Last updated on 10/31/2020
What is Social Anxiety Disorder?
It is normal to feel anxious in several situations. For instance, giving a presentation or going on a date may cause feelings of butterflies in the stomach. However, in social anxiety disorder, also known as social phobia, everyday interactions cause significant fear, anxiety, embarrassment, and self-consciousness because people fear being judged or scrutinized by others.
People with social anxiety disorder be afraid or anxious that leads to avoidance that can disrupt their life. Severe stress can affect the daily routine, school, work, or other activities.
Social anxiety is a chronic mental health condition in which coping skills of psychotherapy and medications can help people gain confidence and improve their ability to interact with others.
What could be the potential symptoms of social anxiety disorder?
Feelings of discomfort or shyness in certain situations are not always the signs of social anxiety disorder, especially in children. The degree of comfort levels in social situations varies from person to person, depending upon personality traits and life experiences. Some individuals are naturally reserved, while others are more outgoing.
Contrary to everyday nervousness, social anxiety disorder includes anxiety, fear, and avoidance that interfere with daily life activities. The disorder typically begins in the early to mid-teens, though sometimes it can start in adolescents and adults.
Symptoms of a social anxiety disorder include persistent:
- Fear of situations involving judging
- Worrying about embarrassment
- Humiliating oneself
- Fear in interacting with strangers
- Fear of your anxiety being noticed
- Fear of physical signs that may cause embarrassment such as sweating blushing, trembling, or having a shaky voice
- Avoiding being the center of attention
- Avoiding doing things out of fear
- Having anxiety prior to a feared event or activity
- Analyzing performance and identifying flaws after a social event
- Expecting the worst possible consequences during a social situation
For children, anxiety is about interacting with adults or peers. They may show their fear by crying, clinging to adults, having temper tantrums, or refusing to speak in social situations.
Other symptoms of social anxiety disorder are when a person experiences anxiety and intense fear only during performing or speaking in public, but not in different social situations.
Sometimes several physical symptoms can accompany the social anxiety disorder, including:
- Fast heartbeat
- Nausea or stomach upset
- Difficulty catching your breath
- Lightheadedness or dizziness
- Muscle tension
- Feeling blank mind
What can be the causes of social anxiety?
Like other mental health conditions, social anxiety disorder is likely to arise from a complex interaction of environmental and biological factors. Possible causes of social anxiety can be:
- Inherited traits: anxiety disorders are inherent; they run in families. However, it is still not known how much of social anxiety is due to genetics and how much due to learned behavior.
- Brain structure: A brain structure called the amygdala plays a vital role in controlling fear response. People having an overactive amygdala may have an excessive fear response, causing heightened anxiety in social situations.
- Environment: social anxiety may be a learned behavior. Some people develop this condition after an embarrassing or unpleasant social situation. Also, there can be an association between social anxiety and parents who either have anxious behavior in social situations or are more overprotective or controlling of their children.
What is the link between social anxiety and depression?
Feelings of anxiety about being around other people can evolve into feeling low in general, mainly if you isolate yourself or stop participating in feared activities. At the same time, several symptoms of depression can also make one fear of being around other people for many reasons.
Researches show that there is a strong relationship between social anxiety disorder and depression.
The generalized social anxiety disorder is associated with an increased co-occurrence with major depressive disorder, post-traumatic disorder, panic disorder, and alcohol use disorders, among others.
Other potential risks of having SAD and depression together
If a person has both SAD and depression, a study published in 2001 in the Psychotherapy Casebook of Primary Care Companion Journal of Clinical Psychiatry demonstrates that the person also has a risk of several other related health conditions due to this combination, including:
- Risk of suicide or suicide ideation
- Enhanced risk of alcohol-related problems
- Lesser response to treatment therapy
- Impairment of occupational or social functioning
Additionally, if a doctor or a health care expert diagnoses you with both a social anxiety disorder and depression, you are likely to have severe and chronic symptoms.
Can social anxiety disorder cause later depression?
The Archives of General Psychiatry,2001 contains a study that says developing social anxiety disorder at an early age has a link to developing depression later on, but not every person having SAD at an old age becomes depressed.
When a doctor diagnoses you with a social anxiety disorder at a younger age, appropriate treatment can reduce the risk of developing depression at a later age.
What to know if you have both social anxiety and depression?
Social anxiety disorder and depression are two of the most diagnosed mental health conditions in the United States. Depression is persistent sadness, while social anxiety is an irrational fear and worry about social interactions.
Social anxiety and depression are two separate conditions, but they can co-occur, which creates a unique challenge. According to reports, nearly 70% of individuals get diagnosed with both disorders. Generally, social anxiety disorder occurs first, then comes depression.
An individual with social anxiety has trouble making friends and maintaining close relationships. Fear of social interactions often results in missed opportunities. A person unable to control symptoms may become frustrated, hopeless, isolated, irritated, and ultimately depressed.
Several people with social anxiety have a history of bully, rejection, or ignorance. These experiences affect their self-confidence and self-esteem, triggering depression later on.
What are the combined symptoms of social anxiety and depression?
If your doctor diagnoses you with social anxiety and depression, you must have signs of both the conditions at the same time. Social anxiety can cause both emotional and physical symptoms before, during, or after social interactions.
