Pharmacotherapy options in social anxiety disorder: which is the best medicine?

When you are diagnosed to have social anxiety disorder, sometimes, the doctor will persuade you to take drugs. But which one is most effective for your social anxiety disorder?

The efficiencies of benzodiazepines, monoamine oxidaseinhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs) in social anxiety disorder have been investigated in placebo-controlled clinical trials.

On the basis of the clinical evidence, an SSRI is recommended as first-line treatment for social anxiety disorder. Treatment should be initiated at a low dose (for example, paroxetine 20 mg) and then increased gradually if necessary to obtain a clinical response. Improvement can be evident after 4 weeks, but if the patient does not benefit from some improvement after 8 weeks one should consider switching to an alternative SSRI or the addition of behavioural therapy. It is important to emphasise that social anxiety disorder is a chronic condition that required long-term maintenance treatment to achieve full remission and to consolidate the response.

Pharmacotherapy should be continued for at least 1 year, to prevent relapse and allow patients to benefit from their improvement in social, education and work functioning.

According to its studies, it takes about 12 weeks for Fluvoxamine to be more effective than placebo, Paroxetine about 4 weeks to show its effectiveness.

In the future posts, I will show you if there are alternatives and treatments that have quicker effects for social anxiety disorders.

reference: Facing the challenge of social anxiety disorder
By: Herman G.M. Westenberg

Cholesterol and cabs good for your depression?

Babeybear, From your letter I can tell you are a beautiful and thin girl suffered social anxiety and a little depression, but for diet, balance is the key. If you don't take balanced diet. It would have negative effect on your depression.

Cholesterol, good or bad for depression?

In fact it has reported that if your cholesterol below about 4.42mmol/L(170mg/dL)then you have more chance of having depression, social anxiety disorder, stroke, poor memory and more chance of attempt suicide.

Why? The reason is the cholesterol, when decomposed, would be the material to compose the transmitters of the neurons, so it would largely influence your mood and memory.

Cholesterol is rich in meat, fish, eggs etc, so take enough cholesterol each day will help you to better your depression symptoms.

Babeybear, you mentioned that you always feel fatigue and dizziness, maybe it's not the symptom of social anxiety disorder, but low pressure, because of your excessive dieting. I recommend you to have further check by your doctor.

Taking carbs, good or bad for depression?

Taking carbs would be good for you.

But please note that eating sugar is not always good for depression.
It's reported that taking sugar will improve your mood, but make you sleepy and relaxed, no motivation for working, while protein/fat meals always enable you to be awake, alert, quick thinking and acting, bright and reduce depression.

The world is a reflection of yourself

(time to introspection of myself, : ) )

You will feel the same way of the outside world as you feel about yourself.

Today I happened to read one article written by Hohn Dery, MD, the outer world is a projection of our own mind.
Our specific moods are reflections of the early life. If you experience neglect, abuse, emotional deprivation, you will have more chance to be low and sad. So what you experience now, is a mirror of your past.
In fact, your mood is also a mirror of what happened in the last few days or months, if you suddenly feel depressed, then there much be something happending not quite long ago that depresses you.


The way to change your mind to feel better:

(In fact it's quite like the way of "panic away" and that book I mentioned depression book)
1. Introspection of your mind, you can write dairies, you know what you are feeling like, more important is why you feel that way. (It's no use writing how you feel bad all your dairies)
2. Once you notice your negative thought, it's time to STOP it. Replace that with a positive one because everything has its advantages.
3. Connect to the outside world, feel compassion and love. But do not always connect with people who are too sad about theirselves and feel no hope about future BEFORE YOU FEEL BETTER.
4. A special way is to visualize yourself in a crown chakra, the crown glowing bright and shining like gold. Because it's said to have the highest frequency of emotional vibration.

What is cognitive behavior therapy (CBT)? Is CBT effective?

In the last post I have mentioned social anxiety disorder(SAD) and CBT.

But what is SAD, what is CBT? Does CBT really effective? Does CBT effective than simple education?


Social anxiety disorder(SAD) is also called social phobia, characterized by a persistent and marked fear and avoidance of the social situations which he/she fears being evaluated negatively or being subjected to embarrassment.


SAD is believed to be the most prevalent of psychiatric conditions. But most individuals are never identified or obtain a treatment of social anxiety disorder.


Unlike transient worries and fears that do not lead to significant impairment of functioning. SAD always result in high levels of distress and significant functional impairment. Few friends, limited extracurricular activities, underachievement. SAD may also combined with depression, anxiety and substance use disorders.


There are two cognitive-behavioral treatments:
1. Individual CBT(I-CBT)
Participants in the individual therapy met for 1 h per week. Followed the same format and covered the same content as G CBT.
2. Cognitive behavioral group therapy(G-CBT)
Met for 2h each week and coled by 2 therapists, groups ranging in size from 4-6 patients. The treatments included psycho education, breathing retraining, cognitive restructuring, simulated and in Vivo exposure to phobic stimuli, social skills training.
3. Psycho educational supportive treatment(PST) which is the control group of CBT
A group of 4-6 persons met for 2h per week led by two therapists. Including discussions each session around various topics relevant to SAD, therapists offered support but not provide specific advice, teach skills, problem solving or assign exposure exercises.

