Social anxiety has been ruining me for way too long
April 17, 2016 9:10 AM   Subscribe

Most typical treatments for anxiety and depression don't work for me: therapy doesn't work, SSRIs don't work and atypical anti-depressants such as Wellbutrin don't work. What other options do I have?

I'm a nervous wreck when out in public: I think everyone's judging me, when I hear people around me laugh I assume they're laughing at me, and I can't look anyone in the eye. My eyes move around like crazy trying to avoid the eyes of everyone around me which makes it hard for me to focus my eyes on anything, I experience extreme dizziness, chest pains, and, after a while, I start getting headachey. While experiencing these symptoms it's absolutely impossible for me to speak to anyone coherently and the embarrassment of not being able to speak coherently further worsens my anxiety.

I've been this way since my mid-teens and I feel I'm too old to still be experiencing this. I want to be able to live a better life, one where going to to the store, talking to someone on the street, using public transportation, or (constructively) arguing with someone isn't a challenge. Sometimes I feel quite hopeless as therapy doesn't work, SSRIs don't work and atypical anti-depressants such as Wellbutrin don't work. At all. Things that do seem to work, to an extent, at reducing my anxiety are exercise and a healthy diet, but I feel even this doesn't do enough. When it comes to drugs, alcohol is very effective at combating my problem but, for obvious reasons, I can't drink all the time. Also, though I haven't done it in a while, it seems to me that, in the past, smoking marijuana to the point where I'd get used to it (when I haven't done it in a while and start up again I typically experience severe paranoia) would sometimes make things better for me. I may get back into weed as I'm now able to legally obtain medicinal marijuana and am thinking that indica dominant marijuana would work better for me than sativa. I'm also thinking that I should get a vaporizer as I've heard they give you a 'smoother' high that is unlike the buzz you get from smoking it (is this true or just a myth?).

Someone recommended to me lately that I try to adopt a Buddhist mindset, something that changed their life and helped them reduce their anxiety, anxiety that was at points in their life so severe it which would prevent them from being able to do anything—even leave their home. Despite my tendency to avoid anything to do with religion, I promised them I'll read the book and will delve into it with an open mind as I'm really at my wits end and I promised them I'd read it.

Also, I read lately that psilocybin mushrooms can work very effectively as an anti-depressant. After reading this I did some Googling and came across a slew of research papers that show that they indeed can effectively reduce anxiety and depression in most people and usually not just temporarily but for the long term. Only problem? I haven't anywhere to get them. Now they are legal to grow in my country, but just the thought of growing them is pretty daunting for me and the initial cost of the equipment to grow them isn't exactly something I can afford to buy right now. If I have to though, I'll eventually grow them—strictly for personal use—and see if I get anything out of them.

I hate making threads like this, but as I said above, I'm really at my wits end. I don't really know what else to say other than: does anyone have self-help book recommendations? Drug recommendations? Or any kind of advice other than 'Just don't think negative thoughts!' (something that is easier said than done, is not at all helpful and is, unfortunately, the type of 'great' advice I tend to get from people in 'real life'.)
posted by GlassHeart to Health & Fitness (20 answers total) 25 users marked this as a favorite
Well, I am pretty sure Paxil helped with my social anxiety/GAD a good deal. I was later unhappy with the particular tradeoffs I wound up making, side effects wise*, but I think it did have a big part in doing the job as far as the core concern went. Social anxiety utterly defined my experience for much of my life (all my early years); now, it's not an issue, like I almost forget what it was like. I'm very comfortable in social situations, and am often taken for an extravert (am I guess "ambiverted").

I think informal, naturalistic exposure (jobs involving dealing with people, in which I was operating from a position of personal strength, with support from management - tutoring and the like, not customer service) helped, also.

*rapid and significant weight gain; apathy (incl indifference to previously central activities, art, and loved ones); SSRI discontinuation syndrome, even with a slow taper. I had and have seriously mixed feelings about it. It's a crapshoot, though; not everyone experiences those kinds of side effects, and there are now better and more widely known ways of getting off that stuff when you need to (i.e. introducing a different SSRI at the same time that you're tapering down). Not sure if Paxil is widely prescribed these days, though.
posted by cotton dress sock at 9:30 AM on April 17, 2016 [2 favorites]

I've been doing a mantra meditation for about 8 years now for social (and other forms of) anxiety. 15 minutes in the morning, 15 at night. I learned about the meditation program I follow from metafilter. Here's the link-

If you commit to it, it's really quite useful.

