The Pros and Cons of Social Anxiety Medication

Social anxiety disorder (SAD), or social phobia, is one specific type of anxiety disorder characterized by intense fear in social situations. SAD goes beyond normal “shyness” and often leads to excessive social avoidance, which can cause significant issues in social or occupational environments.

People with social anxiety disorder are typically afraid that they will make a mistake and be embarrassed or humiliated in front of others. A lack of social skills or experience in social situations can make this fear worse. Sometimes, the anxiety can escalate into a panic attack. To help with these problems, some people turn to social anxiety medication.

Before undertaking a treatment plan that includes social anxiety medication, however, it would be useful to consider the positives and negatives of this route.

The pros of social anxiety medication

The are a number of positive aspects of taking social anxiety medication, including the following:

• Convenient: Once a social anxiety medication has been prescribed, it is relatively easy to follow through on the treatment plan. One only needs to remember to take a pill, and there is very little time or effort involved.

• Often effective: Once a satisfactory dose has been achieved, social anxiety medication can make a big difference in terms of “taking the edge off” your anxiety or panic attacks. One common group of social anxiety medication prescribed is the benzodiazepines, which smooth out muscle tension and shakiness caused by anxiety.

• Variety of choices: Several different classes of drugs exist, with slight differences in both mechanism of action and resulting effectiveness. Because of this, it is possible that if a particular line of social anxiety medication treatment is not effective, a different one may produce better results. For example, a beta-blocker medication, such as propranolol, can also help relieve the physical and emotional symptoms of SAD, especially performance anxiety.  Beta blockers are commonly used to lower blood pressure, so it is important that you have a doctor monitor your treatment while taking this drug.

• Availability: Because many anxiety medications are also used to treat depression, most pharmacies in the U.S. keep a supply on hand.

The cons of social anxiety medication

As with any drug treatment, taking social anxiety medication can also have a number of down sides. These include the following:

• Tolerance to some medications can build up over time: If benzodiazepines are being used as social anxiety medication, they are usually only meant to be a temporary solution, and taking them on a regular basis may build up one’s tolerance. This may lead to the need for doctors to prescribe higher dosages to get the same original beneficial effect.  The good news is that there are other medications which do not cause tolerance to develop, that can also be used to treat social anxiety disorder, such as serotonin-reuptake inhibitors (SSRI’s).

• Associated with a variety of side effects and potential complications: Stomach issues, weight fluctuations, sexual side effects and shakes or tremors can sometimes be associated with social anxiety medications.

• May have adverse effects if mixed with other drugs: You should avoid consuming alcohol or street drugs while taking social anxiety medication.  Social anxiety medication can sometimes interact with other prescription drugs, so it is important to tell your doctors all of the medications you are taking at each visit.

• A possible, blunted, state: Described at times as a passionless mood, patients say that in addition to limiting their ability to feel anxiety, sometimes social anxiety medication also limits their ability to experience the natural joys of life. In effect, they feel numb to all strong emotions.

It is important to note that there are very common treatment options for SAD that do not involve any form of medication for social anxiety. Cognitive Behavioral Therapy (CBT), particularly group CBT for social anxiety, can be extremely effective

SAD significantly increases the risk of developing a mood disorder, such as clinical depression, and having both SAD and depression simultaneously can make it much harder, though certainly not impossible, to effectively treat either illness.

If depression persists despite psychotherapy like CBT and social anxiety medication, consider TMS, or transcranial magnetic stimulation, a new non-drug FDA approved treatment for depression that is effective, non-invasive, and safe.

If you found this post on social anxiety medication interesting and want to learn more about other behavioral health issues, please check out our next post on mood disorder.

Anxiety Treatment Can Help

Anxiety is a normal part of life;  We all need a little anxiety to motivate us to move from one task to another, such as getting out of bed on time to get ourselves to work, organize a holiday party, or plan a trip.  We need healthy levels of anxiety to force us out of complacency and propel us into action.  Even the “flight-or-flight” response we experience when in true danger, such as when being chased by a lion, is essential to our adapting to situations in a ways that increases our chances of success or survival.

