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Suffering from social anxiety disorder and OCD. Cannot focus on anything for a long time and absent minded. Advice

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Addiction Medicine Specialist
Practicing since : 2002
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Hi Doctor, I'm 24 and suffer from social anxiety since 6 years now. It is hell for me. At the same time, I have OCD and suspected ADHD; since I cannot focus on anything for a long time; even small tasks, or listening to someone. I also easily forget things easily; like absent minded. At the same time, I'm hyper sensitive and very thin-skinned. What are the treatments for me? What should I do? I had been to my psychiatrist; but he didnt recognize social anxiety disorder, and told me that I just have to work hard and am lazy. I work in a corporate and it is hampering my daily functioning to a lot extent. I am depressed every day. Plz tell me what should I do.Also some good psychiatrists and psychotherapists in Mumbai. Thanks
Posted Mon, 25 Nov 2013 in Anxiety and Stress
Answered by Dr. Preeti Parakh 35 minutes later
Brief Answer: Explained below. Detailed Answer: Hi, Welcome to Healthcare Magic! Social anxiety disorder and OCD are both anxiety disorders. Since anxiety itself can cause difficulty in focusing and concentrating, I feel that you should not worry about the diagnosis of adult ADHD until your anxiety is gone and you still notice that there is some difficulty in concentrating. Moreover, for the diagnosis of adult ADHD, it is required that you should have had ADHD as a child as well. As you must be knowing, OCD is characterized by repetitive, intrusive, absurd, unwanted, anxiety provoking thoughts (obsessions) and often repetitive activities (compulsions) as well. Compulsions are undertaken to relieve the anxiety associated with obsessions. In some people, OCD itself leads to social anxiety as people feel uncomfortable in the company of others because they fear that their compulsions will make them a subject of ridicule among others. If this is the root cause of social anxiety in your case, then you need to focus only on the treatment of OCD. Once OCD is under control, the social anxiety will improve by itself. Supposing both OCD and social anxiety are independent disorders in your case, even then much change is not required in the treatment strategy. OCD is usually treated with the SSRI class of medicines (fluoxetine, sertraline etc) which give very good results in social anxiety disorder as well. In addition, you can use propranolol on a SOS basis before meetings, interviews etc to control the tremors, sweating, numbness, tingling etc are often felt by people with social anxiety disorder, whenever they are in social situations. Apart from medical treatment, psychotherapeutic interventions are also available. Exposure and response prevention is usually practiced for OCD but the exact type of psychotherapeutic intervention would depend on what are the symptoms of OCD in your case. There are psychotherapeutic interventions for social phobia also. I shall be able to help you better if you can let me know the following details: 1) Since when have you been having OCD and what symptoms of OCD do you have? 2) What are the symptoms that you call social anxiety? Are these generalized or occur only in specific situations like public speaking etc? 3) What treatment you have taken so far for these and what was the response? Please also let me know the dose of the medicines you have tried and for how long. Please get back to me with these details. Please also let me know if you think that your social anxiety is independent or secondary to OCD. Best wishes. Dr Preeti Parakh MD Psychiatry
Above answer was peer-reviewed by
Follow-up: Suffering from social anxiety disorder and OCD. Cannot focus on anything for a long time and absent minded. Advice 9 hours later
Thanks for the reply doc. 1. I have been having OCD mostly from childhood as far as I can remember, though I'm not sure. Continuous, persistent thoughts about events, incidents or any thing for that matter; mostly negative. And I mostly have obsessive thoughts rather than compulsive actions. I had also skipped my 10th prelim exams due to severe anxiety and taken a drop from my engineering in the middle due to anxiety and panic attacks before prelims; though I came back and continued. The most severe cases have been when I was in my college, and I answered very few in the viva exam, I was worried sick that they may not fail me. Kept on getting thoughts after thoughts and anxiety; so much so that I went to college the next day and confirmed that I wouldn't fail. This happened every year. Also back in school, if i got low marks, I would regret over it again and