Also, just wanted to say that, while I have certainly had some fun with mushrooms in the past, I wouldn't use them for therapeutic reasons. Especially since it looks like you haven't had any luck with the pharmaceutical approach before.
posted by brevator at 9:33 AM on April 17, 2016 [3 favorites]

Someone recommended to me lately that I try to adopt a Buddhist mindset, something that changed their life and helped them reduce their anxiety, anxiety that was at points in their life so severe it which would prevent them from being able to do anything—even leave their home. Despite my tendency to avoid anything to do with religion

You can pick up a meditation/mindfulness practice without having to have any part in religion. I manage anxiety that is not as severe as yours with a few things

1. regular offline time (40 min am, 40 min pm no screen after wakeup and before bed) to let the constant "What is happening everywhere?" thoughs subside
2. regular meditation practice daily for 10-20 minutes (you can start with 5 minutes, there are a lot of apps, I got some good suggestions from an AskMe)
3. benzos as needed to break the cycle when all the rest wasn't working

And add to this the usual eat decently, keep caffeine down, exercise regularly, get enough sleep (I sleep an awful lot). I can't say I've made my anxiety go away but I'm able to "sit with it" better and not let it drive the train if that makes sense.
posted by jessamyn at 9:36 AM on April 17, 2016 [8 favorites]

I'm sorry that you're going through this. I have been dealing with a different kind of anxiety (mine is mostly panic attacks) and I know that "i'll try anything" feeling well when it all felt like it was just impossible and would go on forever. Here are some things that helped me:

* I think i first saw The Anxiety and Phobia Workbook recommended on AskMe, and it's amazing. It first helps you get a handle on what's going on with you, then gives you lots of different techniques to address it, from nutrition to relaxation techniques. It's been a real life-saver for me, and i remember it specifically addresses social anxiety problems.

* I'd echo your friend's Buddhist recommendations, but I wouldn't worry too much about the religious part of it - you don't have to buy into any religious beliefs to get the benefits of a Buddhist mindset. I found When Things Fall Apart and pretty much anything by Pema Chodron or Tara Brach to be really helpful. The mindset is about not fighting how terrible you feel, but learning to accept it - often anxiety can spiral because we start to think "oh no it's happening again" and this gives you some techniques to help stop that.

* It sounds crazy to say but learning to breathe has been a huge deal for me. I learned in yoga, but you don't have to have yoga to do it (although that also helped me) - if you breathe into your belly, you trigger the parasympathetic nervous system which helps to calm you down - part of why you start to feel dizzy might be because of shallow breathing, which can then make the whole thing even worse. The first thing I do when I start to feel anxious is start breathing deeply into my stomach, then counting four breaths in, four breaths out over and over. It's amazing what a difference it can make. There are like a million breathing apps that can help with the counting of breaths, I use one daily.

* You mentioned that you've tried therapy but didn't say what kind (i think), so I'd add that CBT helped me tremendously as well. I think it's really down to the therapist but the idea that our thoughts lead to physical responses, then those physical responses make us act, then we accidentally teach ourselves to keep responding the same way every time is really helpful to try and break the cycle.

* Inspired by the Workbook i recommended above, I cut out sugar, caffeine, and alcohol and it's helped tremendously. I know that sounds extreme but I found that it was way too easy for me to feel anxious when my body kept going up and down depending on my blood sugar and caffeine levels (for the same reasons, I would shy away from any drugs). I'm now on a much more even keel, which makes it much easier to manage the anxiety.
posted by ukdanae at 9:46 AM on April 17, 2016 [1 favorite]

You've tried anti-depressants, but have you tried anti-anxiety meds?
posted by Lady Li at 9:47 AM on April 17, 2016 [5 favorites]

Just to be sure, are you working with a psychiatrist or similar professional and explicitly describing anxiety as one of your difficulties? Because I would have expected them to provide other drug suggestions.

