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Social Anxiety - Please Help Me Help My Wife

ssmith3427

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Dec 5, 2015
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2
Hi there,

Allison has had some type of social anxiety her entire life, since the day she was born. As a baby, whenever she would come close to any other human, she would start shaking and crying. As a child she was always extremely quiet and shy and nervous. In social situations she always had the rapid heart beat, loss of breath, blood rushing to the face feeling, excessive sweating, etc.

High school was the same situation, she kept to herself in order to avoid the anxiety, but she did have friends who she socialized with and was okay with. Every lunchtime at school she would need to walk into the cafeteria with her friends - if her friends were already seated inside, she’d call home almost in tears and having a slight panic attack, and get her mom to pick her up, as the anxiety and stress of walking in alone and trying to find where her friends were seated was too much.

In her first year of University, she had a roommate, and her roommate was extremely popular and outgoing and because Allison hung out with her roommate, this boosted Allison’s confidence and made her feel cooler, and in turn decreased her anxiety. Allison was a big partier that year, going to parties drinking twice a week and hanging out with the ‘coolest’ and most confident people there. Although she still had anxiety all the time, it was greatly decreased because of this, as her confidence and self-esteem had increased because she associated herself as one of these popular cool people, which she has always strived to be her whole life. But the anxiety was still there, for example if she was going to class and she has to walk into the classroom even 1 minute late, she would just avoid the class and be too scared to go. Another example is for every single class, she always got there 20 minutes early, because getting there within 5 mins of class starting caused her great anxiety in the sense that she didn’t know if she’d be able to find a seat, if they’d all be taken and she’d look dumb for trying to find where to sit.

Within the last few years her anxiety had been very high. In April 2013 she went on Zoloft, which helped at a dose of 100mg. She had always been a happy person, and the Zoloft made her a little bit happier and much more calm. She said in many situations that it helped calm her physical symptoms ie. racing heart, loss of breath, etc. It helped her get through school for graphic design and do presentations. She said she felt a normal amount of nervousness that a normal person would feel, instead of the extreme anxiety that she would normally get. However, Zoloft was making her gain quite a bit of weight, and made her acne very bad as well. So she came off Zoloft in February 2015.

It is also important to note that from Sept. to December 2015 she did CBT. It helped slightly. Around this time she also went to an endocrinologist. The most significant points are - Androstenedione 18.9 (average in normal person 1.5 - 11.50 mmol/L), Creatine 14.3 (average in normal person 6.3 - 13., mmol/d), and Dopamine 3135 (average in normal person <2600 mmol/d). Note 1, she was on Zolofat for almost 2 years while this test was conducted. Note 2, no seratonin test conducted. Note 3, could she be Dopamine dominant from birth?

Since she has stopped taking Zoloft, her life has spiralled downward. She had become depressed, which she’s never felt anything like in her entire life. She lost interest in things she used to enjoy, she had nothing to look forward to. A lot of this depression was actually caused by her work as a freelance graphic designer. She couldn’t handle the stress of the clients, the clients needs and demands and how they always needed things done asap. She also nearly had a heart attack every single time she would just check her email, because she didn’t know if there would be an email from a client saying they didn’t like her work, or what revisions needed to be done, or if they wanted to talk on the phone. She couldn’t deal with speaking to clients on the phone or meeting up in person, and to be honest even emailing them back. These situations caused her such great anxiety that she was constantly overwhelmed and absolutely hated life.

She went back to the doctor in May 2015 to get a different medication that didn’t cause weight gain- Wellbutrin. She was on 100mg of Wellbutrin, which ended up just increasing her anxiety and made her angry all the time - which is completely opposite of her personality. The immense agitation set her off and the smallest things. She stopped taking Wellbutrin in July 2015. I've no idea why Zoloft worked to an extent, yet Wellbutrin has such a negative effect?

