- Will social anxiety disorder damage my health?
- Is it good advice to avoid what bothers you?
- Which social anxiety disorder medication is best?
- Do social anxiety disorder medications help get a person's life back in order?
- Must a person change their lifestyle while taking social anxiety disorder medication?
- Will I ever outgrow social anxiety disorder?
- Are any of the social anxiety disorder medications addictive?
- What if my social anxiety disorder occurs only on rare occasions such as at a special event where I am performing?
- Can traumatic events cause social anxiety disorder?
- How can I tell if I have depression?
- Should I use alcohol to control my anxiety when I go to parties or other social situations?
- Can social anxiety medications affect an unborn or breast-feeding child?
- Are families affected by an individual's social anxiety disorder?
- How can families and friends help people with social anxiety disorder
Will social anxiety disorder damage my health?
Many people with social anxiety disorder have suffered anxiety in social situations for decades without apparent injury to their health or development of the high blood pressure, ulcers, asthma or other physical disorders that are commonly (but erroneously) thought to result from stress.
It is our strong impression that social anxiety disorder alone does not cause physical illnesses and does not shorten people's lives. It's not uncommon, however, for individuals with social anxiety disorder to believe that alcohol reduces their anxiety. Long-term overuse of alcohol is a complication of social anxiety that can damage your health.
Is it good advice to avoid what bothers you?
No! For social anxiety disorder, such antiexposure can actually make a person's social anxiety, anticipatory anxiety and avoidance behaviors worse. In addition, it may interfere with otherwise effective treatments.
Which social anxiety disorder medication is best?
There is no "best" medication; it varies from person to person. Factors that influence the choice of a medication include both the patient's and the clinician's past experience with the medication, its side effects profile, and its compatibility with associated medical problems and medications. At present, fluvoxamine CR (Luvox CR), paroxetine (Paxil), paroxetine CR (Paxil CR), sertraline (Zoloft) and venlafaxine XR (Effexor XR) have received FDA approval for the treatment of social anxiety disorder. These medications are considered first-line treatments for generalized social anxiety disorder. However, there is sufficient research evidence to support the value of other SSRIs and SNRIs, as well as MAOIs, benzodiazepines, gabapentin and pregabalin. Beta-blockers are helpful for treating performance anxiety, but not for generalized social anxiety disorder. (See "How is it treated?" for more information.)
Do social anxiety disorder medications help get a person's life back in order?
While medications can help reduce symptoms of social anxiety, they are not "cure-alls." Personal problems resulting from social anxiety symptoms may continue to exist and unrelated life problems are unlikely to be helped by these medications. Psychotherapy or other forms of counseling may be helpful in dealing with such difficulties, but it is important that such adjunctive therapy be undertaken within the context of social anxiety disorder so as not to conflict with the primary treatment.
Must a person change their lifestyle while taking social anxiety disorder medication?
A healthy lifestyle, including proper diet and exercise, can benefit any course of treatment. But, most social anxiety medications require few special adjustments by most people. In general, any diet is compatible with these except for the MAOIs. Certain foods and beverages must be avoided if you are taking an MAOI. (Consult your doctor!)
Social anxiety medications should not interfere with exercise. Although fluid replacement is important during and after exercise, extra salt is seldom needed. Vitamin or mineral supplements neither help nor hinder treatment with social anxiety medications and thus are optional.
It is best to ask your doctor's advice about drinking alcohol. Some people may consume alcoholic beverages in small amounts if they wish. However, ability to drive and to operate hazardous machinery may be dangerously impaired by the combination of alcohol and social anxiety medications. Remember that overuse of alcohol can be a complication of social anxiety.
Will I ever outgrow social anxiety disorder?
Social anxiety disorder usually begins in adolescence and is often most severe in the late teens and the 20s. In 25% of individuals it begins in early childhood. Most people learn early how to avoid stressful social situations, thereby temporarily decreasing their anxiety. Over time, though, this leads to relative social isolation. Research indicates that social anxiety disorder, when left untreated, tends to become chronic. For a few there may be some improvement with age, but rarely does it disappear completely. With treatment, however, social anxiety symptoms can improve dramatically.
Are any of the social anxiety disorder medications addictive?
The only class of social anxiety medications that could be of concern are the benzodiazepines, and this would be a problem for only a very few people (those who have a history of drug and/or alcohol abuse). Most people who take benzodiazepines use them in the prescribed amounts for an appropriate medical indication. It is important to realize that physical dependence (not addiction) is common with regular use of benzodiazepines. If they are stopped too rapidly, unpleasant physical withdrawal symptoms can occur. Following a discontinuation program recommended by your doctor can help you avoid these problems.
This problem is relatively common, especially among professional performers. The treatment for performance-type social anxiety disorder differs from generalized social anxiety disorder. The first line of treatment is gradual exposure therapy. A good example of a successful program that accomplishes this exposure therapy is the Toastmasters International program (www.toastmasters.org). Some people prefer to treat their performance anxiety with medication. Beta-blockers, such as propranolol, can be taken 1 to 2 hours before the special event. They slow down a rapid heart rate and decrease both sweating and the butterfly feeling in the stomach. Beta-blockers do not directly decrease anxiety, but rather block the physical symptoms. It is important to take a test dose of a beta-blocker prior to the day of the performance to be sure that no unexpected side effects occur.
Can traumatic events cause social anxiety disorder?
