Social Anxiety

[i61164]

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I think I have just diagnosed myself with social anxiety. Sometimes when I feel like I'm "put on the spot" I have a hard time talking. My heart rate goes up, my voice shakes, and I feel like it's hard to breathe. It has never really happened very often and I would usually have a good explanation (fear of pulic speaking, for example). I even joined Toastmasters and gave 10 speeches in an attempt to conquer my fear. But now I think that public speaking is not really my problem. Through my involvment with Toastmasters I learned that I can give speeches and get to a point where I am comfortable doing so. What really seems to trigger these episodes is when I have to speak in front of a group and I haven't had time to prepare. The episodes will occur even if I am just reading off of a sheet of paper. The reason this has become an issue lately is that I just started third year. I am having a hard time presenting my patients on rounds up to half of the time. Sometimes I can see it coming and I haven't figured out anything that I can do to stop it (I actually thought about vagal massage but haven't tried it). Anyway, since I am going to be making a lot of presentations from now on, I think it's time for me to see a doctor about this. I'll make an appointment with a family medicine doc tomorrow. So obviously I'm not asking anyone here for advice. I just wonder if you agree with my diagnosis.

 

[i61164]

As a follow up, can beta blockers and SSRI's both be used for social anxiety? What would be the pros and cons of one or the other?

 

[jjbmsiv]

I know you're a prolific poster, and I always enjoy reading what you write, but I don't know if this comes too close to the line of dispensing medical advice, since this is of a personal nature for you. 🙁

At the same time, though, 3rd year is one hell of an intimidating experience, and I know most of my friends as well as myself have felt much the same anxiety at presenting an unfamiliar subject to an unfamiliar superior, be it resident or attending. I wish I had some advice for you that didn't sound like a platitude, but reading up on your new patients' maladies the night before can go a long way to diffusing a bad pimping/put on the spot situation. Also, always answer with confidence, though it may often be false! One correct answer _stated resolutely_ will often give attendings the impression you know what the hell you're talking about and they'll abort their line of questioning early or go pick on someone else, even if it was really just a guess!

All this gets easier, it just takes time. And practice. But hey, you know that.

 

[i61164]

Strangely enough, I don't get nervous when being pimped. It only seems to happen when I am presenting patients during rounds. I get part way through "Mrs. So-and-so is a 21 year old G2P1..." and I start to feel my voice getting weaker and I get a powerful urge to stop talking altogether so that I can just concentrate on breathing. But I am stuck because I have to plow forward with my presentation. I am ready to do something about this because it has become a nuisance to me. I'm really not posting this as a way to get medical advice. I guess if I had said that it was a patient of mine with this problem nobody would think twice about discussing it here.

Anyway, maybe we can still discuss SSRI vs. B-blocker without giving advice. One of the psychiatry faculty at my school says that he has been taking B-blockers for his blood pressure and that he is more calm under pressure as a result. He even told us that he thinks students would do better on the USMLE if they were on B-blockers and that there was a study to back this up. Earlier today I was reading about social anxiety on Wiki (my ultimate source for all medical information) and I read that it is treated with SSRI's. So I started to wonder if both would be reasonable treatment choices and if so, would the choice be left up to patient preference.

With regard to the issue of dispensing medical advice, I admit that you bring up a reasonable point. If you think about it, a lot of the stuff that we talk about on here could be taken as medical advice. It would be easy to create a fake account and start asking hypothetical questions that are really about yourself. I guess I just figured that I was asking for opinions rather than advice. Since I am going to have to go to my doctor for treatment anyway, I'll get my advice from him. But if any of you on here on not yet doctors and you have some experience with this problem, maybe you can post without the risk of giving medical advice. On the other hand, you might risk practicing medicine without a license. 😀

 

[Encephalopathy]

I'm just finishing 3rd year. Presenting is a lot of pressure for everyone when they start. You're doing something new in front of a group of people you want to impress and who have had much more experience at it. And of course it's much worse if you're unprepared. I don't know that you should consider it social anxiety, especially if you're comfortable give public speeches. Just like public speaking, it will get easier as you do more of it. Let the discomfort of being unprepared motivate you to prepare better.

As far as beta-blockers vs SSRIs: to me, the main difference is that one is psychoactive. I don't think being nervous during presentations is an indication to mess with the biochemical balance of your brain.

 

[jjbmsiv]

I agree on all accounts!

 

[i61164]

Well, I have an appointment to see a doctor tomorrow, so I guess I'll see if she thinks it's worth treating. When I'm presenting a patient, sometimes I am totally fine and other times I am literally almost unable to speak. I'm not real enthusiastic about just suffering through it and hoping it will get better on its own. These situations are not the same as speeches. You can rehearse a speech over and over. You get comfortable with it. These presentations are "off the cuff." The more patients that I carry, the less it will be possible to rehearse these presentations because there just isn't time. I need to able to write my progress notes and be ready to present these patients without getting all choked up.

 

[i61164]

For any interested readers, if you are having the problem that I described here, talk to your doctor. I talked to my doctor about it and I am really glad that I did.

As "Encephalopathy" says, to call this social anxiety is probably an overstatement, but if it is negatively impacting your life on a frequent basis then it is worth bringing up with your doctor.

 

[Ulquiorra]

Got back from my vacation and read through this thread. Off the top of my head, I would've recommended a beta blocker. But I'm curious to know, what did your doctor recommend?

 

[i61164]

I am reluctant to say because it could be contrued as giving medical advice, but I'll PM you.

 

[whopper]

I'm not giving this as advice but I suggest you ask your doc about this.

Fish oil 1g q daily has been found to have significant benefits in depression & anxiety. I've been telling my depression/anxiety pts to take it because it may benefit them. I of course don't tell them to take it instead of an SSRI but in addition to an SSRI.

Ask your doc about it.