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Suggest treatment for social anxiety

Answered by
Dr. Ashok Kumar


Practicing since :2000

Answered : 2951 Questions

Posted on Sun, 21 Jan 2018 in General Health
Question: Hi,
I asked this question few weeks back but I was not able to respone back to you on time.

I am a 40 year old male. I have a social anxiety disorder. I didn't know I had this disorder until last year. But now if I look back I think I have this disorder from very long time. Please see below the answers to some of the questions you asked me last time.

Before I proceed to guide you, I request you to provide following details.
1. How long the problem is there ?
A. I think I have social anxiety disorder since I was around 15 year old or more.
2. How it was started
A. I moved to Canada with family in 1991. When we moved to Canada I was very young and I couldn't make close friends because my English was very week at that time. Also I was very shy to speak in English. I always thought I will something wrong and people would laugh at me. I believe this might have created the problem for me.
3. Whether there was any stressor? Details if any
A. I did take Sertraline up to 150mg for 6 months and I did help me little but not completely.
4. Do you have family history of any similar illness or psychiatric illness? Details if any
A. No I don't have any family history of this disorder.
5. Do you have any other medical illness? Details if any
A. Not any other medical illness.
6. Please describe the other symptoms of current problem if any.
A. I forget things, sometimes my mind goes blank if I start telling a long story or a joke. I have hard time making eye contact, I don't like people watching me if I'm doing some task.
7. What treatment received till date and what was the response?
A. I took Sertraline up to 150mg for 6 months and it did help some but not completely.
8. What you do at personal level to manage this anxiety?
A. I just took Sertraline for 6 months.
9. Do you have any substance of abuse ? Details if any
A. No abuse
10. How the anxiety is affecting your professional and social life?\
A. It does effect a lot with my professional, if have to attend a meeting I would try to ignore it or just sit quite at the meeting. Also I noticed I don't like to write when someone is watching me. If I do write when someone is watching me my handwriting is worst. Otherwise I know I'm a smart man but I always have very hard time presenting my best in front of other people. I'm normally okay in front of my family members or close relatives.

Please help
Answered by Dr. Ashok Kumar 18 hours later
Brief Answer:
Follow up

Detailed Answer:
Thanks for follow with required details.

First of all I like to state that the description is clear enough to diagnose social anxiety and there is no doubt about it. Having said this realizing the problem is first step in management of your social anxiety.

I am going to mention some self help strategies which might be of great help for you.

1. Learn how to relax. This will help you in decreasing the hyper alertness about negative evaluation by others. The strategies include deep breathing. Whenever you feel there is someone who is observing you just slow down your breath to a tune of 4-5 breath cycles per minute. In a period of just few minutes the slow breathing will calm down to a extent where you can handle the situation.

Muscle relaxation is another thing which can help you in relaxing. In the alternate manner relax and contract the various muscle groups. Progressive muscle relaxation is one such technique which helps you in lng run to deal with social anxiety.

2. Stop unrealistic thinking-
This is another step which involves changing your thinking process. For example a though like "I will feel nervous if other notice me" or "“I’ll make a mistake and others will think I’m stupid" are the maladaptive ways of thinking and add to your problem. If you think something is wrong definitely it is going to be wrong. However we need to acknowledge that by changing the thinking pattern can make a great difference and every maladaptive ways of thinking need to be challenged in gradual manner.

3. Manage your stress- Yes you take it right by use of healthy lifestyle choices such as regular exercise, avoidance of any form of substance, connecting with family and friends, eating healthy, timely sleep and limiting screen time of all forms.

4. Facing fears- This is another important thing as avoiding fears is not goung to solve the problem.

This can be done by meeting new people and interacting with them.

I hope this helps you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ashok Kumar 2 hours later
Thank you for the quick reply. I will follow the recommended steps.

Right now I'm not taking any medication for SAD, I would like to go back to the medication and try again. Do you think it is okay if I go back to SSRI'S or try different combinations of medications that would help better.

Please suggest.

Answered by Dr. Ashok Kumar 33 minutes later
Brief Answer:
Paroxetine is better option

Detailed Answer:
Thanks for follow up.

Medications are never sufficient to control the social anxiety in absence of behavioral approaches but have excellent results when added to behavioral approaches as explained above. I mean to say that medicine alone could not be of complete help and there is need to make consistent efforts on your part.

Regarding the choice of medications there is no doubt that SSRI are recommended as first line of treatment. Among the SSRI's I feel paroxetine is better option among the available choices.

I hope this helps you further.
Feel free to write back to me if you have more questions.
In future, if you wish to ask any more questions, you can use the below-mentioned link to contact me.

Thanks and regards.

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

The User accepted the expert's answer

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