Since then, she had completely stopped working and took that major stress and cause of hating life out of the picture. She feels like a weight has been lifted off her shoulders since she has stopped working. However, even a single client email she reads now puts her right back to how she felt back then. Her anxiety is still very high, in any type of social situation at all her heart races, loss of breath, weak knees, crazy sweating. She always feels like she’s in fight or flight mode, high adrenaline. And the mental thinking part of it is actually worse now than ever before. She has always had the racing thoughts, negative thoughts (while she was on Zoloft the thoughts were more positive, but she still had negative ones). She will constantly have thoughts going through her head like “what are these people thinking of me”, “do they think I’m sitting properly or should I lean in a different direction?”, “should i say hi to this person or will they think I’m weird? Will I come across as rude if I don’t say hi?” These thoughts are constantly swirling around in her head and she can’t stop thinking them. Her thoughts are all basically about how people perceive her, and how they are judging her. She can’t stand the thought of someone judging her in a negative light. In addition she has low self-esteem. She always feels inferior to others. When talking with others, she is 20% focusing on what she is saying, and 80% focusing on how she is coming across - how the other person is perceiving what she is saying.

In addition, when she goes out with her friends she is able to put on this super friendly, super outgoing front. We think it's because she's got so much adrenaline at the time, that it's allowing her to be able to put on this alternate version of herself with no problem at all. It's hard to describe.

Overall problems:

- social anxiety
- constant negative thoughts
- low self-esteem
- minor depression
- needs validation from others in order to be happy and confident (example many people liking her new facebook profile picture will make her feel great and can change her mood right around)
- zero libido (has never had one)
- joint pain (knees, ankles, back)
- plantar faciatis
- hiperhydrosis
- acne

Current Treatment:

- no medication
- exercise 30 minutes every day
- glutin free, dairy free healthy eating plan
- meditation every two days
- plan on seeing a natruopath within the next month

All in all I am looking for different solutions to try and help my wife with her anxiety, be it different medication or alternative lifestyle choices I can implement for my wife. Recommendations are all very welcomed. Thank you!
 
Why did she go off Zoloft?

I know this suggestion will be frowned upon, but has she considered trying benzodiazepines to combat anxiety? It is the golden standard for this type of disorder. We all know it will leave you dependent on them after a while, but as with everything you do there is a price you have to pay; nothing is free. What she needs to consider is whether her symptoms are debilitating to the point where her life quality is lowered so much that it warrants using anxiolytics like benzodiazepines. I would recommend trying them out; if the improvement is significant, then continue on them.

Also, just having a fast-onset benzodiazepine on hand would reduce anxiety in itself because you essentially always know you "have a way out".
 
She should avoid benzodiazepines like the plague. They are appropriate for things like panic attacks, which are sporadic. But this person has constant anxiety, and would have to take benzodiazepines every day to feel better. The current medical consensus is that benzodiazepines should not be used long term to treat social anxiety disorder, and in the end she would end up being a SAD patient with a benzodiazepine dependence.

One thing she may want to try is propranolol. It will help with the physical symptoms of anxiety. There are also several other antidepressants that she could try.
 
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Why did she go off Zoloft?

I know this suggestion will be frowned upon, but has she considered trying benzodiazepines to combat anxiety? It is the golden standard for this type of disorder. We all know it will leave you dependent on them after a while, but as with everything you do there is a price you have to pay; nothing is free. What she needs to consider is whether her symptoms are debilitating to the point where her life quality is lowered so much that it warrants using anxiolytics like benzodiazepines. I would recommend trying them out; if the improvement is significant, then continue on them.

Also, just having a fast-onset benzodiazepine on hand would reduce anxiety in itself because you essentially always know you "have a way out".

She is scared of taking Benzodiazepines because she has read they are terribly addictive and one has to keep upping the dose for the same effect over time. I see your chain of thought, but I think she would like to exhaust every possible solution before trying Benzo. Thank you!

She should avoid benzodiazepines like the plague. They are appropriate for things like panic attacks, which are sporadic. But this person has constant anxiety, and would have to take benzodiazepines every day to feel better. The current medical consensus is that benzodiazepines should not be used long term to treat social anxiety disorder, and in the end she would end up being a SAD patient with a benzodiazepine dependence.

One thing she may want to try is propranolol. It will help with the physical symptoms of anxiety. There are also several other antidepressants that she could try.

I will Google Propranolol, thanks for the suggestion!
 
Hi there!

