For the past several years I have been taking 80mg Nadolol (Corgard) twice daily for migraine prophylaxis. I understand that Propranolol is sometimes prescribed specifically for the treatment of social anxiety and wonder whether I should be considering it instead of Nadolol.

I take Nadolol to help my blood pressure. I have taken Inderal in the past. I have found that Nadolol helps my heart better than the Inderal. I don’t feel my heart beating as much as I did when I took the Inderal. For me, the Nadolol seems more helpful. I hope you will be doing better. Good Luck.

thanks.
and throughout the treatment too

It depends on what kind of set up you are in – full day, one hour…?

In the beginning there is some getting introduced talking and gathering basic and background information.

There will be some aspects of teaching to help you learn the ideas involved in cognitive behavioral therapy.

It should not be very scary or anything like that. You may feel a bit shy or uncomfortable, that would be pretty normal for anyone.

Just go in with an open mind and an attitude of being willing to learn and grow. You are there to do some things that will improve your life and make it easier to be in the world.

I have taken 5-htp and st.johns but they don’t really help that much. Is something like l-tyrosine more appropriate. Thanks everyone!

if you are having trouble with stress or anxiety ….check thsi out http://www.youtube.com/watch?v=yjPcb3eMS6s lil Dr Jack can helps

I have social anxiety and I really want to get on meds, but what is the best to use? I’m usually very happy, not depressed at all, so not sure if Xanax and stuff like that would make me not be that happy anymore or what? Anyone know of something less addictive I can use for just social anxiety?

Thanks!

the doctor will first put you on an SSRI such as effexor, paxil, citalopram/celexa, or the MAOI inhibitor Nardil. I wouldn’t recommend paxil. Citalopram and effexor are the best IMO. Nardil is supposed to be the best but has side effects like you can’t eat many foods like cheese. Citalopram gives me no side effects.

the doctor will also prescribe a benzodiazepine for a month while the SSRI is kicking in if you ask, such as valium, xanax, clonazepam, or lorazepam. These work MUCH better for treating social anxiety disorder.

I would recommend asking your doctor to prescribe a benodiaezepine in addition to the SSRI for long term use, if the SSRI is not doing enough after your prescription of the benzodiazepine runs out. For me, that is the only thing I have found that takes the social anxiety completely away. SSRIs more just take the pain off the edges. Benzos are actually harmless and not addictive if you take them AS DIRECTED for long term use, and work WONDERS for social anxiety disorder.

Please don’t listen to any of these other negative posters especially perfectlybaked. SAD is unfortunately a very understood mental disorder by the general public they think it is just shyness, but trust me I felt debilitated just like you before I took medication, really stiff muscles like everyone was judging or staring at me, but now I am 100% normal.

Good Luck!

Do I go to my gp?

I would recommend you seek medical help either from your PCP or by referral to a psychiatrist. First, they need to exclude medical causes of anxiety. Then they can help you come up with a plan for treatment. Treatment can involve medications (many of the antidepressants are indicated for social anxiety disorder) and also different kinds of therapy. There are lots of behavioral strategies as well as cognitive strategies that you can do to get relief from anxiety disorders that are remarkably effective. Good luck!

I have social anxiety and obessesion problems.

My psychiatrist saids that just like someone with diabetes needs insulin I need prozac.

Does this mean that prozac (like insulin for diabetes) is all I need and that other forms of therapy are unnecessary?

"the treatment" I disagree. I would say "a treatment."

I’ve heard some psychiatrists described as ‘pill pushers.’ A pill pusher would prescribe a pill needlessly and excessively. I talked to a person who was on over ten different meds for mental and emotional issues. I think that would definitely qualify as pill pushing. Do you know this psychiatrist well enough to know what his habits are like? If not, only time will tell. But my idea of a good doctor, any kind of doctor, is one who explains all the options and why he would recommend one over another.

There are other options. Therapy or talk therapy is all-encompassing. Some useful (useful in my non-professional opinion) sub types are cognitive-behavioral therapy and cognitive or behavioral therapies.

There are other medications. Lots of them, I think. There’s a link below to a list of psychotropic medications. There are descriptions next to the names. It’s important to note that many medications are effective to treat disorders other than what is commonly noted. For instance, a psychiatrist once gave me a med for seizures because it’s been observed to stabilize moods. I looked up anticonvulsants (seizure meds) and read that they regulate a neurotransmitter’s release and reabsorbtion (GABA for the one I read about). Just like other psychotropic meds. Well, they effect different neurotransmitters.

