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Expert Q&A

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How can I overcome my shyness and depression?

Asked by Lucky, London, England

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I am a post-grad student, and I have been suffering from depression for more than a year. I'm shy and I have developed an inferiority complex. Many times I don't even express myself to anyone, or hardly talk to anyone. I tried taking coffee but it causes anxiety worse. Last week I tried 4.5 percent vodka. I really don't know why I'm shy. I feel like I have wasted too many years due to this shyness and inferiority complex. Sometimes I even feel offended when someone talks to me or asks a question. I really don't know what to do. Help!

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Lucky:

I am sorry to hear about your struggles, but in fact you have described to me a very common pattern of psychiatric difficulties that are very treatable. Something that is not so clear from your description, however, is whether you became depressed first and then got shy and insecure, or whether you have been chronically shy and (as often happens) you've subsequently developed a depression.

It is very common for people to lose their social nerve in the context of getting depressed. In fact, feeling insecure and inadequate are primary depressive symptoms. On the other hand, some people spend almost their entire lives feeling chronically shy and fearful of interacting with others. Often the fear centers around concerns of doing something very embarrassing. This chronic condition has been called different things over the years, but now psychiatrists call this "Social Anxiety Disorder, or SAD for short.

SAD can arise in very early childhood and almost always is up and running by the middle teen years. The majority of people who suffer from the condition eventually develop major depression. Also, of direct relevance to your case, many people take to drinking to help quell their anxiety. This is a terrible mistake, as many folks with SAD end up with alcohol or drug problems. I strongly recommend you leave the vodka alone and consider some of the treatment options I'll talk about in a moment.

Before talking about treatment, you might be interested to know that SAD can take a few unique forms. Most people struggle with a generalized fear of associating socially with others. Parties, school dances and such are pure hell. But sometimes SAD can take very specific forms. For example, the famous poet Lord Byron was completely unable to eat in front of other people, which is a recognized form of SAD. Other people are unable to sign their names or do other handwriting tasks in front of others. With the rise of computers, I wonder if some folks have a terror of other people watching them type.

Now to the treatment. As in almost all psychiatric conditions, there are both pharmacological and psychotherapeutic options. Interestingly, when it comes to medicines, it doesn't matter much whether you started with SAD and went to depression or got depressed and lost your self-esteem and developed shyness.

In either case, the first-line treatment would be an antidepressant. Although we call them "antidepressants," these medications work at least as well for anxiety conditions such as SAD as they do for depression. Sometimes drugs called benzodiazepines are also helpful, although these medications are a little liable to abuse, and so should be used with a little more caution.

Psychotherapy is also very effective for both depression and SAD. You are lucky (no pun intended with your Web name) that you live in the UK, because it's my sense that therapy is a little easier to obtain there than in the United States. Most studies suggest that combinations of therapy and medications are often more helpful than either form alone.

Again, turning to drink will only make your situation worse. And if the caffeine is making you feel shaky, take it easy with the coffee! A good source of information on SAD can be found at the Anxiety Disorders Association of America Web site.

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