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Everyone gets a little nervous in social situations from time to time. There are the proverbial butterflies in the stomach or a tongue-tied greeting. But when social situations routinely prompt reactions such as blushing, sweating, rapid heartbeat, breathlessness, shaking voice, utter fear and frank avoidance, it could be social anxiety disorder. That’s more serious than run-of-the-mill jitters, but the good news is that it can be treated.
Every case of social anxiety disorder is unique, so treatments will differ as well. Lifestyle changes, learned coping mechanisms, and therapy are common treatments. Medications are as well, but can antidepressants be prescribed to treat social anxiety? While the short answer to that question is “yes,” let’s begin by taking a closer look at the condition.
What Is Social Anxiety Disorder?
Social anxiety disorder is a chronic mental health condition characterized by a persistent and deep fear of being watched and judged by other people. Mild, moderate, and extreme apprehension causes any number of physical responses, such as those mentioned above. An estimated 15 million people suffer from the condition in the United States, often starting around the tender age of 13.
In today’s world, it’s difficult not to experience some sort of anxiety. You may worry about paying your bills or losing your job. Health is a common source of anxiety, especially during a persistent global pandemic. You may worry about mass shootings, racial unrest, political division, or war.
None of this is uncommon. However, when your anxiety begins to control your life and impact the performance of important responsibilities, it becomes a disorder.
There are different types of anxiety disorders, including phobias, panic disorder, generalized anxiety disorder, and social anxiety disorder. Most anxiety disorders share certain characteristics. But if you suffer from social anxiety disorder, you avoid interactions with others because you fear embarrassing yourself or are so self-conscious that you find it difficult to cope when you’re around other people.
You can experience social anxiety in myriad situations, and they don’t all involve speaking in front of an audience. You might fear just crossing a stage, eating in front of people, using a public restroom, talking to a date, or boarding a plane. Social anxiety can affect your relationships, your health, and your sleep.
What Causes Social Anxiety Disorder?
Genetics, brain structure, and environment all contribute to social anxiety disorder. Those who have parents or siblings with the disorder are more likely to suffer from it as well. But it is unclear whether that’s nature or nurture. Being raised by or around people who suffer from social anxiety disorder can lead a person to learn the same type of behavior. That is nurture.
As for nature, a 2017 study concluded that the SLC6A4 gene, which transports serotonin, plays a role in social anxiety disorder. Serotonin is the chemical that controls your mood, and the right amount helps to keep you on an even keel. Too much or too little, especially when combined with stress, can cause chronic social anxiety disorder. The SLC6A4 gene can be passed from parent to child.
And then there’s the structure of the brain itself. You’ve probably heard about the concept of “flight or fight.” It’s the natural response to a perceived threat, processed in the part of the brain called the amygdala. The amygdala, the hippocampus, hypothalamus, and thalamus are components of the limbic system, which is the part of the brain that influences emotion. The amygdala is what makes you feel fear, increases your heart rate, causes you to sweat, as well as prompting other common physical reactions to apparent danger. The information about the danger is processed by the prefrontal cortex. That’s the area of the brain responsible for reasoning, impulse control, comprehension, and problem-solving.
For those who don’t suffer from social anxiety disorder, the prefrontal cortex analyzes the situation and tells the amygdala whether danger actually exists or not. If there is no peril, the prefrontal cortex influences the amygdala to shut down those physical responses. But if you have social anxiety disorder, the prefrontal cortex instead revs up the amygdala, regardless of whether the danger is real or not.
Certain life experiences can also cause social anxiety disorder, such as physical, sexual, or emotional abuse; ridicule; bullying; or family conflicts like divorce, abandonment, and trauma. Individuals with physical characteristics that make them stand out — anything from a speech impediment to a missing limb, tremor, large birthmark, or obesity — are likewise more apt to develop it.
How Is Social Anxiety Disorder Diagnosed?
Social anxiety disorder can’t be diagnosed with a blood test or a digital scan. Instead, a healthcare provider will ask you questions or have you complete a questionnaire about what situations cause your symptoms and what those symptoms are. They will explore a range of potential triggers that could affect your disorder, such as alcohol use, a physical health issue, or certain medications you may be taking.
Your answers will determine whether you meet the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for social anxiety disorder. These criteria include evidence of intense and persistent fear of being humiliated, judged, or embarrassed in social situations; anxiety disproportionate to a situation; avoidance of social situations due to anxiety; anxiety’s interference with daily life; and a lack of evidence that the anxiety is being caused by a health condition or substance abuse.
How Is Social Anxiety Disorder Treated?
Because social anxiety disorder may develop from more than one source, treatment for the condition also varies. It’s common for patients to undergo more than one type of treatment. Your healthcare provider may want to try different treatments in various combinations to find the best course for you.
Cognitive behavioral therapy is the most common psychotherapy used to treat social anxiety disorder. Its purpose is to change the way you think and perceive circumstances. Cognitive behavioral therapy relies on three key principles:
- Your thinking is distorted or unhelpful.
- You have been applying learned, adverse thinking in situations where it is inappropriate.
- You can learn new habits of mind and apply coping mechanisms that can improve your experience of anxiety and your comfort in the world.
Part of your therapy may include confronting some of the social situations that cause anxiety, working your way up from encounters that mildly disturb you to those that bring on the most severe symptoms. You will learn how to perceive situations differently and develop ways to cope with your fears so you can control them.
For example, your therapist may work with you on ways to assert yourself in situations where you feel you’re being judged unfairly rather than shrink from them or avoid them all together. Then, your therapist may engage you in role play to help you apply what you have discussed.