I’ve also heard from two different psychiatrists that the usual way of deciding what they’ll prescribe is what they’ve seen work the most. Not everyone responds in the same ways. They said that if they have ten patients, they’ll prescribe, for instance, prozac to all ten. I may work in 5-7 people, and for the 5-3 people it didn’t work for, they’d move on to another medication. Maybe your psychiatrist has seen prozac work many times and this is why he worded his opinion the way he did.

There are other factors, too. A psychiatrist gave me remeron. It was horrible. He later said that if he had known that I had social anxiety issues he wouldn’t have prescribed it for me. So don’t take that one.

It took me about five psychiatrists to find the good one I have now. Oddly, he’s even better than the ones I saw when I had health insurance. If you decide to go the med route, you should make sure your doc is competent. Maybe try asking him to explain something you’ve already researched so you know if he’s right or not. Call him on it if you have different info so he can explain if there’s been some new development you didn’t read. A certain level of trust is necessary. I’m not saying trust him with your life, but if you think he’s incompetent or unethical you’ve got a problem.

(Sorry this is sooo long!!)

For the last few months, I have been on 20mg of Paxil to treat my social anxiety disorder. It has certainly helped, but resulted in weight gain and an increase in cholesterol. What other medications have people found effective, which do not cause drowsiness or weight gain?

I am not interested in benzodiazepines, natural treatments or CBT.

I have found that Zoloft works well with minimal side effects compared to other anti-anxiet medications. I’ve been on it for months and have had NO side effects. Medications do work differently for people, so it just depends. There are so many of these meds on the market right now, one is bound to work for you. I agree that you should not have to deal with those side effects.

I am a 64-year-old man ,is there any appropriate
therapy available that could improve my long standing anxiousness?

Social anxiety is an experience of fear, apprehension or worry regarding social situations and being evaluated by others. People vary in how often they experience anxiety in this way or in which kinds of situations. Anxiety about public speaking, performance, or interviews is common.

Social anxiety disorder (SAD), also referred to clinically as social phobia, is a psychiatric anxiety disorder involving overwhelming anxiety and excessive self-consciousness in everyday social situations. People experiencing social anxiety often have a persistent, intense, and chronic fear of being watched and judged by others and being embarrassed or humiliated by their own actions. Often the triggering social stimulus is a perceived or actual scrutiny by others. Their fear may be so severe that it significantly impairs their work, school, social life, and other activities. While many people experiencing social anxiety recognize that their fear of being around people may be excessive or unreasonable, they encounter considerable difficulty overcoming it. This differs from shyness, in that the person is functionally debilitated and avoids such anxiety provoking situations by all means. At the same time, a person with social anxiety may only feel the fear of the disorder during certain situations. For example, an actor or singer may feel fine on stage, but afraid of social situations in everyday life.

Social anxiety is often part of only a certain situation—such as a fear of speaking in formal or informal situations, or eating, or writing in front of others—or, in its most severe form, may be so broad that a person experiences symptoms almost anytime they are around other people. Many people have the specific fear of public speaking, called glossophobia. In this case, the fear is not actually of public speaking, but a fear of doing or saying something which may cause embarrassment. Approximately 13.3% of the general population will experience social phobia at some point in their lifetime; with the male to female ratio being 1.4:1.0, respectively. Physical symptoms often accompany social anxiety, and include blushing, profuse sweating, trembling, nausea, and stammering. Panic Attacks may also occur under intense fear and discomfort. An early diagnosis helps in minimizing the symptoms and having other mental illnesses such as depression. Some sufferers also use alcohol or drugs to reduce fears and inhibitions at social events.

A person with the disorder may be treated with therapy, medication, or both. Research has shown cognitive behavior therapy, whether individually or in a group, to be effective in treating social phobics. The cognitive and behavioral components seek to change thinking patterns and physical reactions to anxious situations. This may be done through a technique called role playing. Prescribed medication consists of a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). Such treatment has a high response rate and low risk of dependency but has been criticized for its adverse side-effects and possible increase in suicide risk.

Attention given to social anxiety disorder has significantly increased since 1999 with the approval of drugs for its treatment. Marketing campaigns by pharmaceutical companies may be largely responsible for driving this.

