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Suggest Treatment To Manage Social Anxiety Disorder
Question: I have social anxiety disorder, I feel uncomfortable, hesitation to smile fully in social regions, I have fear of unborn and always feel someone is watching m in bus, train, etc. I have a history in this. And my condition worsens in sun, I literally feel to cry for no reasons.
I had been diagnosed with ocd and social anxiety 3 yrs. back and the medicines that were given not worked properly. And then I was given pexep cr 25 in which my initial days were like nightmares but after some days I felt good. After taking this medicine for about 5-6 months my doc. advised me to quit by breaking the tablet into 4 equal parts and after a month I had completely stopped it. After that I felt very depressed and same has occurred again and most difficult was to stop the medicine. I also felt some small attacks. I am now somewhat ok then compared to 3 years back. From my childhood of about 8 yrs I was very shy especially to girls and talked very less.
Currently I am doing breathing practice, weight exercise, 20 pushups, jumping, meditation, having good diet, and my body is in good shape.
My current problems are:
1. Blushing
2. Before going somewhere my heart runs fast and little fear occurs
3. Despite being good student, no confidence and faith
4. Most time thinking of unnecessary things
5. Cant wait fr bus or train fr more than 5-10 minutes and face becomes red
6. I out with my friends and enjoy but not able to do fully. I always try to give my give my 100%.
7. After about 3 yrs I have started pexep cr 12.5 on advice of my doctor because I was feeling very much anxious due to exposure in sun fr more time and at home preparing fr exams.
8. Even a missed call comes in my XXXXXXX my heart beats fast.
9. I want to have a normal and fearless life. Please guide me what to do sir.
10. Have also attended some sessions of my doctor in which he guided me to think positive and meditate and expose to anxious situations and make notes of it. I had and also doing this but when expose to sun I get very much anxious and water comes from eyes and even in Communication through eye contact. And not able to completely be confident.
11. Most of all is I fell very very much anxious in crowd or when waiting to give exam outside with huge crowd.
12. Due to my exams next month I will be at home for almost 20 days and after that when I vl go fr my exams I will feel anxious(previously happened).
13. Will it ever be cured? Please help to cure it completely.
I had been diagnosed with ocd and social anxiety 3 yrs. back and the medicines that were given not worked properly. And then I was given pexep cr 25 in which my initial days were like nightmares but after some days I felt good. After taking this medicine for about 5-6 months my doc. advised me to quit by breaking the tablet into 4 equal parts and after a month I had completely stopped it. After that I felt very depressed and same has occurred again and most difficult was to stop the medicine. I also felt some small attacks. I am now somewhat ok then compared to 3 years back. From my childhood of about 8 yrs I was very shy especially to girls and talked very less.
Currently I am doing breathing practice, weight exercise, 20 pushups, jumping, meditation, having good diet, and my body is in good shape.
My current problems are:
1. Blushing
2. Before going somewhere my heart runs fast and little fear occurs
3. Despite being good student, no confidence and faith
4. Most time thinking of unnecessary things
5. Cant wait fr bus or train fr more than 5-10 minutes and face becomes red
6. I out with my friends and enjoy but not able to do fully. I always try to give my give my 100%.
7. After about 3 yrs I have started pexep cr 12.5 on advice of my doctor because I was feeling very much anxious due to exposure in sun fr more time and at home preparing fr exams.
8. Even a missed call comes in my XXXXXXX my heart beats fast.
9. I want to have a normal and fearless life. Please guide me what to do sir.
10. Have also attended some sessions of my doctor in which he guided me to think positive and meditate and expose to anxious situations and make notes of it. I had and also doing this but when expose to sun I get very much anxious and water comes from eyes and even in Communication through eye contact. And not able to completely be confident.
11. Most of all is I fell very very much anxious in crowd or when waiting to give exam outside with huge crowd.
12. Due to my exams next month I will be at home for almost 20 days and after that when I vl go fr my exams I will feel anxious(previously happened).
