Can antidepressants, beta blockers and other drugs cure social anxiety? The strongest antidepressants for social anxiety, top of the best.

This article will help you understand whether medications can help get rid of social phobia and in what cases they should be taken. You will learn about the benefits and harms of pharmacological drugs in the treatment of social phobia. In addition, I will describe an effective technique for working on social fears.

What is necessary for taking medications to be truly justified?

Social phobia manifests itself in some typical physiological and psychological reactions: body trembling, excessive sweating, facial flushing, anxiety, depression, apathy, etc. It is precisely to quickly eliminate such undesirable consequences of social phobia that medications are used.

However, there is one important clarification: in order for medication to be truly effective, it must be accompanied by non-drug treatment methods (cognitive behavioral therapy, NLP, Gestalt therapy...). This is true 100% of the time when it comes to treating social phobia.

Without successful psychological treatment of fears, taking medications is absolutely unjustified. In this case, a person taking, for example, antidepressants, will be like a person who is trying to drown his grief in alcohol: while the alcohol is working, the person “feels good” - he forgets about his problems and “has fun.”

When the effect of alcohol wears off, the person returns to reality, and often finds himself even more unhappy than initially.

Of course, alcohol cannot be equated with drugs, but, nevertheless, they have one thing in common: If a person taking antidepressants does not work on learning to stop running away from situations that frighten him along with taking them, after finishing the course of taking antidepressants, he, as in the case of alcohol intoxication, will return to where he started.

The biggest disadvantage of medications in the treatment of social phobia?

Imagine that you are a gardener, and your trees are sick with some kind of nasty thing, because of which all their leaves have turned yellow. You call a specialist and ask him to cure the trees. And he, instead of understanding the causes of the disease and eliminating them, simply takes and paints the yellowed leaves green... “Voila!”, he tells you... But time passes, the paint comes off from the leaves, and the outside the appearance of the trees again begins to correspond to their internal state...

This analogy well illustrates what happens in most cases known to me when psychotherapists prescribed drugs to patients... doctors, just like our would-be tree specialist, followed the path of least resistance.

Their logic is this: if there are no symptoms, there is no disease. They prescribe medications to a person that remove the physiological and psychological manifestations of social phobia, and do not really deal with the real problem. Naturally, we are not talking about 100% of psychotherapists now. I’m just sharing the experience of the guys I’ve worked with personally.

What is needed to really work through social phobia?

To really work through social phobia, it is necessary first of all to work through the “root” – a person’s negative beliefs. This study should be accompanied by exercises aimed at developing calm and confident behavior in situations that cause fear (panic). In conclusion, to build warm relationships with people, you need to learn the main principles of attraction between them and the rules of communication, which, unfortunately, most people do not realize (which is why there are so many scandals, quarrels and misunderstandings between people).

Unfortunately, for some reason, not every psychotherapist is willing (or able) to offer such in-depth work. Therefore, before you start working with any specialist, if he wants to prescribe you to take medications, you should ask what direction your future work will take.

If a specialist does not offer a comprehensive treatment of fears and recommends limiting yourself only to medications (or does not give a clear description of further work), it is better to think three times before dealing with him.

Don't forget that Drug therapy can only be an addition and not the basis of treatment for social phobia.

The basis of effective treatment has been and remains therapy aimed at working through fears, flawed beliefs, and acquiring the necessary social skills.

By the way, in most cases, drug therapy is not necessary at all (and may even be harmful, given the presence of side effects)...

My newsletter is dedicated to working through flawed beliefs and acquiring the necessary skills, which you can subscribe to at the top of this page.

Social phobia (from English - “fear of society”) is one of the most common psychological disorders, which consists of painful exposure to society. It is recognized as a disease of youth: most often it affects people from 15 to 30 years old.

The discomfort experienced by social phobias can vary in severity - from minor timidity to large-scale phobia.

This mental illness is safe for physical health, but greatly reduces the individual’s quality of life. A person experiences a range of unpleasant sensations when being in crowded places, during public speaking, or when there is increased attention to his person.

The first step to a harmonious and fulfilling life is overcoming social phobia. It is quite possible to achieve this; the most important thing is the desire and willingness to cope with difficulties. At first it will be difficult, since any personal growth is a change from established life attitudes to new ones. But when the first results are achieved, a person’s self-esteem awakens. This quality contributes to that inherent only in a strong personality.

