Your doctor is the best source of information on the drug treatment choices available to you.
People with social phobia can benefit from a type of therapy called cognitive behavioral therapy. Cognitive behavioral therapy (CBT) teaches you to confront and overcome your fears. There are various types of programs, but the most effective appears to take a multifaceted group approach. Studies have shown that up to 75% of social phobics can benefit from CBT that includes social skills training (where you will learn through role playing and feedback to interact with unfamiliar people) and strategies to reduce and manage anxiety and minimize negative thoughts. This type of program also teaches you how to gradually re-enter feared situations without experiencing familiar anxiety symptoms.
People with social phobia have a high risk for having other simultaneous psychiatric conditions, including depression, panic disorder, agoraphobia, obsessive-compulsive disorder, general anxiety disorder, and substance abuse disorder Table 04. Up to 80% of people with social phobia are at a high risk for other psychiatric conditions at the same time. Having another psychiatric condition at the same time as social phobia can worsen symptoms, make it harder to find the best treatment, and increase suicide risk. In most cases, social phobia will develop before the second condition. The majority of people with social phobia, however, will seek care for the other condition before seeking care for their phobia.
Two of the most common accompanying conditions are alcohol abuse and major depression. Studies have also linked social phobia with accompanying depression to increased social disability and suicide attempts.
Table 4. Lifetime Risk for Other Psychiatric Conditions Among People with Social Phobia
Condition Percent risk Agoraphobia 44.9% to 47% Generalized anxiety disorder 20% Major depression 14% to 16.6% Alcohol abuse 12% to 18.8% Drug abuse 13% Obsessive-compulsive disorder 11.1% Panic disorder 4.7% to 10%
People with social disorder are more likely to be in a lower socioeconomic class and more likely to attempt suidice than people who do have this disorder. Although social phobia is a long-term disorder, it can be successfully controlled with medication. Most drugs begin to work within two to four weeks. Your chemical makeup combined with the severity of your symptoms will determine how well medication works.
Cognitive behavioral therapy can help to prevent symptoms from recurring when medication is stopped. Studies suggest that the most optimal treatment for social phobia combines medical therapy and CBT. Because CBT teaches you how to master and cope with your fears, your symptoms may be less likely to return if and when drug therapy is discontinued. In one study, the positive effects of a treatment plan that included medication combined with CBT were maintained for a mean 5.5 years after drugs were discontinued.
Contact your doctor if you experience side effects, or if symptoms worsen during treatment. Antidepressant medications can cause mild side effects (e.g., weight gain, sexual side effects, tension, and sleep disturbances) as they begin to build in the bloodstream to their optimal therapeutic level. Other medications used to treat social phobia may also cause certain side effects. Usually these side effects decrease over time; however, if you experience any especially disturbing effects, you should contact your doctor. You should also let your doctor know if your symptoms worsen while you are being treated, as this may be a sign that your medication isn't working, and that you need to try a different agent. Finally, your doctor or pharmacist can advise you of what you should do if you miss a dose or take too much.
Because drugs for psychological conditions take some time to work, your doctor may want to see you every two weeks during the first six to eight weeks of treatment. During these visits, you should be prepared to discuss how you are tolerating your medication, any symptoms that you may have experienced, and any issues that arise. It's also likely that your doctor will use a questionnaire or rating scale to determine your progress. Follow-up visits may decrease over time as your symptoms begin to stabilize. Eventually you may only need to see your doctor every three to six months.
- Alcohol and AntidepressantsThe dos and don'ts of drinking when you take antidepressants are mostly don'ts.
- Antidepressant Treatment TimelineYou can expect to feel some relief from depression symptoms as early as the first week, but the full response could take months.
- Medications to Avoid While on AntidepressantsCould your antidepressant interact with something else you're taking?