13. Will it ever be cured? Please help to cure it completely.
Brief Answer:
Social Anxiety Disorder
Detailed Answer:
Hello thanks for asking from HEALTH CARE MAGIC
I have read your clinical history in detail and I can understand your problem. Social anxiety is really a distressing disorder and it causes significant impairment in social, educational and occupational areas. The disorder follow a chronic course and long term management is needed both as psychological management and medicinal treatment. You have onset of symptoms about 8 years back.
You have symptoms of blushing, palpitations due to anticipatory anxiety, lack of confidence, poor rapport with friends, you can't enjoy out, even you have anxiety in day to day things as hearing XXXXXXX ring, waiting for bus etc.
The behavioural therapy sessions have worked to some extent but they didn't result in full improvement. You are on breathing exercises and meditation but no relief.
You were prescribed Paroxetine CR 25 for about 5-6 months which caused improvement but later it was tapered.
Now coming to your question-
Yes it can be treated, but the treatment runs for long time. Even after remission of symptoms I advise my patients to take medicines for at least 6 months to about 2 years. Anxiety disorders are difficult to treat and stopping the treatment early results in relapse.
As per my opinion there is need to start medicines again. Paroxetine, Sertraline, Escitalopram etc can be used. Paroxetine can cause sedation and weight gain so Escitalopram can be kept as a good option. The drug will help to increase your confidence and will decrease anxiety.
For severe anxiety provoking situations, like for example in presentation or speaking in front of a group medicines like beta blockers as Propranolol can be used. Propranolol decreases the symptoms of anxiety like palpitations, tremors, sweating, blushing of face etc and results in relaxation. The medicines is free of any serious side effects and can be taken as on need basis. These medicines are prescription medicines and consult a psychiatrist for that.
You will have to take these medicines for long and once remission of symptoms occur maintenance treatment will run for at least 6 months to two years. Continue to do relaxation training and breathing exercises.
Thanks, I hope this helps you. If you have any doubts regarding treatment then you can ask again in follow up.
Dr. Seikhoo Bishnoi
Consultant Psychiatrist
Social Anxiety Disorder
Detailed Answer:
Hello thanks for asking from HEALTH CARE MAGIC
I have read your clinical history in detail and I can understand your problem. Social anxiety is really a distressing disorder and it causes significant impairment in social, educational and occupational areas. The disorder follow a chronic course and long term management is needed both as psychological management and medicinal treatment. You have onset of symptoms about 8 years back.
You have symptoms of blushing, palpitations due to anticipatory anxiety, lack of confidence, poor rapport with friends, you can't enjoy out, even you have anxiety in day to day things as hearing XXXXXXX ring, waiting for bus etc.
The behavioural therapy sessions have worked to some extent but they didn't result in full improvement. You are on breathing exercises and meditation but no relief.
You were prescribed Paroxetine CR 25 for about 5-6 months which caused improvement but later it was tapered.
Now coming to your question-
Yes it can be treated, but the treatment runs for long time. Even after remission of symptoms I advise my patients to take medicines for at least 6 months to about 2 years. Anxiety disorders are difficult to treat and stopping the treatment early results in relapse.
As per my opinion there is need to start medicines again. Paroxetine, Sertraline, Escitalopram etc can be used. Paroxetine can cause sedation and weight gain so Escitalopram can be kept as a good option. The drug will help to increase your confidence and will decrease anxiety.
For severe anxiety provoking situations, like for example in presentation or speaking in front of a group medicines like beta blockers as Propranolol can be used. Propranolol decreases the symptoms of anxiety like palpitations, tremors, sweating, blushing of face etc and results in relaxation. The medicines is free of any serious side effects and can be taken as on need basis. These medicines are prescription medicines and consult a psychiatrist for that.
You will have to take these medicines for long and once remission of symptoms occur maintenance treatment will run for at least 6 months to two years. Continue to do relaxation training and breathing exercises.