We will look at the causes, manifestations and treatment of social phobia using various methods.

History of social anxiety

In the 60s of the twentieth century, the first patients appeared with vague complaints of fear of society. Symptoms varied widely among people (from fear of public embarrassment to the inability to be in public). But in general they had one thing in common: they began with a large crowd of people. That's when psychotherapists first became interested in social phobia. The treatment was carried out using the method of psychoanalysis of Sigmund Freud.

Psychologists relied on his theory, according to which childhood plays a decisive role in the formation of personality, and most phobias develop at an early age. In the case of social phobia, the emotional closeness of the parent and the small child is of great importance.

The mother is obliged to pay enough attention to the child, talk to him, smile. Thanks to the manifestation of care and affection, the child begins to subconsciously feel needed. With a lack of care, the baby feels useless: he grows up capricious and irritable. A child experiences a lot of stress when visiting a nursery or kindergarten early. He begins to emotionally miss his parents, and there is a fear of the unknown, which causes social phobia in the future.

Social phobia: causes

Treatment of social phobia directly depends on the reasons that caused it in a particular individual. For example, if a person has a pronounced imbalance of neurotransmitters, then he is prescribed treatment with pills. If communication difficulties arise due to childhood complexes, then cognitive behavioral psychotherapy is indicated for social phobia.

What are the causes of social phobia?

• Hereditary factors (if one of the parents experiences social anxiety, the child will also grow up anxious).
• Imbalance of neurotransmitters. Our endocrine system produces certain hormones responsible for fear, happiness, euphoria, sadness, etc. When its functioning is disrupted, the correct balance of hormones is also disrupted. This leads to mood disorders and increased anxiety).
• Introversion (most social phobes are introverts with a weak type of nervous system).
• Children's grievances.

Most often, social phobia is caused by a combination of factors. A person’s anxious character is influenced by either stress, resentment, or an existential crisis. The psyche cannot stand it, and another person joins the ranks of social phobes.

Distinctive signs of a social phobia

Classic social phobes can be seen from afar: these are slender young people wearing headphones, looking younger than their years. They are characterized by a vacant look and a strange appearance.

The first social phobes to openly declare themselves were young Japanese. At the end of the twentieth century, they formed the hikikomori movement - young people who chose the path of voluntary hermitage. Their distinctive feature is the minimization of communication with society. The hikikomori lifestyle appealed to a certain segment of Western youth. Soon this movement gained popularity in the West and in Russia.

However, reluctance to be in society and fear of society are fundamentally different things. The first is a manifestation of nihilism, and the second is a serious phobia that causes real discomfort to a person. A real social phobe suffers from the fact that he cannot be among people: it is difficult for him to find an office job, he does not go to nightclubs and parties. At the same time, the person realizes that something is wrong with him. He wants to change the situation, but he can't.

Symptoms of social phobia

A person with severe social phobia is seriously limited. Three areas are affected:

• behavioral;
• physiological;
• emotional.

The behavioral sphere suffers the most seriously: a person refuses to attend interesting events, avoids crowded places, and does not know how to speak in public.

The physiological component is manifested by vegetative symptoms:

• tachycardia;
• tremor;
• redness of the skin;
• lump in throat;
• increased sweating.

Emotionally, social phobia manifests itself as an irrational and panicky fear of people. A person understands the absurdity of the situation with his head, but is unable to influence the situation.

Diagnosis of social phobia

Social phobia is treated by psychoanalysts, clinical psychologists and psychotherapists. You should not go to a psychiatrist, since this doctor treats the mentally ill, not neurotics. An illiterate psychiatrist will prescribe a social phobia person serious medications that will reduce anxiety, but will not eliminate the cause of the problem. The ideal option is to find a competent psychotherapist who will help a person get to the bottom of the problem.

An appointment with a psychotherapist begins with the patient telling him about his problems. Next, the doctor will suggest you undergo special tests:

• Luscher test (for the general psychological state of a person).
• Spielberger-Hanin test (to determine the level of anxiety).
• Social phobia test.

Based on the test results and the person’s complaints, a diagnosis is made and treatment is prescribed.