Treatment

Arguably the most important clinical point to emerge from studies of comorbid social anxiety disorder is the necessity for early diagnosis and treatment. Social anxiety disorder remains underrecognized in primary care practice, with patients presenting for treatment only after the onset of complications such as major depression or substance use disorders. Up to 80% of those treated for social phobia claim to have their anxiety under control, according to the Anxiety Disorders Association of America. Improvement is lower for those with more severe social phobia and with comorbid disorders, such as avoidant personality disorder and depression. The patients who achieve full resolution are usually far fewer; there are still many who, after receiving treatment, are unable to function in the long-term without anxiety symptoms.

Research supported by the NIMH has shown that there are two effective forms of treatment available for social phobia (and anxiety disorders): certain medications and a specific form of short-term psychotherapy called cognitive-behavioral therapy (CBT), the central component being gradual exposure therapy. Medications include antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs), as well as a benzodiazepene.

Pharmacological treatments

SSRIs

Selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants, are considered the first choice by doctors in defusing fears associated with social phobia and related anxiety disorders. These drugs are designed to elevate the level of the neurotransmitter serotonin. The first drug formally approved by the Food and Drug Administration was paroxetine, sold as Paxil. Compared to older forms of medication, there is little risk of tolerability and drug dependency. However, their efficacy and increased suicide risk has been subject to controversy.

In a 1995 double-blind, placebo-controlled trial, the SSRI paroxetine was shown to result in clinically meaningful improvement in 55% of patients with generalized social anxiety disorder, compared with 23.9% of those taking placebo. An October 2004 study yielded similar results. Patients were treated with either fluoxetine, psychotherapy, fluoxetine and psychotherapy, placebo and psychotherapy, and a placebo. The first four sets saw improvement in 50.8 to 54.2% of the patients. Of those assigned to receive only a placebo, 31.7 percent achieved a rating of 1 or 2 on the Clinical Global Impression-Improvement scale. Those who sought both therapy and medication did not see a boost in improvement.

General side-effects are common during the first weeks while the body adjusts to the drug. Symptoms may include headaches, nausea, insomnia and changes in sexual behavior. Treatment safety during pregnancy has not been established. In late 2004 much media attention was given to a proposed link between SSRI use and juvenile suicide. For this reason, the use of SSRIs in pediatric cases of depression is now recognized by the Food and Drug Administration as warranting a cautionary statement to the parents of children who may be prescribed SSRIs by a family doctor. Recent studies have shown no increase in rates of suicide. These tests, however, represent those diagnosed with depression, not necessarily with social anxiety disorder. However, it should be noted that due to the nature of the conditions, those taking SSRIs for social phobias are far less likely to have suicidal ideation than those with depression.

Other drugs

Although SSRIs are often the first choice for treatment, other prescription drugs are also commonly issued.

Benzodiazepines are a more potent alternative to SSRIs. The drug is often used for short-term relief of severe, disabling anxiety. Although benzodiazepines are prescribed for long-term use, there is much concern over the development of drug tolerance, dependency and recreational abuse. Benzodiazepines, such as Xanax augment the action of GABA, the major inhibitory neurotransmitter in the brain; effects usually begin to appear within minutes or hours.

In 1985, before the introduction of SSRIs, anti-depressants such as monoamine oxidase inhibitors (MAOIs) were frequently used in the treatment of social anxiety by researchers such as Donald Klein and Michael Liebowitz. Irreversible MAOIs, most notably phenelzine, has been more efficacious than benzodiazepines in the short-term (8-12 weeks). Relapse is common, which may result in long-term usage. Because of the dietary restrictions required, high toxicity in overdose, and incompatibilities with other drugs, its usefulness as a treatment for social phobics is limited. Reversible inhibitors of monoamine oxidase subtype A (RIMAs) also inhibit monoamine oxidase. In contrast with MAOIs, reversibility means that they can inhibit the enzyme only temporarily. Because their action is short-lived and selective, they have a better safety profile than the older MAOI drugs. A special diet does not need to be strictly adhered to.

Some people with a form of social phobia called performance phobia have been helped by beta-blockers, which are more commonly used to control high blood pressure. Taken in low doses, they control the physical shaking of anxiety and can be taken before a public performance.