Anxiety is pathological, however, when it is experienced in situations that do not warrant impulsive action or a stress response.  Excessive anxiety not only leads to discomfort or fear when one should feel at ease or safe, but it often leads to unnecessary avoidances of many life experiences.  Pathological anxiety, in its many forms, can be a tough condition to cope with on a day-to-day basis due to its combination of emotional and physical symptoms. In most cases, anxiety begins with some type of mental trigger, and then symptoms begin to spread, creating physiological reactions throughout the body. It is important to recognize, however, that while anxiety disorder symptoms can be serious and uncomfortable, relief is possible with appropriate treatment. There are many different types of anxiety treatments available, and these approaches can be tailored to specific symptoms and needs.

The most important step an individual with chronic anxiety can make is to actively seek anxiety treatment. There are a variety of management options available:

Types of anxiety treatment

The different anxiety treatment approaches usually fall into one of three categories medication, psychotherapy, and alternative/complementary therapies.

Medication is frequently used as an anxiety treatment in order to alter chemicals in the brain involved in stress. Benzodiazepines, for instance, effect brain cell receptors in a way that reduced brain excitation and results in muscle relaxation, reduced worrying, and — at higher doses — increased sleep.  Benzodiazepines are anxiety treatments that are potentially habit-forming, so it is important to avoid changing your doses without guidance from your physician.  Serotonin-reuptake inhibitors, such as Paxil (paroxetine) and Prozac (fluoxetine), are also utilized extensively in anxiety treatment, as well as antidepressants.

As far as non-medication anxiety treatment, cognitive behavioral therapy (CBT) is frequently effective. Anxiety sufferers are taught, through CBT, to recognize the particular thoughts and behaviors that lead to feelings of anxiety and tension. The goal is to teach the person to manage triggers of anxiety in a step-wise fashion, slowly developing confidence in their ability to cope, as well as increased habituation to situational triggers of their anxiety.

Further, there are a few alternative and complementary options to anxiety treatment. Some of these are herbal remedies and the use of mind-body connections.  Acupuncture is also a very effective approach to excessive anxiety management.

Another non-medication option that is increasing in popularity is Transcranial Magnetic Stimulation (TMS). TMS is an FDA-approved treatment for clinical depression that uses noninvasive MRI-strength magnetic pulses generated from outside of the head to improve the function of very specific parts of the brain. This happens without direct physical contact with the brain or circulatory system. One of the primary advantages of TMS is its lower side effect profile, especially when compared to prescription drug therapies.  While the FDA-approved protocol for the treatment of depression currently involves left-sided high-frequency TMS, the application of low frequency TMS to the right side has been shown to help reduce anxiety and depression symptoms.

Combining Different Approaches to Anxiety Treatment

It is a good idea to take a œteam approach to anxiety treatment. Many successful courses of anxiety treatment combine several different options. This can be particularly effective if healthcare providers — including therapists, psychiatrists, and internists — stay in contact with one another.  A successful integration of one or more of these anxiety treatment options will maximize the chances for a life free of excessive levels of anxiety.

If you are at the point of seeking anxiety treatment, it is likely that you have endured symptoms for an extended period. Try to keep in mind what life was like before the anxiety disorder, as this can motivate you to undertake and maintain an anxiety treatment plan. Anxiety treatment can be successful, but it is up to you to take the first step.

If you feel that you may be experiencing depression related to anxiety and would like to seek  anxiety treatment, West Coast TMS Institute in Sherman Oaks, California is available. Feel free to contact us if you feel you may be experiencing some symptoms of anxiety or mood disorder and would like to set up a consultation for possible depression and  anxiety treatment.

If you found this post on anxiety treatment interesting and want to learn more, please check out our next post on social anxiety medication.

The Most Common Social Disorders

Everybody gets a case of  “the nerves” or  has “butterflies in their stomach” from time to time. These are very normal physiological responses to the kinds of stress we all feel on a somewhat regular basis. When everyday activities cause that level of stress, however, there is the possibility of a social disorder of some kind. When otherwise mundane events, such as going to the grocery store or meeting someone new, cause feelings of fear, crippling self-consciousness or embarrassment, one of these social disorders is likely the cause.

Social anxiety disorder is the most common of the social disorders. It is so common that it is the third-most prevalent mental disorder in the U.S., after depression and alcohol dependence. An estimated 19.2 million Americans have social anxiety disorder, which often makes itself known during adolescence or early adulthood, but can occur at any time, including early childhood. It is more common in women than in men.

Recognizing signs of social disorders

Many of those with social anxiety disorder don’t know they have a disorder at all. Over time, they come to know that their reactions to certain situations are much different than the reactions of their peers. These abnormal reactions generally include some of the signs and symptoms of these social disorders. They typically fall into two groups—Emotional/Behavioral and Physical.