Treatment of social phobia

Robert Kiyosaki’s wonderful work “Rich Dad Poor Dad” describes situations where smart and educated people were left with literally nothing because of their indecisiveness and shyness. While less educated, but more determined and arrogant individuals achieved success. The author shows that situations where fear suppresses the will should not be allowed. Because of it, your inner abilities and aspirations begin to fade, and you stop achieving your goals.

The reason why a person feels unwell in public is social phobia. The treatment will be effective if you have found a suitable treatment method. A psychotherapist is called upon to help find it: it’s not for nothing that he studied the books of famous predecessors and applied the knowledge at seminars.

Social phobia can be treated in different ways. One of the most effective is cognitive behavioral psychotherapy. There are other methods that correct social phobia and provide treatment:

• Tablets and other medications.
• Healing through meditation.
• Treatment of social phobia with hypnosis.

Cognitive behavioral psychotherapy

Treatment of social phobia with cognitive behavioral psychotherapy occurs in the form of meetings between a person and a psychologist (sessions).

A specialist teaches a social phobia person to recognize thoughts that cause increased anxiety. Surprisingly, it turns out that “bad thoughts” revolve around the same thing. Next, a person needs to analyze his thoughts and try to replace them with more rational ones. At the end of psychotherapy sessions, a person becomes his own psychologist, he learns to reason logically and replace categorical attitudes with more flexible ones.

Signs that psychotherapy is having a positive effect:

• reducing anxiety levels;
• new skills of behavior in social situations (when being in the center of attention, when speaking in front of a large number of people);
• a less categorical view of many things.

Social phobia: treatment, pills

And, of course, drug therapy cannot be ruled out. Medical treatment of social phobia involves prescribing medications to a person to reduce anxiety levels. A person is prescribed:

• antidepressants;
• beta blockers.

The former are effective both for social phobia and for high anxiety. The latter relieve physical manifestations of anxiety - tremor, tachycardia, sweating. Many politicians and activists take beta blockers before long public appearances.

But it’s worth remembering: pills treat the effect, not the cause. They are addictive and have many unpleasant side effects. Real relief from a problem is serious personal growth, and not the short-term effect of medical drugs that depress the nervous system. Therefore, resorting to pharmacotherapy should be the last resort.

Treatment of social phobia with hypnosis

Hypnosis is the second most effective treatment for social phobia. It consists of changing a person’s destructive beliefs by immersing consciousness in a state of trance. The hypnotist concentrates the person on the necessary information and suggests it. After several sessions of hypnosis, a person’s panic fear of society disappears, he is calm when society pays attention to his person.

But hypnosis has one caveat: not all people are susceptible to it. Also, this method is not acceptable to everyone: a person may simply not want someone else to delve into his mind.

Meditation

A great way to relax the body and remove internal blocks. Meditation has been known since time immemorial: it underlies many spiritual practices (yoga). The Old Testament mentions the Latin word meditatio - to meditate, to concentrate, to inhale.

Meditation is a spiritual exercise of reflection or self-talk. There are different ways to meditate. To relieve anxiety and calm the mind, there is a breathing meditation technique. She teaches you to breathe correctly and calmly. During practice, a person calms down, reflects, and learns to focus on positive emotions.

A meditating person is calm and does not tend to be anxious. helps improve communication skills.

Bottom line

A complex of various social fears is combined into the concept of social phobia. The strategy of competent treatment is to replace destructive categorical attitudes with more flexible and adaptive ones. An excellent addition to working on your thoughts is breathing meditation: relaxing, removing internal blocks and giving a positive attitude.

All social phobes should remember: water does not flow under a lying stone. You need to look for a treatment method that will help you. At first you will make mistakes and move slowly. But gradually, step by step, you will gain invaluable experience and find something that will help you return to a happy life.

Let me make a reservation right away that this article is for informational purposes only. There is no specific information here about which pills you should take and which you shouldn't. Perhaps it will appear in the future. If you don’t want to miss it, you can subscribe to updates in any convenient way (by mail, by joining VKontakte group, as well as via RSS or using Twitter). Now let's move on to the article itself.