There are benzos as jessamyn mentions, and I've had luck with the SNRI levomilnacipran, and I believe that there are a variety of other ones that might be tried.
posted by XMLicious at 9:51 AM on April 17, 2016 [1 favorite]

Yeah, to follow up on what Lady Li said, you should talk to a psychiatrist about anti-anxiety medication. I don't like benzos like Klonopin and there are undeniable issues with dependence on them, but everything about treating anxiety with medication is a trade-off. If you can barely function in public, then perhaps it's worth it to take 0.5 mg of Klonopin daily. This is a conversation you really need to have with a psychiatrist and you need to make sure they understand exactly how debilitating your anxiety is to you on a daily basis.
posted by pinetree at 10:12 AM on April 17, 2016 [3 favorites]

I had years of anxiety from early childhood through to my mid 30s and what worked for me was the right therapist (the sixth or so one I'd tried), CBT and twice daily meditation practice. Really the key was getting a therapist that I gelled with. That's an intensely personal thing but the first 5 just didn't click and then the 6th did and things progressed quickly from there. I've been pretty much clear for over 10 years now and to say it's life changing is a serious understatement.

I guess my advice would be that you might not want to close the door on therapy due to it being previously ineffectual. You might just not have met the right one.

Good luck. Life after anxiety is possible.
posted by merocet at 10:39 AM on April 17, 2016 [1 favorite]

Proplanolol (Inderal) will not help with thought patterns but it will help immensely if you are having physical anxiety of the sort that makes you wonder how bad it has to get before it's an official panic attack. if you can't talk to people because you shake and your heart races and you start gasping and sweating, or if you get that way in anticipation even before a social interaction starts, this may be your drug. I use it only pre-interview or pre-first-date and it tends to be a bad pre-drinking drug (not dangerous as far as I know, but makes it less fun and gives me headaches.) Very worth trying for physical symptoms and you may be able to trick yourself into letting that help with the mental symptoms too (if you can make yourself believe that they're connected, whether or not they really are.)

If I were you I would want to investigate benzos only under the care of an extremely trustworthy psychiatrist. I have never tried them myself, mainly because I am afraid they might work really well and then what would I do. however, they might be a very useful thing to try in combination with therapy to see if a couple of successful experiences with them could reset your anxiety mechanism -- sort of like, if you can avoid your usual reactions with drugs, you can maybe convince yourself that is possible to avoid them without drugs. The longer you go without feeling OK when around people, the harder it is to have faith that you ever can, so this might be an idea as long as you don't have an irresponsible doctor.
posted by queenofbithynia at 10:45 AM on April 17, 2016 [1 favorite]

Well, first of all there are plenty of other medications that can be prescribed for anxiety. SSRIs tend to be the first thing doctors try because of their relatively low side effect profile, and to be honest I'm a little surprised you were given Wellbutrin as it can definitely increase anxiety. Hopefully you have a psychiatrist you can discuss this with.

CBT gets thrown around here a lot but it is quite effective for anxiety treatment. I don't know what kind of therapy you did before but maybe it would be helpful to find a therapist in the CBT family (there's also DBT, REBT, and other variations) who does more structured treatment with things like worksheets and homework rather than therapy where you're just talking about your feelings. Or maybe it's a matter of finding a therapist who you have a stronger working relationship with-- again, it's hard to say without more info.

I've found that breathing exercises and stretching are great ways of physically calming yourself when your mind is too busy bugging out to be of assistance. Biofeedback machines (I've used this one) are a really neat to use in reducing anxiety because it gives you something to focus on, but the price is definitely a barrier. I personally have never had too much success with mindfulness/meditation because given any room to wander my mind will hop back on the anxiety train, but a lot of people find it beneficial and there are plenty of different techniques to try.
posted by fox problems at 11:00 AM on April 17, 2016

I think you DO need to be in a place where you see how the anxiety is affecting your life, and this question is a good start. I needed to really change a lot about myself, deeply, and did a lot of work to that effect. Basically I had gotten to the point where I hated all the medication I tried and I figured I was going to have to live with this brain I have, so we'd better learn to get along.

Meditation helped me immensely. And it's not an instant fix, and it's not like a fun, relaxing thing you do and instantly feel at peace. It's a practice that can profoundly change you. I have a somewhat formal practice at a Buddhist temple, at times, but I do not identify as a Buddhist.

Something I've been thinking about lately that brings me a lot of peace, though, is the practice and experience of being really outside the dominant Western ideas of Christianity and this really pervasive concept of outside judgement coupled with ego and individual choice. I'm not sure you can get there through just reading a book. Sitting is great and is like a direct arrow into that experience. It is hard and will take a long time, and never really stops. But realizing there are other truths and maybe there ISN'T some inherent hierarchy to the world, and everyone else is also struggling just as I am, has really increased my capacity for compassion. And starting to cultivate true compassion for yourself will naturally lead to more peace around others. And I think this is where some of the Buddhist teachings can be most helpful. It's still a religion with all the cultural baggage that goes with that. But truly believing that everyone has a Buddha nature (even you!) isn't something that necessarily requires even a belief in anything else.

