where to get help with social anxiety disorder

It has been known for some time that certain classes of medications are effective in helping people with social anxiety disorder. Often, however, people will combine both medication and psychotherapy, and this is likely to be a particularly powerful approach.

The first class of medications shown to be effective was the MAOIs (monoamine oxidase inhibitors). However, the MAOIs are inconvenient in that they require sticking to a strict diet (e.g. cutting out cheese) and avoiding various other medications (e.g. certain cold medicines). More recently, the reversible inhibitors of monoamine oxidase (RIMAs) have been developed. Although apparently not as powerful as the classical MAOIs, these agents do not require dietary precautions and can also be useful for social anxiety disorder.

Taking a beta-blocker around an hour before the occasional public performance could help to control heart rate, tremor, and other physical symptoms. Unfortunately, beta-blockers are not useful for people who have a range of different fears, and who have difficulty in many social situations. They are also ineffective for the many people with social anxiety disorder who also have concurrent depressive symptoms.

Another group of medications often used to treat social anxiety disorder is the benzodiazepines (or tranquilizers). Although these agents do decrease social anxiety symptoms, they run the risk of dependence. An advantage of the benzodiazepines is their rapid onset of action (they work within hours), and they may have a useful short-term role in the treatment of social anxiety disorder, perhaps being used in combination with an agent that takes a while to begin working.

Most recently, a class of antidepressant medication known as the selective serotonin reuptake inhibitors (SSRIs) has shown with short-term studies to be both effective and safe. While adverse effects range from transient nausea and headache, to more bothersome problems such as delayed ejaculation, many people do not have any side effects. It should be emphasised that these agents require several weeks of ongoing administration before they begin to work, and also that some people may require doses that are higher than typical starting doses.

Serotonin-nonrepinephrine reuptake inhibitors (SNRIs), like the SSRIs, increase serotonin levels. They also increase norepinephrine levels and are a good choice for patients with generalized social anxiety disorder and depression.

Another medication called gabapentin (Neurontin), an anti-epilepsy medication, has been shown to be an effective treatment for social anxiety disorder. Unlike the SSRIs and SNRI medications, gabapentin is not an antidepressant.

Cognitive-behavioural therapy (CBT) is the mainstay of psychotherapy for the treatment of social anxiety disorder. The principles are very similar to those used in the treatment of other anxiety disorders. First, the most important element of the treatment is gradual exposure to feared situations. A hierarchy of feared social situations is constructed, and the person is encouraged to begin exposing themselves to those that are least feared, and then to move gradually up the hierarchy to situations that are more feared. During exposure, a range of techniques can be used to help relax. For example, a commonly employed technique involves the use of self-statements. Visualization techniques may also be useful.

For more information about social anxiety disorder or any other mental health issue contact the Mental HealthInformation Centre of South Africa tel +27 21 938-9229. You can also ask your GP for a copy of the social anxiety disorder chapter in the False Alarm! How to Conquer the Anxiety Disorders patient guide.

Further resources / references
Anxiety Disorders Association of America, Inc.
11900 Parklawn Drive, Suite 100, Rockville, MD 20852-2624
Tel: (240) 485 1001 / Fax: (240) 485 1035 / Internet: http://www.adaa.org

Depression & Anxiety Support Group of SA
PO Box 652548, Benmore, 2010
Tel: (011) 783 1474/6 / Fax: (011) 884 7074 / Internet: http://www.anxiety.org.za

Books about Social Anxiety Disorder (Social Phobia)
Dying of Embarrassment: Help for Social Anxiety & Phobia. B.G. Markway, C.N. Carmin, C.A. Pollard and T. Flynn. Oakland, New Harbinger Publications, Inc., 1996.
Fear of Humiliation: Integrated Treatment of Social Phobia and Comorbid Conditions. W.W. Menninger. London, Jason Aronson Inc., 1995.
The Hidden Face of Shyness: Understanding & Overcoming Social Phobia. F. Schneier and L. Welkowitz. New York, Avon Books, 1996.
Shyness: What it is. What to do about it. P.G. Zimbardo. New York, Addison-Wesley Publishing Company, 1995.
Social Phobia: From Shyness to Stage Fright. J.R. Marshall. New York, Basic Books, 1994.