There are several different types of pills for social anxiety. The main ones include:

• benzodiazepines
• monoamine oxidase inhibitors (MAOIs)
• beta blockers
• selective serotonin reuptake inhibitors (SSRIs)
• selective serotonin and norepinephrine reuptake inhibitors (SSRIs)

Each type of social anxiety pill has its own advantages and disadvantages, depending on your specific situation.

Benzodiazepines

Description

Benzodiazepines relieve symptoms of anxiety, which is achieved by influencing the central nervous system. Benzodiazepines can cause sedation and addiction, so they are preferred not to be used as the main drug for treatment.

List of drugs

• Ativan (lorazepam)
• Valium (diazepam)
• Xanax (alprazolam)
• Klonopin (clonazepam)

Beta blockers

Description

Beta blockers for social phobia are usually taken some time before events that may cause anxiety. Beta blockers are useful in situations requiring mental alertness because they do not have the adverse effects on cognitive abilities that are true of benzodiazepines.

List of drugs

• Anaprilin (propranolol)
• Tenormin (atenolol)

Monoamine oxidase inhibitors (MAOIs)

Description

MAOIs were once considered the most effective pills for social anxiety, but they carry the risk of serious side effects. Currently, MAOIs are not generally used unless there is reason to believe they will be more effective than other drugs.

List of drugs

• Nardil (phenelzine)
• Transamine (tranylcypromine)
• Marplan (isocarboxazid)

Selective serotonin reuptake inhibitors (SSRIs)

Description

SSRIs are currently the main weapon in the fight against social phobia (due to minor side effects and high effectiveness)

List of drugs

• Citalopram (cipramil)
• Escitalopram (Cipralex)
• Fluoxetine (Prozac)
• Fluvoxamine (fevarin)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

Selective serotonin and norepinephrine reuptake inhibitors (SSRIs)

SSRIs are antidepressants used to treat anxiety.

List of drugs

• Velafax MV (venlafaxine)
• Duloxetine

Other anti-anxiety pills

List of drugs

• Atarax (hydroxyzine)
• Buspirone (buspirone hydrochloride)

The article was prepared using the book "Clinical Handbook of Psychotropic Drugs"

ATTENTION! This article is slightly outdated, perhaps someday I will update it. If you don’t want to miss this event, then subscribe to updates in any convenient way.

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Social phobia is a mental illness associated with the fear of performing any actions in the presence of strangers, speaking publicly in front of an audience, or being in society. This disorder makes life difficult for people, so it needs to be treated. There are two treatment options: with various therapies and with medications.

Medicines are used in case of refusal of psychological treatment for social phobia

Drug treatment of social phobia is used if the patient refuses psychotherapy, and in other cases it is an additional treatment aimed at eliminating anxiety and stress. Medicines cannot rid a person of social phobia; they can only suppress some emotions. The development of medicine does not stand still, and today there are quite a few medicinal methods for treating this disease.

Treatment of social phobia with medications

Pills for social anxiety can have both positive and negative effects. Their advantage is that they can reduce the impact of symptoms on the patient. But you should understand that their effect is not long-lasting, and it is necessary to take pills frequently, sometimes several times a day, depending on the type of medication. This can lead to dependence on the drugs, and in the future the standard dose will not have the desired effect. The course of drug treatment usually lasts no more than one month.

When treating social phobia, doctors prefer to combine psychotherapy methods with medications and homeopathic remedies. Cognitive-behavioral, group, or relaxation therapies help the patient face fear, get used to those situations that frighten him and cause anxiety, and also help the patient develop a new way of thinking about his fears. The advantages of the drugs are as follows:

1. Almost all medications are aimed at reducing the unpleasant symptoms of social phobia: rapid heartbeat, excessive sweating, trembling limbs, difficulty speaking, etc.
2. The drugs help get rid of negative and obsessive thoughts, thereby stabilizing a person’s mental state.
3. Antidepressants are the best way to improve mood and reduce anxiety.

Very often, psychologists and psychiatrists prescribe several medications to their patients with symptoms of social phobia, and sometimes during the course they prescribe different pills for each stage of therapy. In short-term treatment, psychoactive substances with hypnotic, sedative, relaxant and anticonvulsant effects are used. At the second stage of treatment, patients are transferred to other drugs. This is necessary to prevent physical dependence.

