How to manage nervousness and trembling from social phobia?

Question

Hello doctor,

I am a 50-year-old male. I am feeling nervous as my legs tremble whenever I face the crowd or in the middle of the crowd. I have been suffering with this fashion for the past 20 years. I consulted a number of psychiatrists and used a number of anxiolytics, antidepressants, and antipsychotics. I started using Desvenlafaxine 50 mg this afternoon. I am using Telmikind 40 mg for hypertension and also using Clonazepam 0.25. I faced a lot of struggle to taper and stop all the above-mentioned drugs, especially Alprazolam, Paroxetine, and Vortioxetine. I have really faced a lot of humiliation as most of the people, even my staff, laughed at me when they saw my trembling walk, which was not bearable. I know that I am suffering from social anxiety disorder and social phobia, but not able to keep myself away from it. Can any doctor understand my pathetic condition and help me to come out of it? Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

First of all, I would like to confirm that the mentioned symptoms and problems are clearly indicative of social anxiety disorder, also known as social phobia. Having said this, I completely understand that social phobia is very much disabling for almost everyone, particularly for those in active public life. Now, in regard to the treatment, I have a different opinion compared to the treatment received so far. The mainstay of treatment for social phobia is psychotherapy rather than medications. I mean to say that relaxation techniques, mindfulness meditation, andcognitive behavior therapy (CBT) are the initial steps rather than the medications.

Among all the available options, I often get the best results with cognitive behavior therapy and relaxation exercises and often recommend one or another for most individuals with social phobia. Although psychiatrists are well equipped with psychotherapy, most of them do not practice it due to valid reasons such as lack of time andlow revenue, among others. In my opinion,it would be better if you could contact a clinical psychologist in your city. For your condition, I feel 12 sessions of CBT will be sufficient to derive the required results. I would also like to inform you that sessions are often held at intervals of one week and last for 45 to 60 minutes on a given day.

As I can see that you are located near the city, it will not be difficult to get an experienced clinical psychologist around your locality. For the time being, I feel a combination of Propranolol and Clonazepam can be used on a need basis. I often prescribe the tablet Provanol forte (20+0.25) for individuals who need an immediate response to social phobia. However, I must acknowledge that this form of treatment is helpful on a temporary basis and does not alter the course of the problem.

I hope this helps.

Please revert so I can assist you further.

Thank you.