In the digital age, using virtual reality in therapy may be successful for some patients. Therapy might also involve working on your social skills so you can apply them in specific situations.
Medications can be one of the most effective ways to treat social anxiety disorder. That’s largely due to those previously discussed issues with the chemicals and processes in your brain and how medications act on them. Certain medications are designed to keep an overactive limbic system in check.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Serotonin is a neurotransmitter. Basically, neurotransmitters are tasked with carrying chemical messages from one nerve cell to another – those transmitters are then reabsorbed into the cells that released them. “Reuptake” is the important factor here. SSRIs slow the return of serotonin to the original cell that dispensed it so it can travel to more cells.
If an individual’s brain isn’t sending enough serotonin to the limbic system, they may experience depression. SSRIs are antidepressants designed to increase the amount of serotonin available for the brain to use. Increased serotonin also benefits anxiety disorders, including social anxiety disorder. Using them long-term may result in other neurochemical changes that improve your mental health overall.
Buspirone is another medication which treats anxiety. This drug attaches to the serotonin receptors to increase the neurotransmitter’s movement among cells. Buspirone is typically prescribed for those who are taking SSRIs for social anxiety disorder but continue to experience symptoms.
So, to answer the question posed by this article, antidepressants can be prescribed to treat social anxiety disorder, and they show solid results.
Benzodiazepines, nicknamed “benzos,” are a family of anti-anxiety medications that go by many other names. Valium, Xanax, Klonopin, and Ativan are a few of the brand names you have likely heard of. Healthcare providers frequently prescribe benzodiazepines for social anxiety disorder. However, they are controlled substances to which patients can easily become addicted. They also involve some major potential side effects, such as confusion, sleepiness, headaches, and slowed respiration.
Beta blockers are medications that some people take to lower blood pressure, treat angina, migraine headaches, and control heart rhythm. Because they can lessen physiological reactions like shaking hands and elevated heartbeat, they are often prescribed to treat the symptoms of social anxiety disorder. Beta blockers will not, however, address the root causes.
Lifestyle Changes That Can Help Manage Social Anxiety
As with most physical and mental health issues, changes in lifestyle can help reduce your social anxiety. Studies show that eating a healthier diet and avoiding caffeine, alcohol, and nicotine may benefit other therapeutic interventions. So can meditating, practicing relaxation techniques, and engaging in regular moderate exercise.
Poor sleep quality is common among those who suffer from social anxiety disorder. Unfortunately, it can negatively impact treatment of the disorder. On the flip side, once you’re getting better sleep, it can make some treatments more effective.
Getting regular moderate exercise is one lifestyle change that can improve sleep quality. Limiting screen time (smartphones, tablets, video game devices, desktop computer monitors etc) is another. Screens emit blue light that decrease the production of melatonin, a brain hormone critical to a healthy circadian rhythm. Minimizing that disruption can help you sleep better.
Limiting screen time may also reduce your exposure to phenomena that can trigger your social anxiety in the first place. Social media abounds with opportunities to unfairly judge and compare yourself against friends and strangers alike. There is also the potential for online bullying and body shaming, which can exacerbate feelings of anxiety. By reducing the time you spend scrolling social media, you can lessen the impact of both.
Coping Mechanisms for Handling Social Anxiety
Coping mechanisms are strategies you can use when confronted with social situations that make you anxious. There are many you can practice to relieve stress, from deep breathing exercises and relaxation techniques to yoga and meditation.
Preparing for anxiety-inducing encounters is a key coping mechanism. Before you interact socially, you anticipate the reactions you might have and plan for how you will respond to them if and when they occur. Write down what might happen and what your negative reactions to those events might be. Then, for every negative response, write down a positive one you can use to replace it.
Learning to refocus is another effective way to cope with anxiety in a social encounter. Instead of hearing only the thoughts running through your mind, you focus on external events. For example, insert yourself into the conversation, ask others questions, even talk about the weather if doing so will put you in that moment and get you out of your head.
What Questions Should I Ask My Medical Provider?
If you suspect you suffer from mild, moderate, or severe social anxiety disorder, talk to a healthcare provider right away. When you do, there are a few questions you should ask.
First, discuss your symptoms and request a formal diagnosis. This should include asking questions to rule out other potential causes for your social anxiety symptoms.
If you are diagnosed with social anxiety disorder, consult your healthcare provider about possible treatments, including medication, therapy, lifestyle changes, and coping mechanisms.
Make sure you inquire whether they are successfully treating other patients with the disorder. If not, ask for recommendations of providers who are. This would include questions such as, “Should I see a psychologist or psychiatrist?” and “Should my provider be a doctor, or can I see a nurse practitioner?” In many cases, proper treatment will come from a combination of providers, from those who prescribe medication to therapists who specialize in anxiety disorders to wellness professionals and even nutritional therapists and dieticians.
Finally, ask your provider about alternative therapies, such as yoga, meditation, and acupuncture. Although homeopathic approaches are unlikely to resolve your social anxiety on their own, they may be beneficial when used in conjunction with medication and/or therapy.
Face Your Social Anxiety Today
As with any intervention for mental health disorders, starting treatment early will help. Addressing social anxiety while symptoms are mild or moderate will be easier than beginning treatment when they are severe. If you’re past that point, though, don’t beat yourself up. What’s important is treating the disorder from where you are now.
So confront your social anxiety by getting started today. That way, a better tomorrow may be closer than you think.