... psychiatrists use tests such as the mini mental state exam and such, not because they are trying to model the perfect human being. As you know, living in this modern day and age, THERE ARE NO imaging techniques or a simple blood test that will tell you what is mentally wrong with you. it is not as if i pull out your blood and check your potassium levels and then titrate your potassium dosage and sort you out. cut these psychiatrists some slack...

THERE HAS TO BE SOME SORT OF TEST BASED ON WHAT WE OBSERVE AS THE NORM. otherwise we wouldnt be able to treat, or give any form of prognosis.... and we obviously can't leave people depressed or with ADHD and such.... not because they are different or ABNORMAL, because this society functions one way, and we have been taught and conditioned like animals to function such way, and any deviation casts you OUT, hence the high suicide rates and self harm rates among the mentally ill. psychiatrists are a product of this money driven society, just like most professions. the only difference is psychiatry is more philosophical rather than just pure numbers, because we are not developed enough to obtain numbers in order to determine what condition ails someone.


I think you have psychiatry confused with psychotherapy, the latter of which being the more compassionate, humanistic and philosophical profession. I wish psychiatry truly had the individuals chemical health in mind, rather than profit, but the sad truth is, as evidenced by so many who report bad side effects and worsening overall condition, psychiatry is more political than humane. Take any moderately depressed individual (most of whom are prescribed antidepressants which do not work for them) and give them a classical jungian or Gestalt therapy for 6 months, I guarantee the therapy would do more for them in this 6 months than 6 YEARS of prescription antidepressants. We need to adopt a philosophy which embraces diversity (of both individual psychology and subsequent outcome) in this field, otherwise it is going no where fast.

Edited by TheFountain, 05 January 2009 - 05:52 PM.


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#29 Lufega

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Posted 07 January 2009 - 02:55 AM

Tyrosine was working really well for these problems. Actually, extremely well. I was ready to check this problem off the list. Then I added Deprenyl. The first day I used 5 drops and the effect was amazing! It seemed to multiply the effect of tyrosine neatly. I was feeling ready to take on the world. Only problem is, I only felt this way the first day and haven't since. In addition, Tyrosine stopped working even at higher doses. I've been off Tyrosine for 2 weeks now in case the problem was receptor up-regulation but I've continued the deprenyl. Honestly, I've never felt worse! Today, I started school again and my anxiety/social anxiety is through the roof. I was really hoping to start this semester on a positive note.

Any ideas? Was the deprenyl not the Godsend I thought it would be??? I guess I should probably get off it for a while. I ideas??

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