Emotional/behavioral signs usually involve feelings of fear and anxiety that come from social interactions. A fear of embarrassing or humiliating oneself is common. As a result, a person with a social disorder tends to avoid interacting with not only strangers, but also people they know out of fear of saying the wrong thing or drawing attention to themselves.

The physical signs of social disorders are familiar to everyone, but are pronounced in people with the disorder. These include sweating, shaking, upset stomach, clammy hands and a rapid, heavy heartbeat.

Causes and treatments of social disorders

There is not one specific cause of social disorders. Research suggests that multiple factors may play a part, including:

• Biology: Social anxiety disorder may be related to an imbalance of certain chemicals in the brain. This imbalance could slow or alter the way the brain reacts to stressful situations and cause anxiety. It is possible that predispositions for social disorders are passed on through genes.
• Psychological: The development of social anxiety disorder may stem from an embarrassing or humiliating experience in the past.
• Environmental: People may develop their fear through a strong empathetic response to seeing what happened to someone else as a result of their behavior (such as being laughed at or made fun of). Also, children who are sheltered or overprotected by their parents may not learn good social skills as part of their normal development and may struggle in social situations later in life.

The most common treatments for social disorders are cognitive-behavior therapy (CBT) and prescription drugs. The idea behind CBT is to guide the person’s thought process toward a more rational resolution of the situations that trigger their anxiety symptoms. This can include either systematic desensitization or controlled, real-life exposure to the feared situation.  Significant practice often resolves social disorders.  Sometimes, however, CBT is not enough to manage the symptoms of social disorders.  Medications used to treat social disorders such as social anxiety are usually either antidepressants, hypnotics, or beta-blockers.  Beta blockers are regularly used to treat heart conditions, but are commonly used to minimize the physical symptoms of social disorders, such as shaking and rapid heartbeat, which are common triggers of worsening social anxiety symptoms and fears. For social disorders, sometimes hypnotics such as clonazepam (Klonopin) or lorazepam (Ativan) are prescribed to be taken just before an anxiety-provoking event, but should be taken with caution as dependency can develop, as can withdrawal when discontinued abruptly.   The bottom line is that  social disorders can be treated with the help of mental health and medical professionals.  There is no need to suffer social disorders alone.

If you found this blog post on social disorders interesting, then you may want to check out our post on symptoms of anxiety.

SOCIAL DISORDERS AND SOCIAL ANXIETY: When Depression Gets In The Way

Many times you are not aware of what triggers it; other times, you know it is triggered by a sense of being inadequate in a social situation. You start to feel flushed and warm, then sweaty, and have difficulties paying attention to a conversation and feel you are missing social cues and responding five sentences too late.  Suddenly, you feel a panic rising, a need to do something, although you don’t know what.  As the tension mounts, you feel a sense of dread as if you’re going to die or go crazy. You fear you’re going to die if you don’t get away; you have an overwhelming urge to escape.  As these symptoms mount, you realize that others may be noticing you; you become fearful that people are aware of your fear and you feel judged, scrutinized, embarrassed, or on-the-spot.  This, in-turn, drives your anxiety up further.  The cycle of social disorders, such as generalized social anxiety or phobia, has begun.

After this phenomenon subsides, you are still alive, but left with the fear, anticipating that this may happen again. These are symptoms of social anxiety disorder, or social phobia. Some people refer to them simply as “social disorders.”  These conditions are characterized by irrational fears.  Sensing everyday situations can lead to devastation often results in your avoiding more and more social interactions, becoming more withdrawn, and alienating yourself from unfamiliar people and situations. In essence, this is what social disorders and social anxiety behaviors are.  Such social disorders involve a definite fear of interacting with others in certain circumstances.

Symptoms of Social Disorders

There are many symptoms associated with social disorders; Social anxiety symptoms usually exist for 6 months or more and significantly interfere with normal work, academic or personal activities.  Most sufferers of social disorders are crippled by the emotional symptoms associated with social anxiety such as:

• a fear of being humiliated in public
• feeling so overwhelmed it disrupts your daily life
• a fear of speaking to people and becoming embarrassed
• a fear you may be judged
• a fear others can sense you are nervous

Some of the physical signs of social anxiety are:

• clammy, sweaty hands, flushed face
• confusion, muscle tension
• trembling, shaking
• nausea, upset stomach, diarrhea
• fast heart beat

Social Anxiety is quite common in society.  What researchers have concluded so far is that the lifetime prevalence of social anxiety is about 15% in women and about 13% in men. Social disorders and social anxiety usually become a problem around the age of 13 through the mid-teens.

