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Suggest treatment for social anxiety

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Posted on Sat, 19 Jul 2014
Question: hi sir m male age 22 suffering fm social anxiety although i consultd wid phyciatrist but n he gv m XXXXXXX cr 12.5 n but my behavoiur in social situations is weird n sweat alot n unable to talk wid sum1 ... unable to sleep frm 2 weeks n feelng like mind is gng blank unable to memorize n concentrt on study losing interest in everythng feelng like givg up ... plzz help sir ...
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Answered by Dr. Sunil Gupta (3 hours later)
Brief Answer:
Increase in dose of medicines plus CBT

Detailed Answer:
Hi,

I read your query and can understand the distress that you must be going through due to your symptoms.

Social anxiety is a condition in which a person becomes very uncomfortable in social situations. Your symptoms are definitely suggestive of the same. In addition, you also seem to have depressive symptom for last 2 weeks in form of loss of interest, lack f concentration and decreased sleep.
XXXXXXX Cr is paroxetine which is a selective serotonin reuptake inhibitor. It is an effective anti anxiety and anti depressant medication. I would have liked to know when was this medicine started. In any case, considering your symptomatology, I would have considered increasing the dose to 25 mg and then assess. The dose can be gradually thereafter increased to 50 mg/day depending on response. If there is no improvement with it, then another drug like sertraline can be considered. You can discuss regarding the same with your psychiatrist.

In addition, option of psychotherapy in form of cognitive behavior therapy (CBT) can be considered. It consists of regular sessions which will focus on learning relaxation and changing the faulty thought pattern that is leading to symptoms. Usually weekly or bi-weekly 12-20 sessions would be needed.

I do hope I was able to answer your query. Please feel free to ask any further query that you might have.

Best wishes for speedy recovery,

Dr. Sunil Gupta





Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Sunil Gupta (13 hours later)
sir i knw abt cbt n consult about it to the phychiatrist in my city he tld m to thnk p+ve and called it cognitive thrpy n not helpd m fr behavouir n also given me tabs like fluvator 50 , solopose beta and lonazep 2mg for 1 month .... sir plz also mention abt thr side effects ... thankzz
doctor
Answered by Dr. Sunil Gupta (1 hour later)
Brief Answer:
Please see details below.

Detailed Answer:
Hi,

Thanks for following up. I am sorry to know that you had a bad experience regarding CBT. CBT is definitely not just about thinking positive. It is carried out in a proper structured manner. May be you can try to find out who offers CBT as a treatment in your city.

Coming to your medications, as I told you XXXXXXX is paroxetine which is a Selective serotonin reuptake inhibitor (SSRI). Its dose ranges from 12.5 mg to 50 mg/day. Fluvator is Fluvoxamine which is also a SSRI. Its dose ranges from 50-300 mg/day. Solopose beta is a combination of Etizolam which is a benzodizepine and propranolol which is a beta blocker. Lonazep is Clonazepam which is also a benzodiazepine.

Now, it doesn't make sense if you are taking both fluvator and XXXXXXX together at the mentioned doses. The best way would have been to steadily increase the dose of one of the medications. Both are effective medicines for your condition. They are also very safe. The side effects usually include slight nausea when the medicines are started, which subside in some time. Other common side effects include headache, insomnia, decreased sexual desire.

Regarding etizolam and clonazepam, the most important problem is the propensity to develop dependence. Over time, there is a need to increase the dose and it becomes difficult to taper and stop them. So, it is highly recommended that they are taken only for a brief duration till the SSRIs start helping with your anxiety and gradually tapered off. Plus, its better to be only on one of the benzodiazepines rather than two. Other important effect is that they cause sedation. Actually, they are used as sedatives other than anti-anxiety agents.

Propranolol is also used in your case to control the autonomic symptoms of anxiety like palpitations. It can cause dizziness, lowering of blood pressure and bradycardia (lowering of heart rate) as side effects.

