Q: I have been suffering from social anxiety for about seventeen years. Through the years I have lost many friends and avoided many social events due to this. However for the past two years it has been extremely difficult to hold unto my job? Last year I was so desperate and suicidal that my doctor prescribed saphris. I ended up in the hospital exhibiting tardive dyskinesia and all kinds of psychotic behavior. Luckily after the saphris was discontinued and some time later the dyskinesia stopped. Although very silly of me I continued with the same doctor and many other many medications that did not work. In desperation because I was too frightened to go to work I became suicidal and had to go back into the hospital. I’m not ever returning to this psychiatrist . I’m in panic because the phobias are increasing and getting worst. Every day I’m more anxious about the many things I can no longer do. I guess I have been searching for a magic pill that can make me do those things which I cannot do!! What should I do at this point? I feel hopeless .
– Michelle
A: There are drugs that have been reported to help social anxiety. These include Paxil and the MAO inhibiters. In my experience (by the time a patient comes to me and has been to other psychiatrists) I have noticed very little effect from them. There are really two kinds of social anxiety: the more familiar sort is of people who feel unusually self-conscious in some familiar social situations. They tend to have three misconceptions about what other people are thinking about them. 1. They think they are being observed when they are not. 2, They think those who are observing them are making critical assessments of them, when they are not. and 3 They think that if they commit a faux pas, others will remember it, when in fact they do not. The treatment of this condition is graduated exposure in a way that permits the patient to discover what the others around him are really thinking.
A small sub-group of social anxiety disorder sufferers are those people who think that they are having a bad effect on others around them. They think that if they blush, they make others around them blush. They think that people passing them in the street veer away from them. Sometimes they think these others twist their faces into an expression of distaste. This is really a delusional disorder and is difficult to treat. Still, graduated exposure with feedback from someone the patient trusts does help.
I think successful treatment almost always requires the therapist to go into the phobic situation with the patient.(Our clinic at the White Plains Hospital runs a support group for social anxieties. You can call the clinic administrator and see if she can recommend your coming for an intensive treatment program, or if she can recommend a therapist for you closer to where you live.
– Dr. Neuman