Psychotherapy

Research has shown that a form of psychotherapy that is effective for several anxiety disorders, particularly panic disorder and social phobia, is cognitive-behavioral therapy (CBT) (Burns, 1999). It has two components. The cognitive component helps people change thinking patterns that keep them from overcoming their fears. A person with social phobia might be helped to overcome the belief that others are continually watching and harshly judging him or her. The behavioral component of CBT seeks to change people’s reactions to anxiety-provoking situations. A key element of this component is gradual exposure, in which people confront the things they fear in a structured, sensitive manner. This is done with support and guidance when the therapist feels the patient is ready and only with the permission of the patient and at the pace the patient wishes. Cognitive-behavior therapy for social phobia also includes anxiety management training, such as teaching people techniques such as deep breathing to control their levels of anxiety.

Cognitive behavioral group therapy (CBGT), founded upon research done by Richard Heimberg, is a similar psychotherapeutic approach. It is generally held for 12 weekly sessions which run for two or three hours. A range of 4-10 patients and two therapists are involved in sharing individual experiences, participating in simulated exposures, and completing homework assignments in the goal of replacing irrational and automatic negative thoughts in social situations. A sample homework assignment might include reading a book or initiating a conversation with an acquaintance. Even in CBGT, sufferers are treated individually. Each person is exposed to different levels of anxious situations, depending on the severity of their illness.

These two types of cognitive behavior therapy have proven effective in reducing anxiety among social phobics. A 1998 study by Heimberg and Michael Liebowitz and a 2004 experiment showed the efficacy of CBGT.

I have Asperger’s syndrome, and social anxiety as a result. I don’t want to take meds and there isn’t any cognitive behavioral therapy remotely nearby, so I’m looking into acupuncture. Anyone who’s tried acupuncture for anxiety, what’s it like? How effective was it? Do you have to get it regularly for it to work?

Acupuncture can help manage anxiety in many cases. Often it will take more time for the therapeutic effects of acupuncture to be realized over pharmacological interventions because it is a more mild treatment. The upside is less negative side-effects.

In my clinical experience you are looking at 6 to 8 weeks of treatment for the anxiety to come under management, although, it can take longer in some cases. You may need to continue monthly treatments to manage the anxiety. However, everyone responds individually to medical treatments so there is no way to know if this will hold true for you.

I have recently taken several on line tests from which i have found out that i may have social anxiety disorder. I have no insurance, or doctor that i can go to. What would you recommend for me to do in order to get examined and if diagnosed to get some treatment? I live in Illinois close to Chicago. I would greatly appreciate your advice.

Why not treat it with a combination of vitamins, exercise and possibly some calming herbal supplements?

While for the vitamins, going to a good doctor would be helpful as they can do a blood test and determine if you have any vitamin deficiencies or any other underlying causes of how you’re feeling (such as an underactive thyroid, hormonal imbalance or a lack of certain amino acids) you might want to start by taking some good multi-vitamins.

If you’re not exercising regularly, beginning a regular program of exercise is another way you can combat anxiety. Evidence suggests that exercise postively affects the levels of certain mood-enhancing neurotransmitters in the brain. Exercise may also boost feel-good endorphins, release tension in muscles, help you sleep better and reduce levels of the stress hormone cortisol. It also increases body temperature, which may have calming effects. All of these changes in your mind and body can improve such symptoms as sadness, anxiety, irritability, stress, fatigue, anger, self-doubt and hopelessness.

And finally, here are some herbal supplements that may help you (herbs are available at the corner drug store and at health food stores):

Kava (Piper methysticum) is a member of the pepper family that has been cultivated by Pacific Islanders for over 3000 years for use as a social and ceremonial drink. The first description of kava came to the west with Captain James Cook, who traveled through the South Seas in a number of celebrated voyages. To this day, when village elders or others in the Pacific Islands come together for a significant meeting, they begin with an elaborate kava ceremony. Currently, kava is used in Europe and increasingly in the United States to treat stress, anxiety, and insomnia.

Valerian: Nature’s valium. Another favorite for the treatment of anxiety is valerian. Derived from the dried rhizomes and roots of this tall plant, which grows in wet soil in many countries, valerian has been used for thousands of years as a folk remedy. As a natural relaxant, it is useful for several disorders including restlessness, nervousness, insomnia, menstural problems, and "nervous" stomach. Valerian acts on the brain’s GABA receptors to produce a tranquilizing action that is similar to Valium-type drugs, but without the same side effects.