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.