What pills to take for social anxiety

The term “social phobia” appeared in the early sixties of the twentieth century. This is the name for anxiety and fear that a person experiences in certain work or social situations. As a result, he tries to avoid them so as not to experience unpleasant sensations.

Previously, it was believed that such an anxiety disorder was a rare phenomenon, but over time it became clear that this was far from the case. Thanks to modern diagnostic criteria and methods, it has been proven that 13% of the population of our planet suffer from it constantly, and in 7% of males and 9% of females it is observed at least once during the year. However, it is more common in developed countries with a high standard of living.

Experts say: the prevalence of social phobia largely depends on what type of society is inherent in a particular state. If it is individualistic, that is, the uniqueness of each person is emphasized, then such pathology manifests itself more than where collectivism reigns and the individual is not the center of attention.

More about social phobia

This mental disorder debuts in adolescence, youth, disappears completely or continues for many years with varying intensity.

Potential situations in which social phobia makes itself felt:

• the need to keep the conversation going;
• public speaking;
• participation in the play;
• acquaintance;
• meetings with the opposite sex;
• playing in an orchestra;
• communication with superiors;
• reception of visitors;
• eating at home in the presence of other people, even family members;
• performing work in front of strangers;
• medical examination;
• use of a public toilet, etc.

A social phobe fears scrutiny, being humiliated by ridicule, and being criticized or judged if he does not live up to expectations. The themes of his experiences: how others think of him, his appearance seems unattractive to them, his words seem stupid, and he himself seems inattentive, unresponsive and rude. Added to this fear is the anxiety that others will notice that he is embarrassed, cannot find words, loses his thoughts, sweats, blushes, and shakes. The anxiety can be so severe that you may even vomit.

All this can happen to an individual only in relatively small groups, but never in a crowd.

Symptoms

There are two forms of this disorder:

1. Generalized social phobia - the individual is afraid of all social situations that affect him comprehensively. It is difficult and treatment is complicated.
2. Specific social phobia. In this case, the person reacts only to some cases, and anxiety manifests itself weakly.

Pathology demonstrates itself in a very diverse manner; each person will have their own symptoms.

Physiological manifestations:

• breathing is difficult;
• heart rate is accelerated;
• nausea;
• tremor,
• coordination of movements is impaired;
• heavy sweating.

The patient tries to avoid contact with people, does not look the interlocutor in the eyes, and feels awkward. When in society, he is extremely tense and wants to hide and run away from everyone.

Cognitive manifestations:

• “emptiness” in the head;
• inability to concentrate;
• the train of thoughts is not controlled;
• “playing out” the situation;
• inflated demands on oneself;
• focus on your behavior.

As for emotions, a social phobe panics at the thought of what people will think about him. His mood often changes, he gets irritated for no reason, gets nervous, and cries for no reason.

A person suffering from this disorder is overly demanding of himself and critical. The main thing for him is to make a good impression on others, saying that he is extremely cultured, well-mannered, and knows a lot. At the same time, the thought always “lives” in his head that they will still think badly of him.

A sociophobe, expecting a situation that will traumatize his psyche, thinks through ways of retreat and is sure that his plan will not succeed in any case. And when the disturbing moment passes, he reflects on the absurdity of his actions, which made everyone laugh at him. In fact, nothing like this happened, but the patient spends such sessions of self-analysis every day, sometimes not even able to fall asleep from his difficult thoughts.

Pathological fear forces a social phobic to behave unnaturally in the presence of colleagues, superiors, and partners. At this time he has a dull look, his eyes are lowered,

there is a bright blush on her face, her arms are crossed on her chest. He avoids people, can suddenly leave the room, and sometimes, in order to look respectable, he lies and tells fictitious stories. Then the patient has a hard time worrying about his behavior.

Those with social phobia are afraid of negative evaluation, and many admit that their fear is great and unfounded, but they cannot do anything. All these problems of adaptation in certain situations greatly affect the lives of patients, negatively affecting both their personal life and their professional sphere. Social phobes cannot meet people, develop relationships, or start a family. It is not for nothing that this disorder is called the “disease of lost opportunities.”

In an attempt to overcome such difficulties, in order to give themselves courage, patients begin to take drugs and alcohol, which also does not lead to anything good.

And the further it goes, the worse it gets. Therefore, the need to start treatment in a timely manner does not require special explanation.

Every person experiences and worries. But if, out of nowhere, emotions overflow, aggression arises, and fear and anxiety overwhelm you so much that it causes discomfort, then this is a reason to consult a specialist.

According to research, social phobia contributes to the development of depression. In addition, the risk of suicide increases 6 times.

Types of drugs

You can try to develop and take a course of anti-anxiety medications yourself, but it is better to consult a specialist.

Consult your doctor and get the appropriate prescription. The medications themselves are divided into different groups, which are prescribed by the doctor when different symptoms of fear occur:

• tranquilizers;
• mood stabilizers;
• antidepressants.

Each group has its own advantages and disadvantages. All of them are prescribed after over-the-counter medications no longer help.

