Malaysian Anxiety Disorder

[milo001]

credit to wikipedia;


Social phobia (DSM-IV 300.23), also known as social anxiety disorder (DSM-IV 300.23) is a diagnosis within psychiatry and other mental health professions referring to excessive social anxiety (anxiety in social situations)[citation needed] causing abnormally considerable distress and impaired ability to function in at least some areas of daily life. The diagnosis can be of a specific disorder (when only some particular situations are feared) or a generalized disorder. Generalized social anxiety disorder typically involves a persistent, intense, and chronic fear of being judged by others and of potentially being embarrassed or humiliated by one's own actions. These fears can be triggered by perceived or actual scrutiny by others. While the fear of social interaction may be recognized by the person as excessive or unreasonable, considerable difficulty can be encountered overcoming it. Approximately 13.3 percent of the general population may meet criteria for social anxiety disorder at some point in their lifetime, according to the highest survey estimate, with the male to female ratio being 1:1.5.

Physical symptoms often accompanying social anxiety disorder include excessive blushing, sweating (hyperhidrosis), trembling, palpitations, nausea, and stammering. Panic attacks may also occur under intense fear and discomfort. An early diagnosis may help in minimizing the symptoms and the development of additional problems such as depression. Some sufferers may use alcohol or other drugs to reduce fears and inhibitions at social events. It is very common for sufferers of social phobia to self-medicate in this fashion, especially if they are undiagnosed and/or untreated. This sort of self-medicating behavior is usually always counter productive to the sufferer, as many illicit drugs and alcohol are depressants and only make the problem worse. Specific prescription medications have a far better success rate at treating social phobia than self-medication.

A person with the disorder may be treated with psychotherapy, medication, or both. Research has shown cognitive behavior therapy, whether individually or in a group, to be effective in treating social phobia. The cognitive and behavioral components seek to change thought patterns and physical reactions to anxious situations. Prescribed medications includes two classes of antidepressants: selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Attention given to social anxiety disorder has significantly increased in the US since 1999 with the approval and marketing of drugs for its treatment.

[milo001]

i'm an SAD.SAD makes my life difficult.didn't work since last year.

[milo001]

credit to Breakman from socialphobicworld forum.really grateful to him for allowing me to post in here:


How I fixed my social anxiety

short answer: benzo + stimulant prn
long answer: read on

Hello all,

I have lurked around this message board and others like it for over
10 years. I finally feel I have "fixed" my social anxiety and thought
I would let others know how I managed that. I deliberately did not
use the term "cured" since that would be too strong a term.

Some biographical background. I am a 40 year old male (originally
from India) now living in the United States. I suffer from "pure"
social anxiety, i.e. social anxiety without any other comorbid
disorders such as depression, agaraphobia etc. etc.

This is a long post organized based on phases of my life:

Phase 1: Happy Childhood (age 5-13)
If someone asked my how my childhood was, my answer would
be, "very happy". Lots of friends, successful in school, happy
family life etc. In other words, nothing obvious that would foreshadow
my subsequent social anxiety.

Phase 2: What the heck is this?? (age 13-22)
Starting around age 13, I found myself with increasing
symptoms of social anxiety. My SA had a large physical
component (pounding heart etc. in social situations).
Over this time the anticipatory anxiety (before
social situations) also started building up. By the
end of this period of my life, I was starting to
become obsessive about trying to figure out what
ailed me.

Phase 3: It has a name! (age 23)
Around age 23, after a lot of reading I managed
to self-diagnose myself. It was a huge relief
to find out that this affliction had a name.

Went to a doctor and got a prescription for
Inderal. Found this to be an amazing drug which
could really cut out the physical symptoms of
anxiety. Inderal is best taken on a prn (as-needed)
basis and that's how I took/take it.

Based on knowing that my physical symptoms
could be controlled, a slow process of
diminishing anticipatory anxiety began. So,
although drugs such as inderal only provide
symptomatic relief, they also provide a step towards
long-term effects, by allowing effective
exposure to happen.

Phase 4: Experimentation (age 23-39)
After seeing the positive effects of Inderal, I
increasingly came to believe that a chemical
solution to the problem was possible.

I started on a road of trying various approaches.
First stop: benzos. Once again, I started on a
prn basis. great effects! totally different than
Inderal, but very effective. A solution seemed
in reach!