Recovery rate of all kinds of CBT for adults
Check the result above. We evaluated these three CBT treatments to the SAD in adolescents.
The treatment effect was determined by calculating percentages of patients who no longer met criteria for social phobia at post treatment and follow up.
Results revealed that all three methods are effective to reduce the symptoms and distress and increase in social performance. G-CBT was more effective for follow up.

reference: Cognitive behavior therapy for generalized social anxiety disorderin adolescents: A randomized controlled trial, by James D. Herbert

How to build your recovery? The importance of the enviroment for recovery

As in the post, social anxiety disorder, Amy was lucky. But the social service system of our society is not always work in the way to promote getting better from depression and other mental illness. That's the truth no matter that the noble goals voiced by people stresses how important to be nice to the illed ones.

In Kevin Turnquist's report, the environment to promote recovery is so important that nearly no one can fully recover if they didn't find an environment that meets sort of requirements.

1. Home, a stable place for one to recover. It must be safe enough so would smooth their feelings. But our current system seems impossible to reach this goal.

2. Find someone to communicate, only when you connect with the outside world, you have a feeling of returning to the community, friendships, hobbies, work, maybe also your pets. You must find something. Read this post if you have problem communicating with the others: social anxiety disorder.

Another point to add:

Help yourself when the others can't help you. There are quite a lot of depression treatments. Just like cold, if you have cold, no doctor, try to treat that yourself, then you will feel better.

Social anxiety disorder: individuals unworthy?

Cognitive-behavioral therapies(CBTs) is the most well researched psychosocial treatments for social anxiety disorders. Today I want to say something about social anxiety disorder because depression is often accompanied by social anxiety disorder and social anxiety disorder always leads to depression.

But first answer a question: what is the social anxiety disorder? Or what's your problem with the social communication?

When talking about depression, doctors would give you suggestions that you should talk more to your friends and be more active in the social communities. But for many people, it's a bottleneck because you believe:

1. The others always laugh at you, they are bad and unworthy.
2. You don't know what to speak with the others
3. You feel anxious and nervous with the others

These are some of the symptoms of social anxiety disorders.
I don't want to talk too much about the theories, but only one little true story Amy told me some months ago.

Amy worked in a small company, she suffered social anxiety disorder 2 years ago, though nearly recovered, still suffered from time to time and I was trying to help her. One day she met some problems with her work and didn't get a good result. It was not her fault but she still felt a little sad and told her best friend who also in that office. One day later, she happened to hear that friend telling another one about this. At that time, she felt so depressed and sad that she just didn't want to talk to her friend any more.

When she asked me what to do, I told her to face it and talked to her friends instead.

Are you kidding? She is so unworthy!

Yes seriously I think you should talk to her. And that is the most effective way to reduce your depression and anxiety.

Surprisingly, that colleague to whom Amy's friend told went to visit her first, asked her about this, Amy barely smiled and a little self-mockery. That guy laughed, yeah it's interesting, but you are lucky because our boss nearly killed me with my current task. He then gave her some suggestions and told her to be optimistic.

Amy was moved and she suddenly knew the reason why she had social anxiety disorder.
People around you are always not as bad as you think, most of them are friendly especially when you are friendly. The reason why you have a misunderstanding to them is because lack of communication.
But social anxiety disorder varies according to people's different personality, different situations, I will talk about the other treatments of CBT later.

Why antidepressants still prevail when proved not so effective on depression?

I left a question in the older post: Why antidepressants still prevail?
Read here: Why antidepressants don't work
The fact is:



According to Dr Thomas L. Murray, Jr. in his article "The loss of client agency into the psychopharmaceutical-industrial complex"
Some of the assumptions are
1. phychiatry is part of a larger system which is called the psychopharmaceutical industrial complex(PPIC), driven by capitalism primarily.
2. power dynamics are inherent in the doctor-consumer relationship


Composition of PPIC:
1. American Psychiatric association(administrative and research psychiatry)
2. Pharmaceutical industry
3. Public relations
4. Advertising firms
5. Patient support organizations(e.g., the National alliance on mental illness[NAMI], children and adults with attention deficit/hyperactivity disorder[CHIAA])
6.The National institute of mental health(NIMH)
7. Managed care organizations
8. Flow of sources among these groups

The PPIC existed based on a simple assumption that: within a capitalistic society, mental disorders are a chronic condition resulting from a diseased brain that requires expert medial treatment in the form of mass produced pharmaceuticals.(Kuppin&Carpiano, 2006)
So pharmaceutical companies(first line of the following pic)develop a continuous flow of medications and provide funding to NIMH and patient support organizations like NAMI and CHADD. In turn, NIMH and patient support organizations endorse the disease model and its effects lobby policy makers to fund psychiatric research through NIMH.The pharmaceutical industry relies on academic psychiatrists to produce evidence that supports their medications.
Academic psychiatry depends on the pharmaceutical industry for research grants. Insurance companies rely on pharmaceuticals to contain costs.
As a capitalistic system with a drive toward greater profits, modern health care has evolved into a sickness care system. The consumers don't easily leave this system because the empowerment to overcome their emotional problems.