Social Anxiety Disorder and Phased Treatment
Guest: Dr. Sarah Book – Psychiatry & Behavioral Sciences
Host: Dr. Linda Austin - Psychiatry
Dr. Linda Austin: Dr. Sarah Book is Associate Professor of Psychiatry at MUSC, and is CO-PI on a new study looking at social anxiety and coping behaviors. Dr. Book, tell us about they study.
Dr. Sarah Book: Thank you, Linda. Social anxiety disorder is the most common anxiety disorder that we know of. It’s second only to alcoholism and depression in terms of disorders that psychiatrists treat. It’s very common, affecting, maybe, as much as 10 to 20 percent of the population, depending on where you look. It’s very debilitating. Essentially, social anxiety disorder is a disorder that starts, usually, in mid adolescence, sometimes a little earlier, sometimes a little later, and the hallmark of it is individuals have a marked concern about how they come across in social situations, to the point that they will either endure social situations, or avoid them altogether.
Typically, in the middle school years, they might notice that they’re really concerned about being the focus of teasing, or they might be really concerned about giving an oral presentation in a classroom. They might even call in sick on days that they have to give an oral presentation in a classroom. It can affect the educational status that they reach. They may avoid certain classes, for example, in college because they require an oral presentation or too much social interaction. It can affect how much money they make in the work place because they are less likely to be assertive in the work place and ask for raises or get noticed for the good work that they do, because they’re more comfortable blending in.
A lot of people with social anxiety disorder use coping mechanisms. There are lots of different ways people cope. One really common coping mechanism, that we’re hoping to help people overcome, is avoidance. If you don’t participate in a social situation that gives you anxiety, of course you’re not going to have that anxiety. And, many people, especially when they reach their 20s or 30s, they’re kind of looking around and saying, wait a second, I’m not experiencing the things I’d hoped to be experiencing; I haven’t reached the goals I want to reach. And we really want to help people with social anxiety to start experiencing some of the life that they have missed out on because of their anxiety.
We know that this disorder is really treatable. In fact, pharmaceutical companies have kind of, over time, in fighting with each other, come up with another medication to treat this disorder. So, we know it’s treatable. And, our study is offering open label treatment for this disorder.
Dr. Linda Austin: Now, open label, meaning, what?
Dr. Sarah Book: Oh, thank you. Everyone who comes into our study gets medication. And we are using the first medicine to get FDA approval for this disorder. The generic is Paroxetine; the trade name is Paxil. And we will treat with, what we call, open label. There’s no sugar pill option; everybody gets medicine. We’re not looking at whether or not Paxil works, we know it works, what we’re interested in, if we can get their anxiety under control, and we’re sure we can, is what happens, then, to their coping behavior? For example, one thing that’s really common in social anxiety, as I said, it starts in mid adolescence, they start getting into their late adolescence, early 20s, they get into, kind of, the party scene and they learn, wow, if I have a drink, it really helps my anxiety, and then they develop this pattern where they’re using alcohol to cope with their anxiety. And we know that alcohol causes other kinds of problems. We’re interested in looking at, if we can get the anxiety under control, what happens to the coping mechanism, and can we affect, ultimately, some change in their coping mechanism?
Dr. Linda Austin: Who would qualify to be in this study? Are there age limits or any other kind of criteria that would make somebody ineligible for this study if they have social anxiety disorder?
Dr. Sarah Book: The only big thing that would make you ineligible is if you have been on Paxil before, and had a good trial of Paxil, maybe 40 milligrams, at least, for several months, and it didn’t help you.
Dr. Linda Austin: What about the age range?
Dr. Sarah Book: We are recruiting individuals between the ages of 18 and 65.
Dr. Linda Austin: And, what if the person has other psychiatric conditions, would that allow them, still, to be eligible for this study?
Dr. Sarah Book: Social anxiety disorder has a comorbidity with depression, and when you know that going into the study, as you can imagine, living with this kind of anxiety really puts you at risk for, kind of, being chronically dissatisfied with where you are in life, and we know a lot of people with social anxiety disorder also have what we call major depressive disorder.
Fortunately, this medication, Paxil, or Paroxetine, is also a wonderful treatment for major depressive disorder. So, we do not exclude individuals with major depressive disorder. We evaluate. When they come in, we want to know who has major depressive order, so we can help those people to the best of our ability. We don’t exclude them. We might exclude somebody who has what we would call serious mental illness, which is, like, schizophrenia. Also, if somebody has bipolar disorder, if they’ve had documented episodes of mania in the past, we wouldn’t want to bring them in this study because Paxil makes mania more likely to happen.
Dr. Linda Austin: How long is this study?
Dr. Sarah Book: Well, that’s one of the wonderful things about this study, it’s very infrequent in a clinical trial, first of all, that it’s, what we call, open label, where everybody gets medication. And it’s a medication that we are relatively sure is going to help, let’s say at least a 60 percent chance of having your anxiety get better on this medication. Not only does everybody get medicine, you get medicine for 22 weeks, which is a long trial, compared to other medication trials.
Dr. Linda Austin: And then, presumably, if it’s helpful, the person could continue to get the Paroxetine prescribed by their own physician, correct?
Dr. Sarah Book: Yes, they could. And it’s not an expensive medication. So, once you’re established on the medicine, and you know it helps you, your primary care doctor could take over.
Dr. Linda Austin: Is there a telephone number that people can call, or a website they can go to, to learn more about the study?
Dr. Sarah Book: Our telephone number to call, and you would speak to our research assistant, her name is Liz, is (843) 792-5550. And, we have a site in Minneapolis, Minnesota. The phone number, there, to call is (612) 627-4495.
Dr. Linda Austin: Dr. Book, good luck with this research. It sounds very interesting.
Dr. Sarah Book: Thank you so much, Linda.
If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection: (843) 792-1414.