Now, one important thing to note is that not all people have the side effects. Only a few of them do have and that too in most cases they are manageable.

Had I been your psychiatrist, I would have kept you on paroxetine and gradually increased the dose together with propranolol. I would have tapered and stopped the benzodiazepines as soon as possible.

I d hope I was able to help with your query. Please let me know if I can be of any further help. I would be glad if i could do that.

Best wishes,

Dr. Sunil Gupta


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sunil Gupta (3 hours later)
thanks alot sir .... fr ur kind assistance .... one more thing m unable to feel any emotion and care anymore n mind is going blank feeling like empty ... unable to.connect with family friends n with people .... wnt to anothr phychologist and he tld dat u hv symtms of depersonalisation and derealisation m vry scared lossing interest in almost evrythng .... n i knw that dis tabs vl help m but scared ..... can u plzz assist me on this sir .... unless i knw unless i face situation nthg vl wrk n cbt n exposure thrpy r nt provided by the phyc.. here becoz of their other patients also der n they dont hv tm fr that n sir i dont wanna depend on tabs at dis early age ... what i do sir ... givng troubles to my parents also evry day ... dont knw what to do tabs vl help me to boost neurotrasmitter n brain chemical amgdyla but .... sir scared alot what do sir ....
doctor
Answered by Dr. Sunil Gupta (13 minutes later)
Brief Answer:
Please see details below.

Detailed Answer:
Hi,

Thanks for following up. I can understand the distress you must be feeling when you find that your doctors are not able to give you time enough.

Regarding your symptoms of not able to feel emotion, it might be due to depersonalisation and derealisation which is part of anxiety disorder that you have. As your condition improves, the symptoms will improve too. So, you need not worry about them separately.

You should also not worry much about depending on the medicines. As long as these medications are helping you control your symptoms, you have nothing to worry about. They are your friends here and I am very sure that with proper treatment, you will do wonderfully well.

You can start doing things in your own to start helping reduce your anxiety. The first thing is to start exercising daily in form of jogging daily. Also try to meditate twice a day for a few minutes. Make a list of situations that make you uncomfortable or anxious. Try exposing yourself to them as much as possible. In addition, also start keeping a pocket diary with you all the time and write down thoughts and situation wherever you get anxious. Try reading it later and understand what you did wrong in the situation and try to rectify it as much as possible.

With proper effort, I am sure you will be able to control your anxiety. You can contact me anytime you want. I will try my best to help you out and offer you solutions to your problems.

Wishing you the best of great health,

Dr. Sunil Gupta


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Sunil Gupta

Psychiatrist

Practicing since :2005

Answered : 637 Questions

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Suggest treatment for social anxiety

Brief Answer: Increase in dose of medicines plus CBT Detailed Answer: Hi, I read your query and can understand the distress that you must be going through due to your symptoms. Social anxiety is a condition in which a person becomes very uncomfortable in social situations. Your symptoms are definitely suggestive of the same. In addition, you also seem to have depressive symptom for last 2 weeks in form of loss of interest, lack f concentration and decreased sleep. XXXXXXX Cr is paroxetine which is a selective serotonin reuptake inhibitor. It is an effective anti anxiety and anti depressant medication. I would have liked to know when was this medicine started. In any case, considering your symptomatology, I would have considered increasing the dose to 25 mg and then assess. The dose can be gradually thereafter increased to 50 mg/day depending on response. If there is no improvement with it, then another drug like sertraline can be considered. You can discuss regarding the same with your psychiatrist. In addition, option of psychotherapy in form of cognitive behavior therapy (CBT) can be considered. It consists of regular sessions which will focus on learning relaxation and changing the faulty thought pattern that is leading to symptoms. Usually weekly or bi-weekly 12-20 sessions would be needed. I do hope I was able to answer your query. Please feel free to ask any further query that you might have. Best wishes for speedy recovery, Dr. Sunil Gupta