I did finally read Radical Acceptance by Tara Brach and it's a great book to help with the actual mechanics of sitting through your fear and anxiety and accepting it instead of fighting it, thus gaining some power over it.

I'm focusing more on the Buddhist angle since you seemed to in your question. Exercise and diet are also important, at least for me. But I think the main thing is that this is a real project of deep change, and what you're looking at isn't just a pill to take. Having a supportive therapist and a meditation group and teacher will help guide you, although you should definitely start sitting on your own! But don't be discouraged when you're sitting for 15 minutes at home and your brain won't shut up. That's normal. You're practicing.
posted by jeweled accumulation at 12:56 PM on April 17, 2016 [2 favorites]

If you're going to use mushrooms as a tool for this, you would really benefit from sitting with a guide who can help you focus your experience on alleviating your anxiety. I'm not sure there's a lot of correlation between just taking them and it having a positive effect -- it has to be an intentional, guided thing.

Before you haul off and buy a grow chamber, why don't you ask your doctor for a different SSRI? Lexapro is widely used for anxiety, if you haven't given that a shot yet. There's also MAOIs, which you can get as a transdermal patch which minimizes the side effects. I take Selegiline myself and found it to be a huge help with anxiety.

Seconding that I'm surprised your doc had you take Welbutrin, since it will increase anxiety significantly. Maybe you need another doctor or a psychiatrist who is more familiar with treating anxiety.

DBT is really good for teaching stress tolerance, which is a key skill to overcoming social anxiety. Probably best done in conjunction with meds for maximum effectiveness.
posted by ananci at 1:36 PM on April 17, 2016

Strongly seconding queenofbithynia's recommendation of propranolol. I've been struggling with social anxiety my whole life (see also, though it's gotten somewhat worse since then). I've tried / am continuing to investigate a number of different approaches through medication and therapy, but so far propranolol has been the one unqualified win I've come across. Definitely the most effective thing I've tried. It's not a total solution, but it's been a huge help in smoothing over some of the rough patches as I continue to work toward addressing this more comprehensively. If you find that drinking helps (as I do), you may find that propranolol helps in similar ways without the downsides.

What propranolol does for me: my heart rate slows down, my mind stops racing, the fight-or-flight reaction eases and I can take a breath and think more clearly. Also I have trouble focusing at times and I find that caffeine helps with focus but aggravates the anxiety... propranolol helps to even this out for me, and some days the combination of the two is the only way I can get any work done. (Of course IANAD and YMMV on this last point since caffeine and propranolol are relatively contraindicated on paper, but it works for me at least.)

You might consider a multi-stage approach here. Severe anxiety can be self-defeating; you need to overcome the anxiety at least enough to take steps to address it effectively, so it's easy to find yourself in a chicken-or-egg type situation. If you can find something simple and easy that helps ease your symptoms in the short term (like propranolol, or the mindfulness techniques mentioned here, or anything that doesn't take too much work or too long to implement), you might gain a little breathing room that will make identifying your next steps easier.

Best of luck to you! I really hope you're able to find relief soon.
posted by Two unicycles and some duct tape at 2:26 PM on April 17, 2016 [2 favorites]

After trying 2 SSRIs that didn't help, I wasted 3 years of my life in terrible anxiety because my psychiatrist said, "Clearly, you won't benefit from using an SSRI." I did notice you wrote that SSRIs don't work for you....but they're all different, and various people may experience each one differently.

You didn't mention Trazodone and Buspar; I take both of those on top of a relatively small dose of Celexa.

I'm so sorry for what you're going through.
posted by wryly at 2:47 PM on April 17, 2016 [1 favorite]

In addition to the good advice above, you might try keeping a food diary. Both low blood sugar and unrecognized allergies can contribute to feeling anxious. They both can pump adrenaline into your system, promoting a fight-or-flight reaction. When you don't know that there is a medical cause for it, it can lead you to becoming paranoid as you look for some reason for feeling that way.
posted by Michele in California at 3:36 PM on April 17, 2016

I was in an incredibly similar place and nothing was working for me; weed made me have minor auditory hallucinations of people saying mean things and shrooms did nothing for my mood. I was having weird issues with talking and understanding spoken speech, I was walking everywhere instead of taking public transportation because I couldn't handle interacting with the bus driver long enough to pay my fare, I was doing groceries at midnight at a 24h store in order to avoid people, I refused to walk on main/busy streets because I'd freak out about people looking at me, etc. I really wanted to figure out some drug combination that would make my brain stop being so scared and sad all the time.