We have already discussed the symptoms of social anxiety. Now we will see the symptoms of depression that come along:
- Low energy
- Lack of motivation
- Loss of interest in once-loved activities
- Trouble sleeping
- Inability to focus
- Feelings of hopelessness
- Sleeping too much
- Body aches
- Suicidal thoughts
The symptoms of depression comorbid with social anxiety in children include:
- Crying or tantrums
- Stomach aches
- Sensitivity to rejection
- Poor academic performance
What are the available treatments for social anxiety and depression?
Treatments are available for successful improvement of social anxiety and depression when they occur together. If you have both, a doctor may choose some therapy for you that works for both conditions.
Psychotherapy, also known as talk therapy, teaches you how to replace negative thoughts with positive ones. It is helpful in both SAD and depression.
With any type of depression treatment, it helps first to identify the underlying issues that trigger sadness. In our case, the triggering problem is usually social anxiety. Therefore, a therapist may focus treatment on developing social skills and building confidence in social settings.
Cognitive Behavior Therapy
CBT is an effective psychotherapy that helps understand how your thoughts influence your behavior and feelings.
Social anxiety is often due to irrational fears, so one goal of the therapy is to help the person develop a more realistic thought pattern. So, instead of imagining the worst-case scenarios in social settings, people will learn how to expect practical outcomes.
A therapist may also recommend different kinds of therapies that address your fear, such as expose-based cognitive behavior therapy or group therapy.
Exposure-based cognitive behavior therapy helps you face your social fears under the proper guidance of a therapist. Firstly, a simple exposure starts, and then it becomes more complex or intense over time. It can be real-world exposure to fear, if possible. Or the therapist may use imagery with role-playing
Group therapy is an opportunity where you can practice social interactions in a controlled and safe environment. You will receive feedback from people who understand your struggle, and you will be able to talk openly without any fear of judgment.
Repeated exposure or group therapies help gradually diminish social anxiety. Once a person can manage anxiety, their mood, and depression improve.
Lifestyle changes also assist your recovery along with therapies and medications. For example, the following lifestyle changes may help you manage anxiety and depression:
- Getting plenty of sleep
- Exercising regularly
- Eating a balanced diet
- Avoiding alcohol and drug abuse as it can worsen anxiety and depression symptoms
It also helps people socialize more with others when they are comfortable and familiar with small settings. It reduces isolation, loneliness, and ease depression.
A therapist may use psychotherapy or behavior therapies alone or suggest you speak to your doctor about using an antidepressant or other drugs that aim at treating anxiety and depression.
Selective serotonin reuptake inhibitors are the first-line medicines for the treatment of social anxiety and depression. These include Paxil, Pexeva, and Zoloft.
The doctor also prefers benzodiazepines for treating anxiety. The best and most widely used medicines for the short-term treatment of anxiety disorder is Xanax.
How is Xanax useful in treating social anxiety and depression?
Your doctor may prescribe you Xanax if you have cognitive symptoms like worrying about performance or the judgment of other people.
Xanax or alprazolam is a benzodiazepine useful as a short-term social anxiety treatment. The medicine first got approval for medical treatment in 1981 and is currently a standard prescription for anxiety.
A doctor prescribes xanax to the patients of SAD as a short-term option that helps manage symptoms of social anxiety. It may be a first-line treatment but rather useful as a complement to other treatment options.
Xanax typically does not permanently cure your anxiety, but it helps reduce symptoms so that one can better take part in other forms of treatment, such as psychotherapy. As the medication starts working very quickly, it gives you some immediate relief if you suffer from severe episodes of anxiety.
Xanax treats anxiety that may be the central cause of depression. It treats signs and symptoms that can eventually convert to severe depression.
How Does Xanax work for the treatment of SAD and depression?
Xanax provides speedy relief of symptoms often seen in patients with social anxiety and depression. It typically works by binding to brain receptors. This slows down your brain activity and has the effect of reducing fear, anxiety, and feelings of terror. It also leaves you to feel relaxed, sleepy, and calm. Generally, the peak effects of Xanax reach within 1-2 hours of ingestion and wear off in about 8-10 hours.
Is Xanax the right medication for social anxiety and depression?
Xanax can put a lid on sudden overwhelming bouts of fear, panic, and anxiety, thus relieving social anxiety symptoms. But there are particular worries over benzodiazepine use.
According to a report of the Anxiety and Depression Association of America (ADAA), more than 40 million adults over the age of 18 years suffer from anxiety disorders, which is about 18% of the total population of our country.
The Journal of Addiction Medicine had a study saying that American doctors write more than 48 million prescriptions of Xanax every year. It shows the popularity and widespread of Xanax for anxious people.
Like all other medicines, Xanax also has some side effects that may occur while taking the medication for therapeutic use. The most common of them include drowsiness, dizziness, lightheadedness, headaches, and memory problems. Most of these effects improve within a few days.
Xanax is a schedule-IV substance and posses a high potential for abuse. In fact, Xanax is one of the most misused and abused drugs in the United States.
Despite all these adverse effects, people prefer to take Xanax due to its effectiveness and efficacy.