Researchers are still studying social disorders, hoping to find the causes.  There is a relationship between social disorders and other psychiatric and medical illnesses.  Sometimes, a thyroid disorder can trigger these symptoms in some socially anxious patients.  Further, anxiety disorder is frequently associated with other mental health difficulties, such as generalized anxiety and panic disorder, as well as major depressive disorder.

Social Disorders Increase The Risk of Depression

People with social anxiety disorder are up to six times more likely to suffer from mood disorders such as major depressive disorder, dysthymic disorder, or bipolar disorder.  In the vast majority of cases, social disorders precede the mood disorder by several years.  When clinical depression occurs simultaneously with social anxiety, the severity of both disorders and the risk of serious dysfunction interpersonally and occupationally significantly increase.

Clinical symptoms of depression can include lack of joy, disinterest in life, difficulty getting out of bed, difficulty thinking or making decisions, problems concentrating and motivating, feeling physically sluggish or restless, feeling apathetic or irritable, sleeping too much or having trouble with insomnia, and a preoccupation with death or suicide.   Sometimes depression causes people to feel so hopeless that they withdraw from friends and family, more due to lack of interest than due to social disorders; other times, depression simply worsens a pre-existing social disorder.  More often, social disorders precede a depressive episode. When social anxiety and clinical depression co-occur, it is important to get both conditions addressed by a professional healthcare provider as soon as possible in order to avoid further worsening of your health.

Addressing Social Disorders:

Social disorders initially can be addressed with cognitive behavioral therapy (CBT), which involves meeting with a therapist who specializes in social skills training, cognitive restructuring and exposure therapy for social anxiety disorder.  Usually, CBT in a group setting is the most effective approach of therapy.  Sometimes, however, medications, such as benzodiazepines (ie, Klonopin, Ativan, etc.) can be used temporarily until the positive effects of CBT take place.  If symptoms of social disorders are so severe that CBT and benzodiazepines are insufficient, then serotonin-reuptake-inhibitors – SSRIs — (ie, Paxil and Zoloft), or MAO-Inibitors (ie, phenelzine, trancylcypromine), or other medications can help with social anxiety symptoms as well as major depressive episode symptoms.

Addressing Depression:

When patients with social disorders also suffer from clinical depression, their depressive symptoms can be so severe that they cannot apply themselves sufficiently to cognitive behavioral therapy; they therefore require other interventions, such a medications, to reduce their symptoms in order to “take the edge off” enough to focus on talk therapy.

Treatment of Co-Occurring Clinical Depression Can Make It Easier To Address Anxiety

Social disorders, anxiety and phobia are potentially debilitating conditions that increase the risk for depression.  For many, both social disorders and depression can be effectively addressed with psychotherapy and/or medication.  Medications are not always effective at treating depression, however, and can sometimes present intolerable side effects.  When depression is unsuccessfully treated, then it is much more difficult to manage social disorders.

TMS, or Transcranial Magnetic Stimulation, is a new alternative breakthrough treatment for clinical depression.  While TMS is not a treatment for social disorders, treating co-occurring clinical depression maximizes the chances of effectively treating social disorders.

TMS is a safe and non-invasive treatment for depression and uses MRI-strength magnetic pulses to stimulate the part of the brain that regulates mood. It is accepted by the FDA as the only method of treatment for depression that does not require the use of medication, surgery, or direct electrical stimulation. The process is a simple one. It is usually done as an outpatient in a relaxed atmosphere while watching TV or participating in meditation or talk therapy.

While TMS is not a specific treatment for social anxiety, TMS has been shown to improve symptoms of depression, including anxious depressive episodes. Preliminary studies also suggest that TMS can reduce general symptoms of anxiety.   It’s important to realize that severe clinical depression and social anxiety are not like colds…they often do not simply ‘go away’.   Professional help is needed to help people overcome these conditions.

Talking with your therapist, psychiatrist, or primary care physician about these disorders will help you understand what your next step should be. Social disorders and depression can be controlled so individuals can finally enjoy their lives fully.

If you found our Social Disorders and Social Anxiety post informative, click on our post on symptoms of anxiety.