I Don't Know What's Wrong With Me!

Hi Gbjackson3,

Based on what you describe, it sounds like you have a severe case of social anxiety disorder, also called social phobia. It also sounds like you have agoraphobia. However, you did not say whether or not you are receiving any type of psychotherapy or if you are just taking medication. And, as you have experienced, the medications are not helping.

Zoloft and Effexor are both antidepressants, but they are also FDA approved for treating social anxiety disorder. So, I’m not at all surprised that Dr. Xu has prescribed them for you. As for Geodon and Zyprexa, these are both antipsychotic drugs that are FDA approved for the treatment of schizophrenia. However, many doctors do prescribe them “off label” for other disorders. (“Off label” means using a drug to treat other conditions for which it is not approved.)

I have heard of Geodon being used for social anxiety – and in at least some cases with reportedly good results. I have not heard of Zyprexa being used for social anxiety, however.

Both of these medications have very serious potential side effects. Both (Zyprexa in particular) can increase the risk for diabetes, and may cause significant weight gain. As with other antipsychotics, they may cause tardive dyskinesia (a troubling movement disorder) and neuroleptic malignant syndrome (a very serious and potentially fatal condition). So, these medications should always be used with caution – and only if absolutely necessary.

I am not a psychiatrist, and have not evaluated you, so I cannot recommend a specific medication for you. However, I can say with confidence that the best treatment for social anxiety disorder is Cognitive Behavioral Therapy (CBT).

CBT focuses on the underlying irrational thoughts and beliefs that both trigger and fuel your anxiety. With a skilled therapist who is trained in CBT (and knows how to use it well), you can learn how to change the thought patterns and behaviors that have caused you to become essentially paralyzed by this disorder. Remember, every time you stay home to avoid the extreme anxiety you know you'll feel if you leave, you end up reinforcing it even more – that is the vicious cycle of anxiety.

Yours is a pretty extreme case – which is most likely why your doctor has prescribed the antipsychotics (hopefully just to augment the Zoloft or Effexor).

I strongly recommend you find a psychologist in your area who is not only trained in CBT, but who uses it regularly to treat people with anxiety (as opposed to other approaches which will likely be less effective or not helpful at all). Not all therapists are trained in CBT or use it even if they are, so find one who uses CBT specifically.

I think this would be the most helpful treatment for you, based on what you described. Commit yourself to therapy once you start – no matter how challenging the process may feel at times. It can help you significantly.

I hope this helps!