Thanks, I hope this helps you. If you have any doubts regarding treatment then you can ask again in follow up.
Dr. Seikhoo Bishnoi
Consultant Psychiatrist
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
sir, i have already started peper cr 12.5 on prescription of my doctor. i had taken it for 3 days. will it be better to shift to Escitalopram? and why my condition worsens under sun? i feel like shaky and can it be controlled?
Brief Answer:
you may stay on paroxetine....
Detailed Answer:
Thanks for asking a follow up question
Overall if we consider efficacy all of SSRIs have almost same efficacy, and if you have started taking Paroxetine there is no need to shift to Escitalopram. Paroxetine will cause sedation as side effects. You have responded to paroxetine previously so you can continue with that drug.
Paroxetine can cause rare side effect of increased sensitivity to light; so this could be the reason for your symptoms worsening in sun.
The shakiness is occurring due to poor control of anxiety. I would suggest you to consult your psychiatrist for Propranolol. The drug will control your symptoms of tremors and anxiety. No need to worry, if you will take medicines properly then your symptoms will improve.
Thanks, hope this helps you. Still have some unresolved doubts ask again.
you may stay on paroxetine....
Detailed Answer:
Thanks for asking a follow up question
Overall if we consider efficacy all of SSRIs have almost same efficacy, and if you have started taking Paroxetine there is no need to shift to Escitalopram. Paroxetine will cause sedation as side effects. You have responded to paroxetine previously so you can continue with that drug.
Paroxetine can cause rare side effect of increased sensitivity to light; so this could be the reason for your symptoms worsening in sun.
The shakiness is occurring due to poor control of anxiety. I would suggest you to consult your psychiatrist for Propranolol. The drug will control your symptoms of tremors and anxiety. No need to worry, if you will take medicines properly then your symptoms will improve.
Thanks, hope this helps you. Still have some unresolved doubts ask again.
Above answer was peer-reviewed by :
Dr. Prasad
Propranolol can be taken daily or when i feel very anxious?
can shyness be controlled by propranolol?
i am trying really hard to control anxiety in social situations but not suceed.
can shyness be controlled by propranolol?
i am trying really hard to control anxiety in social situations but not suceed.
Brief Answer:
Keep propranolol for SOS basis and yes it will help in shyness
Detailed Answer:
Hello thanks for writing to us again
Propranolol can be reserved for anxiety provoking situations. As per my opinion there is no need to take the drug on regular basis. Before starting the drug don't forget to take prescription from your psychiatrist.
Yes the drug will reduce the symptoms of severe anxiety. Shyness occurs because of fear of talking to someone due to anxiety. When anxiety symptoms will reduce in severity shyness will also decrease.
You have just restarted Paroxetine and this will help to improve your symptoms. In normal individuals drug takes about 4-6 weeks to show its full effects because of its pharmacological properties. Continue to take the medicines and your symptoms will improve. Don't feel depressed, you have responded to this drug before also.
Continue to do meditation and exercise and your anxiety will diminish.
Thanks, hope this helps you.
Wish you a good health.
Dr. Seikhoo Bishnoi, MD
Keep propranolol for SOS basis and yes it will help in shyness
Detailed Answer:
Hello thanks for writing to us again
Propranolol can be reserved for anxiety provoking situations. As per my opinion there is no need to take the drug on regular basis. Before starting the drug don't forget to take prescription from your psychiatrist.
Yes the drug will reduce the symptoms of severe anxiety. Shyness occurs because of fear of talking to someone due to anxiety. When anxiety symptoms will reduce in severity shyness will also decrease.
You have just restarted Paroxetine and this will help to improve your symptoms. In normal individuals drug takes about 4-6 weeks to show its full effects because of its pharmacological properties. Continue to take the medicines and your symptoms will improve. Don't feel depressed, you have responded to this drug before also.
Continue to do meditation and exercise and your anxiety will diminish.
Thanks, hope this helps you.
Wish you a good health.
Dr. Seikhoo Bishnoi, MD
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
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