again and feel miserable, while other kids would say just leave it, it's ok. This is just one of many examples. Another one is checking or thinking about the lock of the door. 2. Social Anxiety is just like it is. Even walking on the street; though it is mild. However, if I cross the street, or pass a group or crowd of people I feel that people are watching me or scrutinizing me. Even back in college, I had a tough time passing the quadrangle or in fests. And I used to stay away from most people to since I'm thin-skined too. While giving speeches etc., I used to get what I call social anxiety attacks, where I used to lose control and think as if everyone is looking at me, finding me funny etc. This usually happened after a minor ridicule or remark. Now in work, it is more tough since I have to give output too, and am not able to do so due to lack of focus and constant fear. I work in a team, and am always scared/anxious to ask something or help since I fear ridicule or shame in front of others. And I dread my boss since he scolds other employees too. This is taking a toll on my performance, and my boss scolds and the vicious circle continues. It has been 2 months since I started working and it's my first job. I also get tremors. Another notable point : Sometimes when talking online, if i get a late response or something, rather than thinking the other person is busy, i get strong conviction thoughts that he/she is avoiding me. Also get thoughts of being cheated etc. sometimes. 3. The medicines that I have taken so far over the last 3 years or so include solaze, mozep 0.5, sizodon, propanol, paxidep CR 12.5, daxid 50 mg, serenace 0.25/0.5 mg, fluvoxin. I do not remember the potency of all of them, since prescription are lost due to change of residence. I also have a habit of stopping their usage when they cause a lot of drowsiness, since i had college or work. Currently I am not taking any medicines. My social anxiety and OCD are completely independent of each other. Thanks
Answered by Dr. Preeti Parakh 32 minutes later
Brief Answer: Explained below. Detailed Answer: Hi, Thanks for the details. You are right in saying that both OCD and social anxiety lower one's productivity a lot and need to be treated effectively. Your treatment history shows that you have been treated with more anti-psychotics than with SSRIs which should have been the first line of management. Your list only has three SSRIs, Fluvoxin, Daxid and Paxil CR. The doses of Paxil CR and Daxid that you have mentioned are just the starting doses and not likely to benefit much in OCD which requires higher dosages. You have not mentioned the dose of Fluvoxin, but perhaps you did not take it for long. SSRIs do not cause sedation, but it is possible that other medicines like serenace, mozep, sizodon etc were prescribed with the SSRI and caused sedation. As a result, you stopped all medicines yourself, blaming them for the sedation. I would have preferred to treat you only on an SSRI, either fluoxetine or fluvoxamine with propranolol to be used on a SOS basis for interviews, meetings etc. The problem with SSRIs is that they take a few weeks to show their response and people often discontinue them before that, thinking that they are ineffective. Also the dose needed for OCD is higher than that needed for other disorders. These medicines are also the first line agents for management of social anxiety, so you do not need any other medicine in addition for social anxiety. Psychotherapeutic interventions work in both OCD and social anxiety, but they are more effective in people with predominantly compulsions. In your case, I feel that not being on medicines is not a sensible decision and you should start a SSRI as soon as possible, preferably fluoxetine. It is cheaper than fluvoxin and very effective. For psychotherapeutic interventions, you may find it difficult to find a doctor who practices these as they are time consuming and take a lot of time. However I know a psychiatrist in Mumbai who did her postgraduation in Psychiatry from PGIMER, Chandigarh and is now a XXXXXXX resident in department of Psychiatry in TNMC and BYL XXXXXXX Hospital, Mumbai. Her name is Dr XXXXXXX Somaiya. She was a junior of mine while I was doing my XXXXXXX residency in PGIMER, Chandigarh and I personally know that she is good in both pharmacological and psychotherapeutic interventions. If you wish you can contact her for both. I have deliberately not given you any big names as they are not likely to be able to help you with psychotherapy and you may also find that they do not listen to you! This time, if you have any problems with medicines, talk to your doctor, rather than stopping the medicines yourself. Best wishes. Dr Preeti Parakh MD Psychiatry
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