It turns out I'm autistic and have CPTSD, which are not at all the answers I expected, and I've since had some luck in managing my symptoms (most of my panic was about appearing autistic and being hypervigilant to people's ableist responses to my autistic behaviours slipping through). I'm still probably going to see a doctor about anti-anxiety medication so I'm not saying abandon that route but it's possible that you're going to have to do some digging around of your own even if therapy isn't an option.

You've received a lot of good advice above but sadly none of that kind of thing worked for me, it didn't even make a dent, and I ended up even more frustrated. If that's the case for you, you're not alone. Best of luck!
posted by buteo at 3:40 PM on April 17, 2016 [4 favorites]

Nthing anti-anxiety meds. Buspar (buspirone) has been a magic eraser for my anxiety (ymmv of course). It's not a benzo, though - it's in a different class of drugs. Which is to say that there are a lot of pharma options out there, but a good psychiatrist is key to finding the right one for you.
posted by okayokayigive at 3:43 PM on April 17, 2016 [1 favorite]

Anxiety sucks. As Jessamyn said upthread, and I've said here before, benzos are what you take for anxiety when it's really fucking you up. They also take effect extremely quickly.
SNRIs like Pristiq work differently than SSRIs, and some of my friends have had good results with them after SSRIs didn't get the job done.
Finding medication that works can give you space for therapy to work, or even just space to find a therapist.
Good luck.
posted by Kreiger at 6:26 PM on April 17, 2016

You could also try an antipsychotic such as Abilify or Latuda (I have tolerated the latter better). I was having terrible anxiety, despite already taking Klonopin, Wellbutrin and Lamictal. I fiinally got a handle on it after my doctor added Latuda, and then Celexa on top of that. So yeah, antipsychotics are a possibility. Don't just give up on drugs, there are so many to try, and in so many combinations. If your doctor isn't being helpful, please find another one. You should be seeing a psychiatrist, not a GP.
posted by kitcat at 10:33 AM on April 18, 2016 [1 favorite]

Just taking a quick look at your past AskMe questions (hope that's OK) here's what I'd recommend in books:

- The Highly Sensitive Person
- The Wisdom of the Enneagram
- The New Diary by Tristine Rainer

All of these can be purchased used for basically the cost of shipping, last I checked.

Beyond that I'd recommend Jungian psych in general, maybe starting with MBTI and Socionics and working your way deeper into the concept of the function stack. This will help you find out what kind of positive, wow-I-should-do-more-of-that characteristics to expect of yourself, as well as the warning areas--things you may push yourself to try, but that you aren't necessarily naturally gifted at. May help you avoid setting yourself up for failure.

I also recommend that you take, and record your results from, the following personality tests:

- Big Five
- Enneagram
- MBTI (give the Jung Typology test at Human Metrics a shot)

If you have any questions about whether your MBTI type is accurate, you can correlate the three results to arrive at a more certain result. With your certain result in hand, you can find online communities for your type and check in, see what they suggest. Warning: It can be really mind-blowing to find out there are people just like you, maybe more like you than you thought possible.

Also please do a google search for "filetype:pdf" and review some of the tools in their free PDF library like the fear ladder. These may help you plan for situations, for example if you need to meet someone downtown, you can give it a test run the day before during a calmer time, and with your headphones in, etc.

My loose guess is that you are what the models describe as an "intuitive introvert" and you are periodically overdosing yourself on external stimulation without having developed effective tools or internal models that could help you deal with so much stimulation on your own. This is similar to where I was in the past and I found that medication and therapy didn't help me so much as figuring out my natural gifts (with the help of the above texts) and then applying them to problematic situations did.

Also if I'm right about your general personality characteristics (definitely an if, so caveat guessor) then I would suggest that sensory approaches like drugs would probably not be as helpful to you as identifying and then taking decisive action. Even little changes or positive steps (like writing about how you feel and what you might do about it--as you are doing here at AskMe--or taking a walk around the block, etc.) may make you feel better about yourself than drugs with even the best reputation.
posted by circular at 12:05 PM on April 18, 2016 [1 favorite]

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