Social anxiety (SA) disorder also known as, Social Phobia, is a debilitating condition that almost everyone has experienced at some point in their lives. The most common form of social anxiety is fear of public speaking. This article will go over some of the common prescribed drugs as well as some over-the-counter (OTC) products that have been suggested to be good short term options to manage anxiety. One should always speak with their doctor before starting any new medication or supplement.
Social anxiety becomes a disorder once it starts to interfere with ones’ life. A small amount of social anxiety is normal, but when it becomes more severe it can affect ones’ life to the point they have to plan their day around their SA. For instance, one may not be able to go out alone or may have embarrassing physical symptoms like sweating and blushing around other people. This can create a negative feedback loop that feeds the anxious thought patterns. Some people also have illogical fears such as not being able to urinate around other people (paruresis) which is another type of social phobia.
Many people with social anxiety actually become fairly good at blending into the crowd. A socially anxious person may think they appear nervous or awkward around others when most of the time people don’t really notice and never would even guess that person is anxious. Even though a socially anxious person may be mistaken for “introverted” or “just a little shy”, dealing with this problem is something that is difficult.
Managing Social Anxiety
First off, if you do have social anxiety, it is best to consult a doctor first. A doctor will usually approach one of two options or a combination of the two. Those two options are: medication and Cognitive Behavioral Therapy (CBT). CBT is very effective but one has to force themselves to do it and it can be difficult when going at it alone.
One example of a CBT exercise would be your therapist instructing you to do increasingly embarrassing things and then encourage you to evaluate the outcome. As you do this, the thoughts should correct themselves but nevertheless, it can be extremely difficult to face the fear itself. It will also take a lot of repetition and practice to overcome the socially anxious thought patterns.
As a socially anxious person, you likely already know a lot of the above information and it may sound like a broken record. Unfortunately, CBT is the only thing that will really cure the anxious thought patterns. Medication is often introduced to help manage symptoms during hard times and CBT practices. Although medication will never cure social anxiety, it can temporarily block some of the panic involved and is usually meant as a temporary “band aid”.
Typical Medications to Treat Social Anxiety
Benzodiazepines (aka. Benzos) are extremely effective at blocking anxious thoughts and symptoms. They calm down the nervous system and also the brain. Your doctor may prescribe a benzodiazepine for your social anxiety. Unfortunately, benzos have many serious problems. First off, they are addictive and build tolerance very quickly. Benzos are extremely effective in the short term but should be avoided long-term as they can make anxiety worse and also cause cognitive defects.
SSRI’s & TCA’s
SSRI’s and TCA’s are commonly prescribed as a first line treatment for social anxiety. The problem is that SSRI’s and TCA’s may not be effective for social anxiety. There is lots of literature that points to that fact the SSRI’s are not much better than placebo for depression and anxiety. Also, high serotonergic activity in a part of the brain that controls fear response has recently been linked to social anxiety so it is possible SSRI’s and TCA’s can make your social phobia worse but more study needs to be invested into this area.
SSRI’s work by blocking the reuptake of serotonin (and other catecholamine neurotransmitters) and therefore, increase the serotonin levels in the brain gradually. This “low serotonin” hypothesis is extremely basic and long overdue for an overhaul in the medicinal community. Always follow your doctor’s directions, but please do your research around SSRI’s and these types of drugs including the possible side effects.
Beta blockers are a type of medication that act as an alternative to benzodiazepines. While they are not nearly as effective as benzos, they can work at blocking some of your physical symptoms. They won’t do much for dulling thoughts like benzodiazepines do but they can help reduce, sweating, rapid heartbeat and other physical symptoms of anxiety.
OTC Nootropics for Social Anxiety
Now a little disclaimer before you read this list, most of these OTC “nootropics” listed here are not actually nootropics. Most on this list could be addictive and might have side effects and interactions. If used carefully, these products might help to temporarily reduce social anxiety. A caveat is that most of these products are addictive and can build tolerance. The quasi-nootropics listed here should be used with care and you should always consult a healthcare professional before use. Also, mixing OTC nootropics and supplements with your medications can have negative consequences so be sure to practice due diligence before use.
Phenibut is very effective for social anxiety and anxiety in general. Some people claim phenibut can drastically reduce and even eliminate situational SA at varying dosages. Phenibut may even be as effective as benzodiazepines in some people but can build tolerance quickly if used improperly.
Phenibut works as a GABA-b agonist which acts as a calming agent in the brain and nervous system. Some explain phenibut effects similar to alcohol but without the same motor impairment. Phenibut should not be used more than 3 days consecutively and can build tolerance very quickly. Nevertheless, phenibut can reduce and or eliminate social anxiety when used as needed – just be careful to not overdo it or your may end up with addiction and withdrawal symptoms. Also, avoid mixing phenibut with other GABAergic drugs like alcohol or benzodiazepines and avoid using it when driving or operating machinery.
Tianeptine works differently then phenibut. It is not known exactly how tianeptine works but many claim it as a nootropic and anxiolytic nootropic. In one study, tianeptine and SSRI’s administered together cancelled the effects of each other out. Tianeptine is a Selective Serotonin Reuptake Enhancer (SSRE) which is considered opposite of SSRI’s. It also has an effect on NMDA glutamate receptors which has been suggested to cause its nootropic and anxiolytic effects.
If you consider tianeptine, make sure to be very careful with it. It has shown to be very well-tolerated however, in higher dosages it has shown to have opiate-like effects. When used in higher dosages, it can drastically reduce anxiety however, it can also be very addictive when used wrongly. Make sure to research tianeptine and talk to a healthcare provider about it before deciding to use it. Tianeptine can also interact with OTC and prescription medications and is not approved anywhere in the world as a medication to treat SA.
Progesterone is a natural hormone found in the body. It has been known as a “female hormone” but it is actually very important in men too and should not be confused with estrogen. Progesterone can spike during pregnancy and this may be why some pregnant women feel tired or mildly sedated. Real progesterone when ingested, can have a calming effect because it acts a positive allosteric modulator of the benzodiazepine binding site. While it may not be as powerful as benzodiazepines, it is claimed to have a calming effect.
There are a lot of fake progesterone products around. Most over-the-counter progesterone products come in creams and ointments. One effective formula is Dr. Ray Peats’s Progest-e formula which is pure progesterone bound with vitamin-e. The vitamin-e absorbs quickly into the skin and this delivers an effective mechanism for the body to absorb natural progesterone.
We suggest to read up on progesterone’s effects before using as it can affect other hormones and interact with medications. If you have low progesterone levels, this product may certainly help calm the nervous system but like with the other nootropics, should not be overdone. You can get you progesterone levels tested at the doctors or with home testing kits.
The only real cure for social anxiety is Cognitive Behavioral Therapy but prescription drugs can help take the edge off. There are also a variety of OTC nootropics and supplements that can be effective “band-aids”. It is healthy to adopt the mindset that anxiety can only be cured through therapy and that supplements or drugs are just a temporary solution to help manage the symptoms.
Social anxiety is a very treatable condition but can take a lot of hard work to fix. In the end, no one should rely on a chemical or natural substance to “cure” them because it will never work. Also, the things that do work can build tolerance fast and cause side effects so going after the root of the SA is the only true way to work through social anxiety.