Phenelzine for extreme anxiety in the workplace
I'm currently ramping Phenelzine (at 45mg, bumping up to 60mg this week) and wanted to see if anyone with a similar presentation of social anxiety has found success once they hit a therapeutic dose.
My anxiety manifests as a severe physical reaction in "trapped-situation" circumstances. This shows up most intensely and predictably in the workplace when I feel any sense of "stakes" in the interaction though in the past has also been an issue on planes, cars, middle seats in theaters, etc. Presentations are the worst but even casual one-on-one meetings require me to medicate in advance.
When triggered, my anxiety causes an immediate sympathetic cascade (adrenaline surge, racing heart and mind) and a laryngeal reflex where my voice physically locks up. I believe this is called paradoxical vocal fold motion aka vocal cord dysfunction. The vocal cord lock emerged about 7 years ago and has gotten worse since then.
The only thing that has worked over the past 25 years is a combination of propranolol and the benzo alprazolam (xanax). I've had a successful career that wouldn't have been possible without regular, strategically timed use of both. What hasn't worked at all: CBT, hypnotherapy, meditation, exercise, DARE method, stellate ganglion block, SSRIs, SNRIs, guanfacine, buspirone, and countless other meds.
For those who experience this kind of severe, sudden physical response (especially the vocal cord lock), did Phenelzine eventually suppress that immediate runaway autonomic response for you? Did you notice the shift happen at 60mg or higher? Any insights would be appreciated.