Q: I am 33 years old man who has been a shy guy, not able to mix comfortably with new people or groups since childhood. I feel tensed and nervous while interacting with strangers or even with relatives. I get arrogant with people whom I feel are low in confidence and due to this comfort zone I tend to move around with people who are low on confidence and don’t pose any threat to me. I have tried hypnosis therapy, counselling and behavioural therapy, but all in vain. The psychiatrist prescribed Lithosun SR, Pramipex, Sulpitac, Lenozep, Fluvoxamine/Prodep. I felt a bit better during that period but confidence and the comfort level remained same. However, I have stopped taking these medicines due to the serious side effects they have, like decreased sexual desire, arousal and delayed ejaculations, etc. I never felt any improvement with anti-depressants. How can I overcome these problems? The main symptoms are lack of confidence, tendency of over spending, feels better after spending/shopping, always feels something is lacking, tries to find faults with almost everything, not able to speak in groups and superiors, mood disorders, anger and irritation, stubborn, mild depression, fatigue, lack of enthusiasm, feeling stressed, not able to laugh freely. Please help.

A:I am extremely impressed with your understanding of your problems. These problems are not very uncommon, and many times are not discussed or no attempts are made to help them out. As you realise most of the concerns are present right from your childhood , when you have identified yourself as a shy child. What this basically implies that there is a strong likelihood that anxiety and shyness are a part of your personality right from the beginning and not have had a recent onset. There are various ways one can conceptualise the management of these issues. There are no concerns of being shy in nature as long as it is not I impacting on your day-to-day functionality- one certainly does not need to go on stage on an everyday basis until one is a politician or a stage musician. There could be other examples of things, which you feel uncomfortable but are not required to be done on a daily basis. So, the focus should start with how is your anxiety affecting your day to day life and what all routines does it effect. Does it stop you from taking public transport, meeting and greeting colleagues, customers (whatever work you do), interacting with your friends, relatives, partner, children, going to the shops, paying bills etc. Once you get that list ready, you would need to rate the level of anxiety associated with each activity and list it from minimum anxiety provoking activity to maximum anxiety provoking activity. This is just the homework before you are able to visit a clinical psychologist to undertake therapy under a cognitive behavioural framework. What is most important is the issues are right from childhood, and you are focussing on decreasing the distress associated with day-to-day living activities rather than occasional or rare activities initially. Also it is worth trying the combined approach of both psychological treatment and psychiatric treatment to show maximum results. What finally would pay is persistence, consistence and hope and continuity.