Duration of treatment

It is necessary to understand that social phobia is a chronic disease, so treatment will be very long: from two months to a year. In approximately 50% of cases, relapses occur after 6 months of treatment. Doctors say that this happens due to abrupt cessation of medication. Medicines should be discontinued gradually, reducing the dose with each dose.

It is worth starting drug therapy with the safest drug. After 4–8 weeks, the doctor assesses the patient’s condition and determines the effectiveness of treatment.

If the symptoms remain unchanged and the patient’s condition does not improve, then it is necessary to increase the dose of the medicine or prescribe another one.

The body's response to drug treatment

Throughout the course of taking medication, the human body’s reaction may be different: excitement and anxiety may disappear, but side symptoms may appear (fatigue, drowsiness, aggressiveness, dejection, etc.). The effectiveness of treatment is manifested in the following changes:

• the patient’s anxiety, which he experiences when necessary for social communication or social activities, appears less and less often;
• a person is often in a relaxed state, due to which he does not perceive the people around him so keenly and can make contact;
• obsessive and frightening thoughts disappear;
• Thanks to the pills, the social phobia gets out of the depressive state faster.

In most cases, the effect of drug treatment begins to appear after 2-3 weeks. Each body reacts to therapy differently, so you should not jump to conclusions that the drugs do not help. Under no circumstances should you stop taking the pills, even if there are no changes at the initial stage. Only a specialist can diagnose and determine further treatment.

Thanks to the pills, the severity of the negative reaction to others is reduced

What medications are there for social phobia?

Today, pharmaceuticals are at a fairly high level. There are many different medications available to treat social phobia. All tablets are divided into several types:

• psychoactive substances acting on GABA receptors - benzodiazepines;
• biologically active substances that block the destruction of monoamines by monoamine oxidase - monoamine oxidase inhibitors (MAOIs);
• pharmacological drugs aimed at blocking beta-adrenergic receptors - beta blockers;
• third generation antidepressants intended for the treatment of anxiety disorders and depression - selective serotonin reuptake inhibitors (SSRIs);
• “dual-acting” antidepressants intended for the treatment of severe depression - selective serotonin and norepinephrine reuptake inhibitors (SSRIs).

Each type of tablet is used in certain cases and has both advantages and disadvantages. Side effects can be quite severe and require additional treatment. It all depends on the individual characteristics of the human body.

You cannot select medications on your own; this should be done by the attending physician after a complete examination. The choice of any medicine must be approached individually.

This class of psychoactive substances has hypnotic, sedative, anxiolytic, muscle relaxant and anticonvulsant effects. In the treatment of social phobia, they are used to combat mental anxiety, insomnia or agitation. Also, these tablets help get rid of physical dependence syndrome, which occurs in patients with long-term use of certain medications, alcohol and drugs. Benzodiazepines are sometimes used to prevent panic attacks.

These substances affect the central nervous system, reducing the excitability of neurons. Depending on the half-life of drugs, benzodiazepines are divided into 3 groups:

1. Substances with a short duration of action. Drugs in this group act from 1 to 12 hours. It is not recommended to take them before bed, as insomnia may occur after discontinuation of the drugs. Also, with prolonged use, the patient may experience increased anxiety.
2. Medium acting benzodiazepines. The half-life ranges from 12 to 40 hours. They can be used as a sleeping pill; after stopping the medication, insomnia may return.
3. Long-acting drugs. Substances remain in the body for 40-250 hours. When you stop taking them, withdrawal syndrome rarely occurs. For older patients and people with damaged livers, there is a risk of chemicals building up in the body.

Medicines of this type are taken orally, but can be administered intravenously and intramuscularly. They quickly calm the nervous system and relieve anxiety. They are very effective and well tolerated.

Benzodiazepine-based drugs are used to treat phobias

Side effects

With a single use of tablets, fatigue, drowsiness, dizziness, decreased thinking abilities, as well as decreased attention and concentration are possible. With long-term use, sexual dysfunction, impaired coordination, and lethargy may appear. When administered intravenously, there is a risk of respiratory distress and decreased blood pressure.

Sometimes the use of benzodiazepines is accompanied by decreased performance, memory impairment, skin rashes, and weight gain.

In rare cases, patients experience nausea, appetite changes, vision deteriorates, nightmares appear, and consciousness becomes confused. There is also a possibility of worsening depression and the emergence of suicidal tendencies.

