Therapy and Antidepressant Medication the Best Treatment for Social Anxiety

Panic and anxiety disorders are the most common mental health disorders. It's estimated that one in four Americans will suffer debilitating anxiety during their life.  More than 80 million prescriptions for anti-anxiety medication are written annually in the US. 

Social anxiety disorder is the most common anxiety disorder and the third most common mental illness in the US, impacting more than 19 million Americans.  People with social anxiety disorder, or social phobia, are overwhelmingly worried and self conscious in everyday social situations. They have an irrational fear of public embarrassment or disapproval, and avoid circumstances where they may be watched or judged by others.  They are extremely uncomfortable being the centre of attention or being around people they don't know. They may blush, sweat, shake and have difficulty talking or making eye contact in social situations, experiencing nausea, muscle tension, palpitations and cold, clammy hands. These physical symptoms add to their fear of being noticed and criticized.

Social anxiety is much more intense and long-lasting than everyday shyness or nervousness, interfering with the ability to engage in even routine work, school and social situations. People with social anxiety struggle to do ordinary things like take public transit, enter a room with people in it, order and eat a meal in a restaurant, return an item to a store or use a public washroom. Social anxiety sufferers realize that their fears are out of proportion to the situation, and often suffer from low self esteem, social isolation and a lack of achievement, resulting in depression.  They may "self-medicate" with drugs and/or alcohol. Phobic individuals are twice as likely to be addicted to alcohol as people without phobias.

Social phobia most often arises in childhood, adolescence or young adulthood, affecting more women than men. The cause of social anxiety is not totally understood, but it's believed to be a combination of factors including chemical changes in the brain, genetics, and environmental factors like stress or trauma. Early treatment is important to avoid needless distress and faster recovery. Left untreated, social phobia leaves sufferers avoiding social contact, limiting their personal and professional lives.

Fortunately, anxiety disorders are among the most treatable of mental health conditions. Social anxiety is commonly treated with a combination of medication and therapy. Antidepressant drugs are generally the medication of choice, in particular selective serotonin reuptake inhibitors (SSRI'S) and SNRIs (serotonin-norepinephrine reuptake inhibitors).  Antidepressants work by affecting the concentration and activity of neurotransmitters in the brain. Effexor, Celexa, Cymbalta, Prozac, Zoloft, and Paxil are all commonly prescribed for the treatment of anxiety disorders. Antidepressant medications address both anxiety and the depression that so often accompanies it. Some patients may be prescribed an anti-anxiety medication such as a benzodiazepine along with their antidepressant medication. If necessary, beta-blockers may also be prescribed to minimize physical anxiety symptoms such as shaking and a rapid heartbeat.

Combining antidepressant medicine with therapy offers the most effective and rapid relief. Cognitive behavior therapy (CBT) is considered the most effective psychotherapy for social phobia.  The cognitive component helps sufferers identify and change the thinking patterns causing them distress, such as "people are always watching and criticizing me". The behavioral component helps them change their actions, such as avoiding or shutting down in stress-provoking situations.

Ironically, the very symptoms they need relief from, the lack of awareness around social phobia and the stigma of having a mental health diagnosis make it difficult for social anxiety sufferers to seek treatment. It's estimated that less than one-third of the people who need help actually receive it.  As the condition usually arises in children and young people, it's crucial that parents and educators recognize the difference between "shy" and a social phobia.