I see serotonin2A beat me to it, I really recommend trying propranolol or a similar "sympatholytic", that will blunt the adrenaline/stress response.

I think a lot of her physical symptoms are from adrenaline and these sorts of drugs will help curb her adrenaline and let her function closer to natural, without a stress response that you would expect from a life threatening situation. If she starts having trouble with sleep on propranolol I recommend extended release melatonin, 1mg will do the trick. Rarely these beta blockers inhibit the production of melatonin a bit in some few people.

Going back on anti depressants is another option I would definitely think about (could consider doing both with propranolol on hand for break through anxiety), I recommend Citalopram, it has the highest affinity for serotonin instead of norepinephrine (adrenaline). One of the benefits of chronic administration of SSRIs is it helps to desensitize a type of serotonin called 5-HT2A. Normally serotonin is thought of as a good thing (and kinds such as inhibitory 5-HT1A are good) but 5-HT2A is generally a "bad" kind that is very excitable and can lead to anxiety.

If I remember right there are mutations in 5-HT2A that can give some people problems since birth, as well as serotonin transporter mutations. Just curious, is there any hint of autism spectrum disorders in the male side of her family? People who work with computers and technical jobs etc?

Ultimately, her 5-HT2A might be out of balance (worth mentioning there are adrenaline receptors on serotonin brain cells), and although you can try to correct this with chronic administration of SSRIs (and if the SSRIs were indeed working for her mood then I think that hints that you should try citolapram) I think directly antagonizing (shutting down) the 5-HT2A is an option that should be considered as well. If you wanted to try this route in the future I would try a drug called Mirtazapine and see how It goes. If taken at night it will help her sleep better as well (5-HT2A antagonists are primarily sleep medications). She could definitely experience weight gain on Mirtazapine however.

So I would definitely try propranolol, and don't knock it if 20mg doesn't work, she might need 80mg or more if her adrenaline physiology is different. Careful with low blood pressure of course. Propranolol won't do much for the thoughts in her head except for she might be better off mentally because of a reduced adrenaline response in her body, and this sense of confidence could help with negative thoughts. But an SSRI could help address the serotonin issues she's been having and help stop the thought patterns that are setting off the adrenaline in the first place.

Do we know anything about her birth? Did her mom have pre term labor or was she born premature? Was her mother given any drugs to delay birth such as terbutaline?

Also, I should ask at this point, who's been overseeing her care? A general practitioner? I'm not sure if I would bother with the naturopath if you're running low on pennies, a neurologist/psychiatrist will be much more helpful. Also careful with insurance regarding the naturopaths. Also just to be clear homeopathy is bogus. There are definitely benefits to things like Turmeric and I take it myself but don't think things like it will cure your wife or anything. I hope your naturopath is willing to prescribe the propranolol and Citalopram.

I can definitely recommend mindfulness meditation and especially meditating on the breath (great for someone with anxiety and panic attacks), the goal is to shut off the voice in the head, which it sounds like would be very difficult for your wife, therefore it is even more important. Sometimes there are not necessarily problems with one specific brain cell such as serotonin but the problem is the brain cells are connected sub optimally, it's hard to correct a problem of connectivity with drugs that don't actually change the connections. Of course CBT and counseling are important, exposure therapy will be important as well but for some reason some people are bad at doing "fear extinction", and might need assistance with medication to fully live their lives. There are after all some conditions like schizophrenia that do not respond to counseling and must be medicated.

SSRIs are probably the best shot your wife has at changing the connections, along with mindfulness meditation and exposure therapy. Exercise I absolutely approve of, 30-45 minutes of cardio had so many incredible benefits for the brain and builds new brain cells that help your wife with fear extinction.

Best of luck, any questions are welcome.
 
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My bet is that if her anxiety is directly related to her strong need to be accepted by people, be part of the group etc., perhaps emotionally intimate with people etc., you should look into that to solve the problem. Are you a person who shows a lot of affection? Working on your sexual life might be helpful, it's a powerful way to create strong deep bonds, I can't imagine deepening romantic bonds without sexual life, and I suppose you could both find a lot of satisfaction in it once she manages to overcome her anxiety.

