Managing Social Anxiety: Medication Insights and Strategies

Medications for Social Anxiety Disorder

Hello, doctor.
I have been in a high-stress work environment for a long time.
Three years ago, I realized that the stress had escalated to the point where I became very anxious, and I constantly felt tense and anxious.
One to two years ago, I noticed that my hands would tremble when performing fine motor tasks, and the shaking worsened when I was nervous.
I was diagnosed with "essential tremor" at the hospital.
At the beginning of this year, due to the fear of shaking in social situations, I developed symptoms of social anxiety, especially before meetings and presentations, where I experienced severe palpitations, sweating, and intense tremors.
Unable to cope, I visited a psychiatrist who prescribed me the following medications: Lexapro 50mg once daily, Inderal 10mg twice daily, and Alprazolam 0.5mg twice daily.
However, due to concerns about addiction and side effects, I have not been consistently taking the SSRIs.
I primarily take the medications when I anticipate more anxiety-inducing situations, so my actual intake is about 10mg of Inderal daily and approximately 0.5mg to 0.75mg of Alprazolam weekly.
I have managed to cope with workplace demands for nearly a year this way.
However, yesterday, before an important presentation, I took 10mg of Inderal and 0.25mg of Alprazolam, and an hour and a half later, I still experienced anxiety, palpitations, sweating, and tremors.
This was very discouraging for me.
I would like to ask the doctor: 1.
Am I developing a tolerance to the medication, or is the dosage insufficient? 2.
If I do not take SSRIs continuously and only rely on Inderal and benzodiazepines as needed, along with psychological counseling and regular exercise, will this approach help improve my social anxiety? Thank you very much for your response.

Niming, 40~49 year old female. Ask Date: 2015/03/31

Dr. Liang Sunyuan reply Psychiatry

Hello, based on your description, it seems that you have managed well over the past year, with only a recent episode of heightened anxiety during an important meeting.
In fact, even with prescribed medication, achieving perfect control is not always possible; everyone can occasionally make mistakes or lose control.
Individuals who typically do not experience anxiety may also feel excessive anxiety during significant events, and as long as you can return to your baseline afterward, that is what matters.
I suggest you continue to observe your situation.
If you return to normal after this incident, you can consider it a singular event and accept that it is okay to occasionally not perform perfectly.
However, if your symptoms continue to worsen, I recommend following up with your healthcare provider to discuss whether a medication adjustment is necessary.
Wishing you all the best.

Reply Date: 2015/03/31

More Info

Managing social anxiety can be a complex process, especially when it involves medication and psychological strategies. Based on your description, it seems you are dealing with a combination of social anxiety and physical symptoms, such as tremors and palpitations, which can be exacerbated by high-pressure situations. Let's break down your concerns and explore some insights and strategies.

Understanding Your Medication
1. Tolerance to Medication: It is possible that you may be developing a tolerance to the medications you are currently taking. Tolerance occurs when the body becomes accustomed to a drug, leading to a diminished response over time. This could explain why you experienced anxiety symptoms despite taking Inderal (propranolol) and Alprazolam before your important presentation. It might be beneficial to discuss this with your healthcare provider, as they may consider adjusting your dosage or switching medications.

2. SSRI Usage: Selective Serotonin Reuptake Inhibitors (SSRIs) like Lexapro (escitalopram) are often prescribed for social anxiety disorder. While you have expressed concerns about side effects and dependency, SSRIs can be effective in reducing anxiety symptoms over time. If you are not taking them consistently, it may hinder your overall progress. It’s essential to have an open conversation with your doctor about your fears regarding SSRIs and explore the possibility of a treatment plan that addresses both your anxiety and your concerns about medication.

Non-Medication Strategies
1. Cognitive Behavioral Therapy (CBT): CBT is a highly effective treatment for social anxiety. It focuses on identifying and changing negative thought patterns and behaviors. If you haven’t already, consider working with a therapist who specializes in CBT. They can help you develop coping strategies for anxiety-provoking situations, challenge irrational beliefs, and gradually expose you to social situations in a controlled manner.

2. Mindfulness and Relaxation Techniques: Incorporating mindfulness practices, such as meditation or deep-breathing exercises, can help manage anxiety symptoms. These techniques can reduce the physiological responses associated with anxiety, such as heart palpitations and sweating. Practicing mindfulness can also help you stay grounded during stressful situations.

3. Physical Activity: Regular exercise is known to reduce anxiety and improve mood. Engaging in physical activity can help alleviate stress and promote overall well-being. Aim for at least 30 minutes of moderate exercise most days of the week.

4. Social Skills Training: If social situations are particularly challenging for you, consider participating in social skills training. This can help you practice and improve your interactions with others, making you feel more confident in social settings.

Long-Term Management
1. Monitoring Progress: Keep a journal to track your anxiety levels, medication usage, and any triggers you encounter. This can help you and your healthcare provider identify patterns and adjust your treatment plan accordingly.

2. Support Systems: Surround yourself with supportive friends and family who understand your struggles. Joining a support group for individuals with social anxiety can also provide a sense of community and shared experiences.

3. Gradual Exposure: Gradually exposing yourself to social situations can help desensitize your anxiety response. Start with less intimidating scenarios and work your way up to more challenging situations, allowing yourself to build confidence over time.

Conclusion
Managing social anxiety is a multifaceted approach that often requires a combination of medication, therapy, and lifestyle changes. It’s crucial to maintain open communication with your healthcare provider about your symptoms and treatment preferences. Together, you can create a tailored plan that addresses your unique needs and helps you navigate social situations more comfortably. Remember, progress may take time, but with persistence and the right support, improvement is achievable.

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