Benzodiazepines may impair vision

Monoamine oxidase inhibitors

These biologically active substances, depending on their pharmacological properties, are divided into types:

1. Reversible MAOIs. Drugs in this group are safe and well tolerated. Moclobemide is prescribed for depression, blocks the destruction of serotonin and norepinephrine, pyrazidol suppresses strong emotional arousal, befol is prescribed for depressive syndrome, anxiety and delusional disorders, hallucinations, incasan is used for mental disorders, sudden changes in mood and in the treatment of alcoholism.
2. Irreversible MAOIs. The drugs contain 3 main active ingredients: selegiline is involved in the metabolism of dopamine, increasing the neurotransmitter in different parts of the brain; Rasagiline is an antiparkinsonian drug; Pargyline is an antidepressant used for mental and nervous disorders.
3. Selective MAOIs. These substances are aimed at inhibiting one of the types of monoamine oxidase.
4. Non-selective MAOIs. These substances inhibit both types of MAO-A and MAO-B. Drugs in this group maintain mental balance, reduce anxiety and anxiety, help recover from depression, and are used in the treatment of mental illnesses.

Therapy with MAO inhibitors and the dosage of medications are determined individually. Patients are prescribed a special diet during the course of treatment and for 2 weeks after it. There are also restrictions on the concurrent use of certain medications.

Side effects

Reversible MAO inhibitors can cause insomnia, anxiety, headaches, and dry mouth. Irreversible MAOIs can cause constipation, decreased blood pressure, nausea, decreased appetite, confusion, psychosis, and arrhythmia. In rare cases, disturbances in vision and functions of the urinary system are observed.

Beta blockers

For social phobia, beta blockers are used to treat anxiety because these drugs affect the sympathetic nervous system. They are aimed at reducing symptoms: reducing heartbeat, trembling in the limbs, reducing sweating and redness.

Doctors recommend taking medications from this group as a sedative before any alarming event. Their duration of action is several hours, so they are often taken not only by those suffering from social phobia, but also by completely healthy people before important and exciting events: an exam, public speaking, business meeting, etc.

Beta blockers have little effect against the negative thoughts that often lead to the physical symptoms of social anxiety disorder. They are not the mainstay of treatment for mental illness.

Side effects

Chronic fatigue may develop with frequent use of beta blockers. Patients with asthma may experience an exacerbation of the disease, while diabetics may experience a decrease in LDL cholesterol and a decrease in blood sugar. After discontinuation of the drug, blood pressure may increase.

Chronic fatigue is a side effect of beta blockers

Selective serotonin reuptake inhibitors

These drugs are currently the main ones in the treatment of social phobia. They are highly effective and have much fewer side effects. They belong to one of the groups of antidepressants and are prescribed for mild to moderate depression to reduce anxiety. For severe depression, these medications are not as effective as tricyclic antidepressants.

These medications must be taken daily, following the treatment regimen. The results may appear in a few weeks. You cannot start taking these medications on your own, as there are a number of restrictions on their use. SSRIs are incompatible with some medications, and their interaction may cause new symptoms (headache, vomiting, increased blood pressure).

Side effects

The most common side effects are insomnia, feeling tired, weight gain, headache, dizziness, decreased appetite, sweating, and sexual dysfunction. Some patients experience irritability, aggressiveness, and nervousness.

Selective serotonin and norepinephrine reuptake inhibitors

These drugs also belong to the group of antidepressants and are used to treat anxiety. They are well tolerated by patients and have minimal side effects. They have a powerful antidepressant effect and are superior to SSRIs in their action. Psychiatrists often use them to treat severe depression because they are similar in strength to tricyclic antidepressants.

Phobias are quite widely represented among patients; they have their own boundaries and clinical variations. Along with such recognized variants of phobias as social phobias, nosophobia, specific or isolated phobias, panic disorder, classified both in ICD-10 and DSM-4 as anxiety disorders, should also be included in the phobic circle disorders.

Firstly, both the psychopathological and substantive features of the patients’ experiences during a panic attack are more typical for phobias than for anxiety: paroxysmal thanatophobia, cardiophobia, lyssophobia arise, and not anxiety, tension, devoid of a certain content. Nevertheless, fear in the structure is not obsessive in nature. It is, rather, fear taking over. But other phobias, traditionally classified as obsessions, are largely, if not for the most part, fears that are not obsessive, but overvalued.

