Concurrent Treatment of Social Anxiety and Depression

Social anxiety disorder and depression are tightly linked. Historically, many treatment programs have used selective serotonin reuptake inhibitors as the primary medication. But recent research on the role of serotonin sheds doubt on the effectiveness of SSRIs for the concurrent treatment of these disorders, highlighting the necessity of comprehensive, individualized treatment programs designed to ensure that recovery is promoted, not hindered.

As I stood in line at the taqueria waiting for my turn to order, the seconds raced by. After what felt like both an eternity and no time at all, I stepped up to order. I’d rehearsed my exact meal a dozen times in my mind—but I still couldn’t get it right. The words seemed to tumble out of my mouth and I could feel my face flushing. My sentences were stilted as if I had no idea what I was even doing there. For the next week, I would replay this five minutes of my life over and over again, berating myself for what I perceived as a monumental failure.

Social anxiety disorder can force you to live a life penetrated by fear. Each potential social interaction can cause you to ruminate over its potentially embarrassing consequences, pushing you to avoid human contact and live a life of seclusion. The feelings of hopelessness and lack of social experience that define social anxiety disorder can also cause depression, with one study revealing that approximately 35 percent of individuals with social anxiety disorder reported that they had experienced at least one episode of major depression.

Despite the wealth of research linking social anxiety disorder and depression, each illness has a different underlying biology, and that makes identifying medical care for both a tricky process. Typically, both disorders are treated with an antidepressant that increases levels of serotonin in the brain, but there have been recent advancements in this field of research, and they could force us to reevaluate that approach.

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The Role of Serotonin in Depression and Social Anxiety


Depression is a complex disorder that is often invisible to the human eye. One of the most common ways of treating it is with selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants that increase the levels of serotonin in the brain. Because serotonin is a neurotransmitter that is connected to mood, appetite, and sleep, SSRIs are a fairly standard option for people who struggle with depression. In particular, research suggests that the 5HT1-A serotonin receptors are an ideal target for treating the disorder, and also points to the ability of serotonin to promote the creation of new brain cells, which could be the main mechanism that works to decrease symptoms of the disorder.

Social Anxiety Disorder

SSRIs are also commonly prescribed to treat social anxiety disorder, and are often a first choice for long-term treatment because they aren’t addictive and they have fewer side effects than shorter-term solutions like benzodiazepines. As with depression, research has shown that the 5HT-1A receptor has a direct connection to social anxiety, with studies revealing that people who live with social anxiety experience less activation of these receptors. In those cases, SSRIs can help mitigate that minimal activation, and restore serotonin levels in the brain.

Emerging research, however, has called this idea into question: according to one study, one of the underlying causes of social phobia might be increased levels of serotonin in the amygdala, an ancient structure of the brain linked to fear. Because there are so many different types of serotonin receptors, it’s possible that the activation of specific receptors might help relieve social anxiety, while the activation of others could increase it. If this new research continues to be supported, doctors and therapists may have to devise new ways to treat social anxiety disorder, especially for those that suffer from co-occurring depression. “We may have to rethink how anxiety-reducing drugs, like serotonin reuptake inhibitors (SSRIs), actually exert their beneficial effects in anxiety-disordered patients,” said Tomas Furmark, a psychology professor involved in the research.

Concurrent Treatment Options for Social Anxiety and Depression

Given the conflicting data on the role of serotonin in depression and social anxiety, concurrent treatment requires a program specifically designed to ensure that each disorder is being properly managed. Norepinephrine reuptake inhibitors (NRIs) have been shown to be effective for the treatment of both severe depression and panic disorder, making them a good alternative option for those suffering from both depression and social anxiety disorder.

Successful treatment will take more than medicine. Holistic therapies such as massage programs, yoga, and mindfulness-based cognitive therapy (or MBCT) can be used to supplement NRIs and provide relief for both disorders. MBCT encourages the acceptance and analysis of the thoughts that enter your mind, allowing you to pinpoint those that lead to both depression and social anxiety. Relying on the therapies and medication mentioned above rather than an SSRI is one way to ensure that symptoms of social anxiety disorder aren’t exacerbated during the treatment process.

Promoting Healing, Not Hindering It

The link between social anxiety and depression can create a cycle that’s very difficult to break free from, a kind of feedback loop in which one disorder feeds right into the other. Between feelings of hopelessness and a fear of rejection in social situations, secluding yourself from the world can seem like the best option, but the truth is it often makes things worse. If you’re struggling with both of these disorders, you’ll need an individualized treatment program that can properly account for your reactions to specific medications and adapt to them accordingly.

With the right residential treatment program, you’ll finally receive a comprehensive diagnosis that homes in on the precise mental health issues that you’re experiencing. An individualized treatment plan will be crafted that shifts with your reactions to specific medications and therapies. The end result is a plan that can help you manage both your depression and social anxiety so that you can break free from them, and move forward with the things that matter most to you.

Bridges to Recovery offers comprehensive residential treatment for people living with depression and social anxiety disorder, as well as other co-occurring mental health disorders, substance abuse, or process addictions. Reach out to us today to learn how you or a loved one can take control of both of your illnesses concurrently.

Lead Image Source: Unsplash User James Douglas