I had similar problems with anxiety for years though they have quite different roots in my case, still certainly related to interpersonal bonds. I dulled my problems for most of that time, I took many types of drugs (including antidepressants), got dependent on opioids and benzodiazepines, and it's all useless. In my opinion going back on SSRI's is one of the worst options out there for her even if they had helped her in the past. I suppose she wants to solve the problem and live her life truly happily and not just cover the problem for another few years. She needs to look into herself and find the root of all those emotions that make her life so unbearable (meditation & self-hypnosis can be helpful). Perhaps SSRI's allow for rewiring, but honestly speaking if I were to try increasing my serotonin levels to work on myself/release emotions, I would go for MDMA or some more selective serotonin releaser in single doses, SSRI's never again, and let her not take benzodiazepines, ever, in her situation it's going to be a downward spiral into dependence, in the end they're going to make her anxiety even worse. I've read some interesting stuff about propranolol too, supposedly it helps to release trauma during therapy (you talk about your trauma while blocking adrenaline/noradrenaline response and begin to see your trauma in a different light). You could also look into MBTI, it's a personality test, it's been very useful for me to understand myself and how differently people think, do stuff, and make decisions.
 
I'd recommend CBT (cognitive behavioral therapy). CBT is about developing skills for dealing with the anxiety when it arises. one mistake she seems to make all the time is running away from the situation that makes here anxious (eg not going to a lecture at all just because you're one minute late). this is the natural response to a stress factor, but unfortunately it also makes things worse over time, because one gets so used to running away from what makes them anxious that it gets harder and harder to confront it. but as I said, CBT is there to learn to confront the situation and not run away.

I also get anxious in certain situation (eg lecture hall, train, crowded places in general), but I learned not to run away from that (I had times where I was unable to go on a train alone because I would freak out immediately), and nowaydays I just stay put and accept it. and accepting the anxiety makes it better over time. :)
 
I agree with serotonin2A about the benzos. I'm prescribed Ativan solely for panic attacks. My psychiatrist was bugged when I told him I was using them for sleep and reiterated that they were for panic attacks only and only PRN. He instead prescribed me mirtazapine and doxepin for both sleep and depression (they are cyclic antidepressants).

It sounds like some serious psychotherapy is in order, but I wouldn't give up on medications yet. It took me four years of seeing an addiction psychiatrist before we stumbled upon the right cocktail of drugs that I don't feel like I need alcohol to be comfortable in my own skin.
 
I'm seeing a misinterpretation of her symptoms as anxiety she sounds manic depressive or bipolar, maybe lithium treatment or valproate
 
Phenibut has been a wonder drug for me as far as social anxiety is concerned. As long as you keep the doses reasonable (1-1.5g is a good starting dose, don't go above 3) its effects are sustainable, unlike benzos.
 
^^^I second the valproate as an option, though there can be serious long term side effects so it wouldn't be the first thing I tried.
 
Sounds perhaps like avoidant personality disorder, ever look into that as a possibility? Also, does she have any history of abuse sexual or otherwise?
 
I second propanol, it defeinly is good when i get a high amount of adrenaline, my arms start to sweat etc. I also agree that her anxiety may be to "fit into the group". I had/have this problem. I used to have it much worse but I am starting to realize that trying to fit in is stupid(not calling your wife stupid). What also helps a lot is gabapentin. It works on alpha2delta receptors and blocks calcium channels, I think it also effects glutamate, I may be wrong on those things, so anyone correct me if im wrong.

But it makes everything that shouldn't matter, well.. Not matter. To simplify its effects, it takes away the feeling that everyone's eyes are on you.
 
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I have a social anxiety disorder and propranolol is definitely the best for me. I love the fact that it doesn't effect your mind at all, but lowers the adrenaline. The best combination for me is propranolol and GHB, but the GHB is illegal and hard to get. I don't think it's possible to get any better than that combination. The GHB is good because it feels like alcohol and increases your natural desire to socialize without effecting your mental performance like alcohol does and the propranolol makes you less nervous, so together it's the best combination.
 
propranolol is a good idea but getting back on zoloft is an obvious chocie too
 
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