Secondly, they become a source of social anxiety and other phobias much more often than the basis of generalized and other protracted anxiety disorders. In this case, panic attacks lose their independence and act as one of the components of the phobic syndrome.

Modern treatment of phobias

Currently, the methods of treating phobias are quite diverse. Psychopharmacotherapy actually takes the leading place in the treatment of phobias. Of the classes of psychotropic drugs, the first position is taken, according to the results of most studies and established therapeutic practice. This is followed by and. Application, psychotherapy are first-order methods of treating phobias, which in some cases can be used independently, in the form of monotherapy. Next come beta blockers, which, as a rule, play a supporting role in complex treatment, excluding some cases of social and isolated phobias. General vegetative stabilizing measures are practically significant, especially in the earlier stages of phobic disorders.

There are also treatment methods with limited or controversial effectiveness (laser therapy, acupuncture, the use of thymostabilizers), used as additional ones in complex therapy, as well as treatment methods with relatively high efficiency, but rarely used at present, for example, sub-shock methods.

It is also worth noting that with their advent, their intensive use in the treatment of phobias began, including parenteral administration of high doses of relanium. However, a certain disappointment set in relatively quickly, after which such treatment practically ceased. The effectiveness of tranquilizers was not as high as expected. In addition, the use of tranquilizers has time limits due to the risk of addiction (the duration of the course of treatment should not exceed four and sometimes two weeks, according to some studies. The withdrawal of tranquilizers in most cases is accompanied by an exacerbation or resumption of phobias. As a result, tranquilizers, while maintaining a noticeable place in the treatment of phobias, have lost their dominant position. Currently, in the treatment of phobias, especially panic disorder, alprazolam, clonazepam, Relanium, phenazepam are mainly used. The latter is very promising due to the lower risk of addiction, according to a number of narcologists, and the emergence of injection addiction. forms.

The beginning of the use of OM for anxiety-phobic disorders dates back to the 60s of the last century, when positive results were obtained in the treatment of panic attacks. In fact, all or almost all antidepressants, both known for a long time and those that appeared relatively recently, have been used or are currently used for phobias. Tricyclic antidepressants (TCAs) and irreversible monoamine oxidase inhibitors (MAOIs) were the first to be introduced into the treatment of phobias. The latter, however, are currently almost never used to correct phobias. The main TCAs ( , imipramine and especially clomipramine) are still widely used. With the advent of new groups of antidepressants, selective serotonin reuptake inhibitors (SSRIs), reversible monoamine oxidase inhibitors (MAOIs), the intensive introduction of these drugs into the treatment of phobic disorders began.

The most significant advantages of imipramine include accessibility, reasonable cost of outpatient therapy, availability of injectable forms, and the possibility of use in children. Disadvantages: the need to use high doses, lower effectiveness compared to SSRIs (although the comparison results are not entirely clear), insufficient clarity of ideas about the mechanisms of their action in phobias, frequency and severity of side effects, including anticholinergic ones (tachycardia, extrasystole, arterial hypertension, tremor), which correspond to somatovegetative manifestations of panic attacks and other phobias and, in some cases, contribute to the strengthening of phobic disorders. It is known that anticholinergic effects occur in every fifth patient with phobias receiving amitriptyline or imipramine.

Clomipramine compares favorably with amitriptyline and imipramine in its higher effectiveness, associated with its pronounced serotonergic activity. The disadvantages associated with classic TCAs do not apply to tianeptine, a representative of the CVD group, which is used in a standard daily dose, is well tolerated and appears to be a very promising long-term treatment for phobic disorders.

Significant advantages of SSRIs compared to classic TCAs:

• higher efficiency;
• the presence of pathogenetic grounds for their use;
• lower frequency and severity of side effects;
• Great possibilities for long-term use.

However, SSRIs are inferior to TCAs in some respects. First of all, this is a non-medical disadvantage:

• currently less affordable;
• problems of long-term outpatient therapy;
• lack of injection forms for most drugs;
• impossibility of use in children and adolescents under 15 years of age (with the exception of).