Traumatic events seem to increase the risk of developing social anxiety disorder. People with social anxiety disorder are twice as likely to have experienced trauma as a child. Many people who experience traumatic events develop posttraumatic stress disorder (PTSD) and they are much more likely to develop depression or social anxiety. However, many people with social anxiety disorder have never experienced a traumatic event. Trauma may be a trigger in some people who have a predisposition for social anxiety disorder. To learn more about PTSD, visit the PTSD site.
How can I tell if I have depression?
Clinical depression is one of the most common medical problems. Approximately 8% of men and 16% of women will experience an episode of major depression during their lifetime. At any point in time, more than 30% of people with social anxiety disorder suffer from depression, and more than 50% will have depression at some point in their life. Depression is a serious problem that can dramatically decrease quality of life, functioning at work and home and when serious, can increase risk of suicide.
Depression is not just a problem of low mood. Many people who have depression find that loss of interest in usually enjoyable activities is the prominent feature. Other common problems are difficulty with sleep (too little or too much), change in appetite, fatigue, difficulty concentrating, anxiety, thoughts of death and low self-esteem.
Should I use alcohol to control my anxiety when I go to parties or other social situations?
Using alcohol to decrease anxiety in social situations is a common strategy for individuals with social anxiety disorder. Unfortunately, alcohol creates a false sense of relief from symptoms. In many situations, at work or during a performance, for example, drinking alcohol is inappropriate at best and may cause substantial impairment in functioning and judgement. In addition, people who have social anxiety disorder are at an increased risk of developing alcohol abuse or dependence, which is often worse than the social anxiety disorder itself.
Can social anxiety medications affect an unborn or breast-feeding child?
The use of medications during pregnancy and breast-feeding is a complicated issue. It is known that these medicines cross from the mother's blood to the fetus (unborn baby), so it is important to discuss possible risks with your doctor to determine whether the particular medication you are taking should be lowered in dose or temporarily discontinued. In general, the most commonly used medications for social anxiety disorder, the SSRIs, have a good safety record when taken during pregnancy, though their benefit in treating a mother's social anxiety disorder should be weighed against the small risk of negative effects for the baby. There is some suggestion that SSRI use during pregnancy may be associated with slightly lower birth rates and an increased risk of premature births. Also, one SSRI, paroxetine (Paxil, Paxil CR and Pexeva), was recently identified as causing heart defects in some babies and it is now in FDA pregnancy category D, while all other antidepressants remain in category C (a less risky category).
Birth defects have occurred occasionally in babies whose mothers have taken social anxiety medication during pregnancy, but whether the medication actually caused the abnormalities is difficult to know (even without any exposure to medicines, a small percentage of babies will be born with malformations). There is no medication that can be considered absolutely risk-free when used during pregnancy.
With regard to breast-feeding, all of the social anxiety medications will pass into breast milk and, as a result, small amounts will get into the infant. While unlikely, it is possible that a breast-fed infant could experience mild side effects from some of these medications.
In general, to be on the safe side you should discuss with your doctor the potential risks and benefits of any medication you might be taking during pregnancy or while breast-feeding. The most conservative approach would be to avoid all medicines at these times unless the severity of the social anxiety disorder makes this impossible. Remember that behavior therapy can be an effective treatment for social anxiety disorder, and it could be an attractive alternative to medication during pregnancy and breast-feeding.
Are families affected by an individual's social anxiety disorder?
In addition to sharing the somewhat increased risk of developing social anxiety disorder, family members may be asked (or even coerced) to give up social activities or to attend them alone, leaving the socially anxious person at home. However, permitting the affected family member to avoid appropriate family functions and responsibilities may actually make the problem worse. Those who give up social contacts are missing the possible benefits of naturally occurring behavior therapy. Once the process of leaving the socially anxious family member out of social interactions starts, however, it can become so habitual that family members often view the arrangement as "just the way we do things in our family."
How can families and friends help people with social anxiety disorder?
Some individuals with social anxiety seek reassurance from family members about their condition. They may ask for reassurance that the situation won't be stressful. They may ask whether others can tell that they are anxious or see them trembling, sweating, blushing, etc.
Family members naturally want to reassure the affected person, but unfortunately that can be counterproductive. Because socially anxious individuals do experience anxiety and physical symptoms, and truly may be more noticeable because of it, such reassurance can seem hollow. It may even undermine the effective components of behavior therapy, which include repeated exposure to the phobic situation and remaining in it until the anxiety symptoms subside (habituation).
However, family and friends can help correct overly negative assessments of a performance and support even the smallest positive steps. Encouragement to confront social situations is supportive; the counterproductive reassurance we've just covered is not. All of us benefit from support and encouragement as we struggle with troubles in life, and this is certainly true for people with social anxiety disorder.
You should be aware that some people with social anxiety disorder become reassurance "junkies,"seeking their regular "fix" of reassurance. As with other addictions, the fix doesn't last long and soon they are back for another fix. Like other addictive substances, reassurance eventually makes their overall condition worse. It is important not to be harsh or sarcastic in the process of withholding reassurance. It may be helpful to have a neutral statement that can be repeated in a monotone voice each time the situation comes up. Statements such as, "The instructions are that I'm not to reassure" are often beneficial. (Practicing neutral statements aloud with others before using them with the patient is often helpful.) While withholding reassurance may sound uncaring, it's important to remember that you're actually using a behavior therapy approach that has been shown to be helpful.
