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Suggest treatment for social anxiety

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Posted on Thu, 10 Aug 2017
Question: Patient ProfileGender: MaleAge: 44Visited a Doctor: YesMedications Tried: Dear Doctor, I am male aged 44 years vegetarian. Height 175 cm, weight 78 kg doing Government job. Since childhood, I have been suffering from Anxiety problem. It seems to be social anxiety. I have been taking treatment since 1998 till date. I went to psychiatrists and psychotherapists. But in vein. I went to CBT, Hypnotherapy, Talking therapy, RTMS and all sorts of therapies. Presently I am taking VENLIFT OD 150 MG 2 TABS, STABLON 12.5 MG 2 TABS FOR DEPRESSION, RIVOTRIL 2 MG ONE OR TWO TABLETS, LONAZEPAM 2 MG TO REDUCE GRADUALLY RIVOTRIL, INDERAL 40 MG ONE OR TWO TABLETS, NEUROBIAN, OMEGA FATTY 3 ACID ONE TABLET in a day. My present problem is I am unable to express my facial expressions freely. I get nervous and shows its symptoms on face. My jaws become freeze and unable to express my facial expressions freely. It becomes hurdle in my life. How to overcome this problem. Also when I am in the group or when I am at the centre of attraction my panic attacks occurs. Doctor as you suggested I follow strict regime every day like. After waking up and doing my regular work, I do mild exercises with pranayam, (medication, exercise, diet and proper sleep and social situations) but in vain. Kindly suggest how to overcome. Kindly prescribe the medicines exactly so that I will start the treatment from you and start working on this. Kindly help me out.
doctor
Answered by Dr. Seikhoo Bishnoi (3 hours later)
Brief Answer:
Low dose Olanzapine can be added

Detailed Answer:
Hello thanks for asking from HCM

I can understand your concern. You are on treatment since last 19 years and have received medicines, CBT, rTMS etc and still symptoms are persisting. Currently you are on Venlafaxine 300 mg per day, Tianeptine 25 mg, Clonazepam 2 mg, Lorazepam, Inderal 40 mg etc but some of your symptoms are still persisting.

Currently you have symptoms of social anxiety like difficulty to express facial expressions freely, nervousness, difficulty in social situations etc. These are part of persistent anxiety.

In my opinion you are taking adequate doses of medicines and the symptoms should be under control. But if the symptoms are persisting then you should try Behaviour therapy especially relaxation exercises. Progressive muscles relaxation exercise in social situations will reduce your autonomic outbursts and the anxiety will decrease. If with behaviour therapy the symptoms persist then low dose antipsychotics like Olanzapine or Risperidone can be added. Low dose of Olanzapine will help to supplement the actions of the drugs your are taking and will help in reducing the anxiety too. Olanzapine in dose of 2.5 to 5 mg daily will help you. You can talk with your doctor for prescription of the drug.

Thanks and Take care
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi (15 hours later)
Dear Doctor, whether I am following the path of right medication. Am I not using excess medicines. One more thing Doctor, when I wake up early in the morning, I get immense Depression. Gradually when I take the medicine of Venlift OD 150 within 5 minutes it will go away. Also when ever I sleep and get up during morning, afternoon or evening same situation happens. Why? What is the reason behind it. At that I have to take anti depressent then only I become normal. Kindly suggestl.
doctor
Answered by Dr. Seikhoo Bishnoi (8 hours later)
Brief Answer:
I think you are on right medicines and right doses.

Detailed Answer:
Hello again

Yes you are on right medicines but if the symptoms are persisting then low dose Olanzapine can be added to the prescription. This will help in improving the symptoms.

Early morning worsening of symptoms and then improvement of symptoms as day passes is one of common feature of depression. The improvement is happening immediately after taking Venlafaxine because of psychological reasons. No need to worry about that.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Seikhoo Bishnoi (20 hours later)
Dear Doctor, Yesterday nigh I took 5mg of olanzapine. Till the sleeping effect is there. Kindly suggest me whether I continue this medicine or any other medicine which do not prone to sleep can be suggested. Waiting for your reply please.
doctor
Answered by Dr. Seikhoo Bishnoi (3 hours later)
Brief Answer:
Reduce the dose to 2.5 mg

Detailed Answer:
Hello thanks for asking again

If the 5 mg dose resulted in sedation and drowsiness even on next morning then in that case you can reduce the dose to 2.5 mg for a couple of weeks. Once you become better then the dose can be increased to 5 mg again.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Seikhoo Bishnoi

Psychiatrist

Practicing since :2007

Answered : 5187 Questions

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Suggest treatment for social anxiety

Brief Answer: Low dose Olanzapine can be added Detailed Answer: Hello thanks for asking from HCM I can understand your concern. You are on treatment since last 19 years and have received medicines, CBT, rTMS etc and still symptoms are persisting. Currently you are on Venlafaxine 300 mg per day, Tianeptine 25 mg, Clonazepam 2 mg, Lorazepam, Inderal 40 mg etc but some of your symptoms are still persisting. Currently you have symptoms of social anxiety like difficulty to express facial expressions freely, nervousness, difficulty in social situations etc. These are part of persistent anxiety. In my opinion you are taking adequate doses of medicines and the symptoms should be under control. But if the symptoms are persisting then you should try Behaviour therapy especially relaxation exercises. Progressive muscles relaxation exercise in social situations will reduce your autonomic outbursts and the anxiety will decrease. If with behaviour therapy the symptoms persist then low dose antipsychotics like Olanzapine or Risperidone can be added. Low dose of Olanzapine will help to supplement the actions of the drugs your are taking and will help in reducing the anxiety too. Olanzapine in dose of 2.5 to 5 mg daily will help you. You can talk with your doctor for prescription of the drug. Thanks and Take care