Daily doses of TCAs used for phobias are quite high and approach the doses used in the treatment of severe depressive episodes. At the same time, analysis of the relevant data on SSRIs only partially confirms the well-known position about the advisability of using low doses of SSRIs for phobias, which are significantly lower than the doses used for severe depression. This is true for fluoxetine, citalopram, fluvoxamine and, to some extent, paroxetine. The daily doses of a and OIMAO (moclobemide), especially often and most successfully used in disorders of the phobic circle, are close to or correspond to the maximum.

To date, the insufficiency of central serotonergic structures in phobias can be considered established, which is usually considered as their main pathogenetic mechanism. This explains the significant effectiveness found in many studies for phobias of clomipramine and SSRIs, which increase the concentration of serotonin in the intersynaptic spaces.

It is more difficult to explain the effectiveness of amitriptyline and imipramine in relation to phobic symptoms. There is a point of view that while many TCAs can be successfully used for panic disorders, for obsessions only clomipramine and SSRIs are used. However, various TCAs began to be used for phobias long before the advent of SSRIs. Amitriptyline and imipramine have a fairly high serotonin reuptake inhibitory ability, not inferior or slightly inferior in this regard to fluvoxamine and paroxetine. In addition, the effectiveness of TCAs may be partly due to their positive effect on depressive symptoms associated with phobias. The concept of the essential unity of phobias and depression should also be taken into account. Nevertheless, it is premature to reduce the pathogenetic mechanisms of phobias to the insufficiency of the functions of serotonergic structures. Most likely, the pathogenesis of phobias is more complex, and not all of its links have been established.

The effectiveness of monotherapy for phobias in all groups of antidepressants is relatively high. Compared with amitriptyline and imipramine, the effectiveness rates of clomipramine and SSRIs are slightly higher. The lower efficacy rates of moclobemide are noteworthy. However, when assessing them, it must be taken into account that moclobemide was tested mainly for social phobias, which are particularly resistant to treatment. As a result, taking into account the better tolerability of SSRIs and the possibility of using relatively low doses, they show noticeable advantages compared to TCAs. It should be noted that when assessing the immediate effectiveness of antidepressants, the proportion of patients with improvement in condition is most often determined. Significant improvement is rarely specifically identified. Long-term results of treatment of non-psychotic disorders, including phobias, are generally successful in cases where the immediate results of therapy reach the level of significant improvement. Otherwise, there is a high risk of exacerbations and relapses. According to various sources, for phobias it is 30-70%.

The antiphobic activity of specific antidepressants from the SSRI group is usually considered the same, which raises some doubts. To clarify this issue, comparative clinical trials of drugs are needed. The effectiveness of various methods of treating phobias has been repeatedly compared: monotherapy, tranquilizers, psychotherapy alone and their combinations, with mixed results. However, complex therapy for phobias has the largest number of supporters. Monotherapy for phobias with antidepressants is becoming increasingly popular; Long-term monotherapy with tranquilizers should not be carried out at all due to the high risk of addiction. Psychotherapy is used relatively often as the only way to correct phobias.

Indications for monotherapy with antidepressants are very limited. These are isolated phobias, monosymptomatic variants of agoraphobia, nosophobia, social phobia and those cases of agoraphobia, social phobia when the degree of generalization of pathological fears and the degree of avoidant behavior are low and phobias do not show a tendency to progress. In addition, monotherapy with antidepressants can be used as long-term maintenance treatment after a successful course of active complex therapy. For social phobias and isolated phobias that arise in one, relatively rare and predictable situation, one-time doses of beta blockers or alprazolam before the occurrence of such a situation are sufficient.

When there is a combination of different phobias, the presence of several frightening situations with incomplete avoidance, a combination of antidepressants and psychotherapeutic measures is indicated. For generalized phobias with complete avoidance, maladaptive personality, frequent and severe panic attacks, chronic or recurrent course of phobic disorders, the presence of a tendency towards their progression, the endogenous nature of phobic symptoms, the most active complex therapy is indicated, which is advisable to begin with the prescription of tranquilizers, including parenterally . Further treatment includes antidepressants, psychotherapy, and vegetative-stabilizing measures. After a month, tranquilizers are replaced with neuroleptic behavior correctors or small or moderate doses of neuroleptic antipsychotics.