Influences

social anxiety disorder influencesNeurochemical and neurocognitive influences

Some scientists hypothesize that social phobia is related to an imbalance of the brain chemical serotonin.

A recent study report increased Serotonin and Dopamine transporter binding in psychotropic medication-naive patients with Generalized Social Anxiety Disorder.

Sociability is also closely tied to dopamine neurotransmission.

Low D2 receptor binding is found in people with social anxiety.

The efficacy of medications which affect serotonin and dopamine levels also indicates the role of these pathways.

There is also increasing focus on other candidate transmitters, e.g. Norepinephrine, which may be over-active in social anxiety disorder, and the inhibitory transmitter GABA.

Individuals with social anxiety disorder have been found to have a hypersensitive amygdala, for example in relation to social threat cues (e.g. someone might be evaluating you negatively), angry or hostile faces, and while just waiting to give a speech.

Recent research has also indicated that another area of the brain, the ‘Anterior cingulate cortex’, which was already known to be involved in the experience of physical pain, also appears to be involved in the experience of ‘social pain’, for example perceiving group exclusion.

Substance induced

While alcohol initially helps social phobia, excessive alcohol misuse can worsen social phobia symptoms and can cause panic disorder to develop or worsen during alcohol intoxication and especially during alcohol withdrawal syndrome.

This effect is not unique to alcohol but can also occur with long term use of drugs which have a similar mechanism of action to alcohol such as the benzodiazepines which are sometimes prescribed as tranquillisers.

Benzodiazepines possess anti-anxiety properties and can be useful for the short-term treatment of severe anxiety.

Like the anticonvulsants, they tend to be mild, well tolerated, and extremely safe.

Benzodiazepines are usually administered orally for the treatment of anxiety; however, occasionally lorazepam or diazepam may be given intravenously for the treatment of panic attacks.

The World Council of Anxiety does not recommend benzodiazepines for the long term treatment of anxiety due to a range of problems associated with long term use of benzodiazepines including tolerance, psychomotor impairment, cognitive and memory impairments, physical dependence and a benzodiazepine withdrawal syndrome upon discontinuation of benzodiazepines.

Despite increasing focus on the use of antidepressants and other agents for the treatment of anxiety, benzodiazepines have remained a mainstay of anxiolytic pharmacotherapy due to their robust efficacy, rapid onset of therapeutic effect, and generally favorable side effect profile.

Treatment patterns for psychotropic drugs appear to have remained stable over the past decade, with benzodiazepines being the most commonly used medication for panic disorder.

Approximately half of patients attending mental health services for conditions including anxiety disorders such as panic disorder or social phobia are the result of alcohol or benzodiazepine dependence.

Sometimes anxiety pre-existed alcohol or benzodiazepine dependence but the alcohol or benzodiazepine dependence act to keep the anxiety disorders going and often progressively making them worse.

Many people who are addicted to alcohol or prescribed benzodiazepines when it is explained to them they have a choice between ongoing ill mental health or quitting and recovering from their symptoms decide on quitting alcohol and or their benzodiazepines.

It was noted that every individual has an individual sensitivity level to alcohol or sedative hypnotic drugs and what one person can tolerate without ill health another will suffer very ill health and that even moderate drinking can cause rebound anxiety syndromes and sleep disorders.

A person who is suffering the toxic effects of alcohol or benzodiazepines will not benefit from other therapies or medications as they do not address the root cause of the symptoms.

Symptoms may temporarily worsen however, during alcohol withdrawal or benzodiazepine withdrawal.

Complications

Left untreated, social anxiety disorder can be debilitating.

Your anxieties may run your life.

They can interfere with work, school, relationships or enjoyment of life.

You may be considered an “underachiever,” when in reality it’s your fears holding you back from excelling.

In severe cases, you may drop out of school, quit work or lose friendships.

Social anxiety disorder can also lead to other health problems, such as:

* Substance abuse
* Excessive drinking
* Depression
* Suicide

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