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What is the cure for social phobia?

Q: I am a 36 year old male. From early childhood I am a very shy person that led one of my teachers to comment in my report - hardly utters a word in class. I managed to complete my degree and graduated as a lawyer. At college I did not attend tutorials as I have to speak but attended all lectures and managed to pass all the written exams. I did not socialise during my college years. I only spoke with a few friends of mine. After graduating I started to work but tried to avoid meetings where I have to speak. I did attend the court and somehow managed to present my case. Since last year I started getting very tense and sweaty when I had to present my case, my whole body seemed to be squeezing, specially my stomach. When I try to concentrate my legs become wobbly and I have pain in the back of my head. I feel like running away. I thought I had some medical problem and did many tests including blood, ECG treadmill, thyroid, testosterone and when one neurologist said I may have had a mild stroke I rushed to do an MRI of the brain. All tests were within normal limits. Finally, I went to Apollo hospital in Colombo and consulted a neurologist. He said my problems are due to anxiety and prescribed amitriptyline 20 mg at night, alprazolam SR 0.5 mg in the morning and inderal 10 mg morning and night. When I took these medicines I felt much better. I have now stopped Alprazolam because some say it is very addictive but the neurologist says I can continue to take it. Any way I am taking only Elavil 20 mg and Inderal. My question is I still try to avoid social gatherings and still experience a lot of sweating and distress when I am at a public place or presenting a case in court. Is there any treatment for these problems. Your answer would be greatly appreciated.

A:You seem to have suffered from what is now called social phobia, all your life. The two medications you take are antiquated and often have unpleasant side effects. I would hate to prescribe over the net but I can definitely say the following: 1. You are right to not take alprazolam - it is highly addicting and not a definitive treatment. 2. While amitriptyline may work, it frequently has intolerable side effects at higher doses - I would pick a medication from the group collectively called SSRIs. That is fluoxitene, sertraline, paroxitene or citaprolam. None is better than the other and you should see a psychiatrist to make the right choice and get definitive and safe treatment. The problem you face is entirely curable. Psychotherapy would also be very helpful along with the medication.

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