E901, first off, respect for asking for help like this. It’s not easy to put yourself out there with the prospect of any potential ridicule regarding an issue as personal as this, even with the anoyminity of the internet; and the predictbaly crass and idiotic responses seen thus far only confirm why it’s difficult.
Obviosly no one is privvy to the dynamics of your particular situation, and any suggestions you recieve over the internet need to be taken with a pinch of salt. This is clearly affecting your quality of life, and there are people who understand what you’re going through and wish to help you, but without any sort of persnonal assesment, I’d be weary of giving out anything other than general guidelines.
Social anxiety is rather complex in itself, and is going to operate in a vicious negative feedback loop with any co-morbid depression.
You said you were seeing a therapist, and it was her who gave you the original diagnosis. Presumably as well as advising that may need medication, she also adressed what goals you may need to work on from a non-drug perspective? This is going to somewhat important if the social anxiety is indeed the central facet in your problmes. A great deal of social anxiety amounts to the fear of negative judgements; as such, sufferers become excessively risk averse with regard to social encounters, and withdrawl becomes commonplace - propergating the cycle. You will need to learn new skills in a CBT style that will help you stay productive, and not get bogged down on a daily basis. You may well also need to adress some of the destructive underlying schemas in more of a psychotherapy fashion, this is the long-haul stuff but may need to be investigated. If she hsan’t talked or alluded to any of this, then you may need to find someone else. All the above is presuming that social anxiety is indeed you primary problem, (it may well not be, and I still wouldn’t want to presume)but there’s good data it responds better to adjucting behavioural therapies as opposed to other clinical manifestations such as MDD and/or PTSD where pharmacology is the mainstay of treatment.
Regarding medication, this is an area where everyone feels entitled to an opinion, even if they have scant knowledge of the issue. Go figure. The interent is generally not a good place to gather data on wether it’s a good idea to go on them or not.
As with most things in life, nothing is clear cut and/or black and white. I’ve seen people struggle for years on end with their issues, and were only finally able to make decent headway when given pharmalogical treatment. Night and day differences like this do occur quite frequently, and the peer-reviewed, meta-analysed data is in. They unquestionaly help with those whose problems are clincial.
On the flip, the notion that a course of medication is a silver bullet that will always alleviate all problems is a pretty far-fetched and overly optimistic stance. Many severe and chronic anxiety and depression sufferers need to work very hard on their issues on a daily basis even with medication. The medication takes the edge off, but living with mental illness is still a burden, and it remains a challenge. Also, medication is simply not effect with those with minor depression/anxiety/dysthimia. Any half-decent GP, PCP or psychiatrist should reiterate all of this.
If I really had to get off the fence, right now, and go on what you’ve written here, then yes, a course of medication may well help you. The cost to benefit ratio would appears to be good.
Anti-depressants of the SSRI, tetracyclic and trycyclic class do not have an effect on testerone signalling. This is pretty conclusive. There is some evidence of minor increases in prolactin. But nothing that is going to affect you seriously.
It is the anti-psychotics (ripseridone/zyprexa etc) where the serious side-effects are more apparent (I’d imagine this is where most of the anti-drug hysteria begins), though having spoken to many schizophrenics in remission over the years, the trade off between weight gain and cognitive slow down versus terryfying hallucinations was, all things considered, a fair price to pay.
Preferably, see a competent psychiatrist rather than a GP, they have far more experience in tailoring medication to specific symptoms. Screening for hypothyroidism/hypogonadism and an auto-immune profile as well would be very wise. There is no such thing as cook-book psychiatry and taking a shotgun approach is not a good idea either. I’ve heard far too many accounts of PCP’s handing out SNRI’s (Effexor/Cymabalta) after depression complaints without enquiring about co-morbind anxiety, and then wonder why their patients wind up in the ER after a panic attack (due to the nor-ephinephrine release of the aforementioned drugs).
Any further enquiries feel free to shoot me a PM or ask here.
I wish you the very best of luck.
