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The Connection Between Social Anxiety and Depression
2021-11-23T22:58:40Z
Medically reviewed on by
Regional Medical Director Greater St. Louis
The Connection Between Social Anxiety and Depression
You were invited to a big party tonight, but the thought of going fills you with dread. There will be new people to meet, which means they’ll be judging you—your appearance, your personality, your conversational skills. You just know they’ll think poorly of you, so you wonder why you should even bother going. You text the party host that you can’t make it and stay home alone again, a result of your social anxiety.
A form of generalized anxiety, social anxiety disorder is a deep-seated, unfounded fear of negative social interactions. Typically, someone with social anxiety knows that their feelings of dread make no sense, but they can’t help it. If you don’t explore treatment options for social anxiety disorder, it can cripple your sense of normal life and leave you feeling isolated.
But while you may be lonely, you aren’t alone in coping with this anxiety disorder: 15 million American adults have social anxiety. And for many of them, social anxiety disorder can lead to depression.
Social Anxiety and Depression
Work meetings, first dates, public speaking, talking to strangers—these situations all pose potential pitfalls for someone with social anxiety disorder. Exposure to others in a public setting triggers an irrational worry about being perceived negatively and that this harsh judgment will result in humiliation or embarrassment.
This type of anxiety and social withdrawal go hand in hand. If you have social anxiety disorder, you may become fearful before social events, to the point that you’ll avoid them whenever possible. And social anxiety doesn’t disrupt big events, but your normal everyday routine, too—for instance, you may walk an extra 10 blocks to work to avoid being around others on the subway.
And if you can’t avoid these situations, you may experience symptoms that include:
- A feeling of dread
- Feeling self-conscious or nervous
- Elevated heart rate
- Inability to speak clearly (mumbling, stuttering)
- Sweating
- Shakiness or trembling
- Shortness of breath
- Nausea
- Muscle pain
- Feeling dizzy or faint
Can Anxiety Lead to Depression?
There is a difference between anxiety and depression; some symptoms are also different, while others overlap. However, it’s possible to have both social anxiety and depression at the same time, which can be referred to as comorbidity. For people with social anxiety, the prevalence of comorbid depression ranges anywhere between 20% to 70%.
Without a strong support network and treatment options for social anxiety disorder, you may feel loneliness, hopelessness, and isolation. Those are also hallmarks of major depressive disorder. The sadness that can result from social anxiety can lead to depression.
Additionally, social anxiety and depression both carry a risk of social withdrawal, although for different reasons. Someone with social anxiety will withdraw from situations because of their fears. Someone with depression, however, will isolate themselves because they don’t get pleasure from being in social situations. This withdrawal may also make it hard to seek help, but there are treatment options for social anxiety disorder that can help manage symptoms of both social anxiety and depression.
Treatment Options for Social Anxiety Disorder
Social anxiety is typically treated with medication and talk therapy, either on its own or in combination.
Medications usually include selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines. SSRIs are a class of antidepressants that can be used for anxiety as well as depression. They include fluoxetine, sertraline, and citalopram. Benzodiazepines can be prescribed also but are sometimes avoided because there is a risk of drug tolerance and dependency with prolonged use. Typical benzodiazepines include clonazepam, lorazepam, and alprazolam. These are often prescribed as a short-term solution.
With psychotherapy, exposure-based cognitive behavioral therapy helps patients face their fears in social interactions. This type of exposure therapy is much like the name implies: Over time, patients are exposed to a situation that triggers their social anxiety. The goal is to show patients that their fear of the particular situation is unfounded, leading to a decrease in their anxiety. The patient also grows in self-confidence as they learn to successfully navigate these social interactions and replace the anxiety with realistic thoughts and expectations.
TMS for Social Anxiety
Transcranial magnetic stimulation (TMS) is an option if those first-line treatments of talk therapy and medication aren’t reducing social anxiety. TMS therapy for depression and anxiety alleviates the depression symptoms caused by social anxiety. Although TMS is not approved for anxiety disorders, it can still be very helpful for anxiety sufferers because of the large overlap between depression and anxiety.
During TMS treatment sessions, an electromagnetic coil placed on the scalp sends magnetic pulses to specific areas of the brain. The pulses turn into gentle electrical currents that stimulate the brain to alleviate depression symptoms.
In addition to targeted treatment, TMS provides patients with an FDA-cleared method for reducing symptoms of depression. It is also non-invasive and doesn’t require a sedative, so there is no down time, and you can drive yourself to and from treatment sessions. TMS therapy for depression and anxiety takes place every weekday over the course of several weeks, then tapers off in frequency over the following weeks.
If you have social anxiety, it’s common to have depression also. If that’s the case for you, then TMS can help. To live a fuller life that’s not constricted by social anxiety disorder, contact us to schedule a free consultation and talk about your options.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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