Tried benzos (clonazepam) on an on-going basis.
This was my first brush with the penchant of
the (or at least my) brain to develop tolerance
to attempts to push it out of its equlibrium state.
I needed escalating doses to achieve the
same effect. With all that I had read about
benzo withdrawal, I felt that this (continuous
benzo administration) was a path best avoided.

Dialed back to benzos + beta-blockers prn.
With this regimen, I felt that I had my SA
"controlled", but not "beaten". Something
was missing.

Tried SSRI's. Dismal failure. Strong side
effects (eg. zero ability to orgasm). Gave it up.

Participated in a clinical trial for d-cycloserine.
This also involved concurrent CBT. Found this
helped somewhat. Later found that I had
received the placebo, so my response was the
CBT and not the d-cycloserine.

Phase 5: The "fix" is in (age 40)
As mentioned in the previous para, by this
time my SA was "controlled" but not "fixed".

Started doing a lot of self-introspection. Concluded
that the conception of Social Anxiety as primarily
an anxiety disorder was incomplete
at best.

I reasoned that if it was primarily an anxiety disorder,
it would be accompanied by many other anxiety
disorders (such as Agaraphobia, simple phobias,
GAD etc.). I have a "jumpy" disposition, but I felt
that that by itself would not explain why this particular
anxiety disorder came to so define my life.

Even taking benzos and beta-blockers I always
felt that the anxiety was still there, but being
blocked. (odd, I know).

This led me to my current working model that
in SA there is something that causes the fear
in the first place and something distinct that determines
how one reacts to the fear.

The latter is one's "nervous" disposition, one's
"jumpiness", sensitivity to stimuli etc. The benzos and the
beta-blockers calm the body by working on these
systems (increasing GABA and blocking adrenaline
respectively). I call this the "reactive" system.

For the time being I will call the other system the
"causal" system. (Note that I am not saying that this
corresponds to some particular brain structure. Just
a conception that I find useful).

I now believe that Social Anxiety lies along a spectrum, and
is not a monolithic disorder. People have varying
degrees of disfunction in their "causal" system and
in their "reactive" system. If one's SA is primarily
a disfunction of the "reactive" system then
benzos + beta blockers should provide complete
relief.

In my case, I have to come to believe that the causal
system is the "root" cause and contributes maybe
70% of my SA. The reactive system contributes maybe
30%.

After more reading (and talking with my pdoc), I
came to believe that the "causal" system is the
dopamine system and that drugs that boost dopamine
have the best chance of dealing with it.

The drug class that best boosts dopamine is the
stimulant class. However, I was perplexed by seeming
contradictions such as the fact that stimulants boost
anxiety but are also allegedly calming. Also I read
many horror stories about stimulant addiction.

In any case I decided to give stimulants a try (in
my case Vyvanse, but I believe any stimulant
will do the trick). For the first time I felt that my
SA was finally "fixed".

To avoid stimulant addiction and dose escalation,
I take the stimulant also on a prn basis.

Stimulants (taken carefully) I now believe are the
missing link. (I have heard that drugs like Nardil
uniquely boost both dopamine and GABA hence
hitting both systems).

The subjective experience of stimulants is
quite interesting. On a stimulant I find myself
very outgoing, love to talk, feel more authoritative,
more confident etc.

If SA has an evolutionary reason it is that for a
stable social dominance hierarchy, some people have to be
at the top of the hierarchy and some have to
be at the bottom. I believe SA may have been
evolutionarily selected for, since the general
characteristic (in its non-pathological form) is
a part of this social balance.

In any case, the feeling of a stimulant is that it
moves one up the social dominance hierarchy.

This also resolves (in my mind) the stimulant-causes-anxiety
paradox. The stimulant removes the root cause
of the fear. In my case, its impact on the
root cause (dopamine system) outweighs any
increased reactivity in the reactive system.

Phase 6: The cure? (the future)
At this point because of the prn-nature of my
solution, this obviously cannot be considered
a "cure". However, knowing that a non-anxious,
outgoing person is available on demand has signficantly
improved my life. I do have some constraints.
(for eg. I have an absolute constraint of not
taking a stimulant or benzo more than twice
in a week). But for the first time in my (post-
childhood) life I feel that I can stop obsessing
about this problem. If a cure comes along, so
be it. If not, I will be easily able to manage.

Final thought: I know everyone is different
and responds differently to meds. However, I
wanted to share my success as well as the model
I have evolved over many years. I hope this
can help you.

[ridz]

i know this site from socialphobiaworld..i'm now taking fluoxetine and clonazepam..no improvement yet..tensionnya...anyone know about cognitive behavior therapy....