• Thus, tranquilizers are prescribed if the patient experiences frequent panic attacks without good reason. They quickly provide help, but the person feels severe drowsiness and slow thinking.
• Mood stabilizers will help slowly, but they are less harmful. They have virtually no side effects and are addictive only in some patients.
• Antidepressants are good for anxiety attacks, but after 3 weeks of active use, they can cause a constant feeling of drowsiness and addiction.

There are contraindications, you need to consult a specialist!

Reasons for late detection of social phobia

Numerous studies have shown that the average duration of this anxiety disorder is about 23 years. Unfortunately, many people suffering from it consider their condition to be just character traits and do not seek help. They get used to it, which causes enormous damage to themselves, they do not realize themselves, and they do not demonstrate their uniqueness.

Teenagers are completely convinced that puberty is to blame for everything, they will simply outgrow it, and over time everything will get better.

This state of affairs leads to the fact that in the first year after the onset of symptoms of the pathology, only 5% of social phobes go to the doctor, and 20% – after 15–20 years, when their condition becomes literally unbearable.

In addition, the rare diagnosis of the disorder is also associated with labeling psychological help: I ​​turn to psychiatrists, and they immediately recognize me as crazy and put me on the register. This is what frightens ignorant people.

It’s also bad that there is very little easily accessible and intelligible information about the dangers of social phobia and its successful treatment.

You should put aside silly fears and visit a psychoneurological dispensary or other specialized medical institution.

There is a prejudice that when examining and making a diagnosis in the ICP, a person is immediately registered as a psychiatric patient. This is wrong. Patients who are carriers of serious diseases that are dangerous both for themselves and for those around them are subject to observation, which implies, among other things, social restrictions.

Pharmacological treatment of phobias in our clinic

The clinic of Doctor of Medical Sciences Minutko uses methods that make pharmacological treatment truly safe: monotherapy (prescription of one ideally selected drug) and control of the dosage of this drug within the “therapeutic window”. A reasonable combination of psychotherapy and pharmacological drug treatment (only if indicated) gives excellent treatment results.

Only a competent approach makes treatment truly safe.

We are monitoring this carefully.

Diagnostics

The Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, specifies the criteria for diagnosing social phobia. The patient should exhibit the following symptoms:

• noticeable anxiety or fear due to a social situation (one or more) where he will be under close attention;
• fear of being in an awkward position, receiving a negative assessment from people, ridicule, insults, rejection;
• active avoidance of the above situations;
• fear about the same situations;
• excessive fear that does not correspond to the threat (which, in general, does not exist);
• fear and avoidance worsen the quality of life, interfere with normal social activities and work.

The psychiatrist must make sure that the patient does not have other phobias that cause fear: PTSD, agoraphobia, body dysmorphic disorder, etc.

Antidepressants SSRIs and SSRIs for panic attacks, VSD, OCD and social phobia

SSRIs are selective serotonin reuptake inhibitors. To put it simply, antidepressants increase the amount of serotonin in the brain, which gives anti-anxiety and antidepressant effects.

The most modern and popular second generation SSRIs are ESCTALOPRAM, SERTRALINE and PAROXETINE. It is these antidepressants that are most often prescribed for panic attacks, VSD, OCD and social phobia. These are the names of the active ingredients, they may differ from the trade names of the drugs themselves. Manufacturers come up with their own trade name to promote a product, so you need to rely not on the trade name, but on the active substance.

Taking antidepressants is often associated with unpleasant side effects in the first days of use. In order to smooth out side effects, a very gradual increase in dosage is recommended . It is better to start with 1/4 of the tablet, monitor your condition and if everything is fine, then increase the dosage by another 1/4. An approximate dosage regimen may look like this: two days 1/4 tablet, five days 1/2 tablet and if everything is fine then switch to a whole tablet. As soon as the active substance accumulates in the body, the unpleasant side effects will disappear and your condition will improve. As a rule, this takes no more than two weeks.

Also, to combat side effects, a “cover” drug is prescribed in the first 2-3 weeks of taking antidepressants. This is usually a tranquilizer or antipsychotic. The purpose of this drug is to stabilize the condition and compensate for side effects until the antidepressant begins to act.

You can take antidepressants for quite a long time without serious health consequences. Usually the course is prescribed for six months. A long course is necessary to form the habit of living without anxiety. However, if the psychological causes of increased anxiety are not resolved, then after the course is discontinued, after some time the anxiety disorder will resume. According to some statistics, after stopping an antidepressant for panic attacks, in about half of the cases, panic attacks return within three months. To prevent this from happening, it is very important during the course to solve the psychological causes of the problem through working with a psychologist.

After stopping a course of antidepressant, the so-called “withdrawal syndrome” appears, which is accompanied by unpleasant sensations. To reduce withdrawal symptoms, you need to very gradually reduce the dose of the antidepressant. It is recommended to gradually reduce the dosage by a quarter of a tablet and monitor your condition.

Probably the main disadvantage of SSRI antidepressants is a decrease in libido. About half of patients experience this side effect. This is expressed in a decrease in sexual desire and difficulty in achieving orgasm in both men and women. An erection in men most often remains. Sometimes this side effect goes away after some time, sometimes it doesn’t go away, and sometimes it doesn’t appear at all, everything is individual. Therefore, if the sexual sphere is very important to you, then it is better to choose an antidepressant from another group.

Also, for the treatment of panic attacks, VSD and other anxiety disorders, antidepressants of the SSRI group are used - selective serotonin and norepinephrine reuptake inhibitors. At low doses, these antidepressants behave like regular SSRIs, but at medium doses they increase the amount of norepinephrine, which gives a stronger antidepressant effect. Thus, this group is preferable for anxiety-depressive disorder. In addition, antidepressants in this group reduce libido less. The most popular representative of this group is VENLAFAXIN .

Treatment

The doctor develops a treatment strategy depending on the patient’s condition. Today, the most effective method is considered to be a combination of medication and psychotherapeutic treatment. The first eliminates the tip of the iceberg and relieves vegetative manifestations, and the second – the cause of fear.

Tranquilizers and antidepressants are used to relieve anxiety. Tension and other physiological symptoms are treated with beta blockers. But “pills for social anxiety” alone will not help the matter. The action of pharmacological agents is supported by various types of psychotherapy. This combination allows you to achieve an optimal sustainable result.

Cognitive-behavioral (behavioral) therapy

The psychotherapist selects techniques depending on the symptoms of the disorder. The specialist’s goal: to change the patient’s thinking so that he responds adequately to circumstances that previously caused him fear and anxiety. A social phobe must understand how wrong his perceptions and feelings are. By learning to resist such beliefs, he can get rid of the problem.

Sessions can be conducted individually or in a group. Between them, the patient does homework, which becomes more and more difficult each time.

The most effective group therapy is in such forms as training in self-affirmation, increasing self-confidence (assertiveness), and social skills. A person suffering from social phobia is helped by an environment that has the same problems. He realizes that there are many like him, a lot of people face such a problem at a certain period of life.

An unpleasant situation is created for the patient, but he manages to overcome his fear thanks to the presence of other patients, their sincere support and care. For example, a person who is overcome by fear at the thought that his hands will tremble while performing some action is asked to pour tea for everyone in group classes.

Group members, with the help of a therapist, play roles, and “rehearsals” continue until their new behavior is established. In order for the patient to see himself from the outside, video recording is often used. Patients, together with a specialist, discuss role-playing games, their mistakes and achievements.

Here are 3 behavioral therapy provisions that are either combined or used separately:

1. Cognitive therapy or working with thoughts that cause anxiety. First, negative thoughts are monitored and it is determined whether they are true. Then they are transformed into realistic ones.
2. Acquiring social skills, which are usually not enough for a social phobe, since he is not able to start a conversation, etc. This can be achieved with the help of the above-mentioned role-playing games in a group.
3. Overcoming alienation. Without it, healing is impossible. Patients perform so-called disclosure exercises: attend a party, return a purchased defective product to a store, get to know someone, etc.

The social phobe accepts responsibility for complying with these provisions. He keeps a workbook in which he writes down negative and positive points and constantly re-reads them. At the beginning, there will be more unfavorable notes, this may even lead to some despondency and doubt. But in the future, the positive will prevail and this will become a visible result of treatment.

Some exercises will take a lot of energy at first and cause anxiety. But the more effort you expend, the greater the benefit. Moreover, there are also relaxation exercises that reduce physical stress and give you the opportunity to relax.

Psychotherapy, depending on the patient’s condition, can take from three months to a year, or even more.

Hypnotherapy

Hypnosis helps to immerse the patient in the past and understand what happened in his life, what terrible incident gave impetus to the development of social phobia. An altered state of consciousness (trance) helps to extract from the most hidden depths of memory an unpleasant fragment that is “hidden” so well that it is completely inaccessible in a waking state.

While in a trance, the individual for the second time finds himself in a situation that once significantly affected him and caused a strong destructive emotion. But this time everything happens differently than before: the patient interprets what happened differently and it does not receive a negative connotation. And, as a result, he no longer feels anxiety and fear about this.

As a rule, in the treatment of social phobia, the method of deep immersion is used - somnambulism. In this state, the brain works in such a specific mode when all processes of higher nervous activity are subordinated to a single experience.

The patient can be put into a state of mild somnambulism if he is completely ready for such a procedure, unconditionally trusts the specialist, and has no prejudices about hypnosis.

What should you remember when treating phobias?

• any medications, if we are talking about their safe use, should only be prescribed by a doctor;
• if pharmacotherapy for phobias and fears remains the only treatment method, then sooner or later the problem will return again: drug treatment removes the state of fear, but not the cause itself. Only high-quality psychotherapy in addition to pharmacology can provide a definitive or long-lasting effect.
• control, control and once again control of the effectiveness of drug treatment, dosage, and the occurrence of side effects.