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Medications' Side Effects in Social Anxiety / Phobia: What They Are, Why they Occur, Myths and Realities – Overview

Ruy Miranda
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In this series of consecutive articles, we examine several aspects related to the side effects of medications used in the treatment of Social Phobia / Anxiety Disorder and excessive Shyness. However, such topics will not be wholly exhausted in this series and we may come back to them in future articles. We will use concepts and information from other articles. If anything in this article is not clear to you, in all likelihood it may become clear if previous articles from the series and others in this website are read or reread. Such articles from this website are, among others: Social Phobia/Anxiety Disorder: Treatment, Shyness and Social Anxiety Disorder: Neurophysiological Approach, Shyness and Social Anxiety Disorder: Medication Action


First of all, let us review the concept of side effect. It refears to medications acting on some part of the body other than that which needs treatment. Two examples follow.

If you take some antibiotics against a serious throat infection, intestinal disturbances may set in because the same antibiotic that kills the bacteria infecting your throat can also kill intestinal bacteria. Their death breaks the intestinal flora balance and disturbance then sets in.

If you take an anti-depressant medication to reduce the Social Phobia / Social Anxiety Disorder symptoms, sexual orgasm may be delayed or even become impossible. In addition to producing the desired effect (reduce or eliminate Social Anxiety symptoms), this medication also acts on the neurotransmitters involving orgasm.

Therefore, the side effects are due to a double or multiple medication action.


Medications Side Effect Motives


Any medication that interferes in a biological substance responsible for multiple actions in one’s body may produce the desired action but also undesired actions. The undesired action are the side-effects.


You must have read and/or heard much about a body-produced substance known as serotonin. In case you have not yet noticed, please observe the large number of disturbances linked to its production, use, mobilization or metabolizing. Serotonin is involved in the explanation of many different illnesses. However, its role is nearly always just a possibility, and never a scientifically-proven conviction. Such hypotheses may well be confirmed by future scientific research. There is already plenty of evidence that serotonin acts as a neurotransmitter in different parts of the body, thus regulating different functions. Thus, it seems that serotonin is a biological substance essential to the balance of many bodily functions.

If you take any substance that interferes in serotonin production, use, mobilization or metabolizing, this substance may act in multiple places. Acting in a place where there is unbalance is good because it reestablishes balance. However, acting where there was balance may bring about unbalance or side effect. Think about the example of the medication that acts on the Social Phobia Anxiety Disorder symptoms and also interferes in sexual orgasm.


A given medication may interfere in the action of different neurotransmitters, resulting in expected as well as in undesirable actions.


There is another way a medication used to reduce the suffering caused by Social Phobia / Anxiety may also produce a side effect, namely, by acting at the same time on different biological substances. Let us see one such example. Anti-depressant medications, especially in the three-cycle group (such name is due to a type of basic chemical structure common to all of them) may be useful in Social Phobia / Anxiety and also cause visual difficulties in focusing on objects. Every indication in this case points to, on the one hand, its action on the serotonin and/or noradrenaline (desired anti-depressant and anti-phobia actions) and, on the other hand, to the undesired action on another neurotransmitter known as acetylcoline (acting on ocular muscle fibers and ligaments, leading to eye focus).


The complex interaction of biological substances for life maintenance is the scenario for unpredictable side effects.



There are other ways, still unknown, in which Social Anxiety Disorder medications produce side effects. Life complexity accounts for this lack of knowledge. The same substance may cause from zero to dozens of side effects on different persons. I will mention three examples of situations I have witnessed myself. They partly illustrate this information.

In the 80s, I prescribed a three-cycle anti-depressant to a man and, as I always do, I started with a small dosage. His first information is forever etched in my mind because of the image he used to describe the medication’s action: “It is as if I were thirsty and drank water.” The expected action was occurring (thirst quenching) and there was no side effect (a normal amount of water causes no side effect). In order to evaluate this case more precisely, I listed a whole series of possible side effects, and his answers were all negative.

This same medication prescribed to a woman in her early fifties made her go into what she called an “uncontrollable sleep,” which lasted twenty-four hours. Had I started her treatment with a higher dosage, the incident could have been very serious.

The third example, also rather surprising, took place in the late 90s. A man, about forty, came to me and said he had been using, every day for the past seventeen years, a mono-amino-oxydase inhibitor. A general clinician had originally prescribed it to him and, thereafter, he had simply purchased it over the counter, with no medical prescription at all. No side effect had appeared in all these years nor had there been any harmful interaction with other medications or food.

However, the science begins to reveal that some differences in the metabolism of the individuals may cause these very different effects. But this will be the subject of another article.


Predictable Side Effects of Medications



Despite this multiplicity of bodily responses to Social Anxiety / Phobia medications, there is a set of undesirable side effects more common in groups of chemical substances. For instance, if medications of the benzodiazepinic group are used, there is a major chance of certain side effects. Three-cycle anti-depressants tend to produce different side effects - and so forth, and so on. That is what we will discuss in the next article.


January, 2005


You may also want to read:
Antidepressants Tri-cyclics - Side Effects - Part 2
Medications Action, Side Effects from Individual Differences in Metabolism - Part 3


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This web site, the Social Anxiety Disorder and Shyness Directory and these articles contained on this web site are not solicitations, are not medical advice and are not intended as medical advice. This web site, the Social Anxiety Disorder and Shyness Directory and these articles are intended to provide only general, non-specific medical information and are not intended to cover all the issues related to the topics discussed. This web site, the Social Anxiety Disorder and Shyness Directory and these articles do not create any physician-client relationship between Ruy Miranda and you, and they do not replace the eventual relationship between you and your physician, psychologist, or other healthcare professional. This article’s author recommends no particular medication and does not represent the interests of any person, company or pharmaceutical laboratory.


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You may want to read other articles on Social Anxiety Disorder / Social Phobia and Shyness:

Basic Articles:

Self-Concept/Self- Actualization – Shyness Nucleus

Self-concept, Body Image, Self-depreciation and Shyness

Shyness and Social Anxiety Disorder: Neurophysiological Approach

Shyness Articles:

What Is Shyness? Fear, Anxiety, Anguish?

Questions and Answers on Shyness

Humiliation Stories, School Spankings: Examples of Shyness Causes

Social Anxiety Disorder Articles:

Social Anxiety Disorder: What It Is, The Anxiety Attack Symptoms

Social Anxiety Attacks: Incidence, Onset, History, Evolution

Social Phobia / Anxiety Disorder: Treatment

Social Phobia / Anxiety Disorder: Differential Diagnosis

Avoidant Personality Disorder

Medications in Social Phobia: Side Effects - Part 1

Antidepressants Tricyclics: Side Effects - Part 2

Metabolic Pathways Individual Differences and Medications Side Effects - Part 3

Genetic Changes: Medications Side Effects - Part 4

First Line Antidepressants - Side Effects - Part 5

Social Anxiety and Shyness Articles:

Panic Disorder, Shyness, Social Phobia - Differences

Why Self-Help in Shyness and Social Anxiety Disorder / Social Phobia Doesn’t Help You

Shyness and Social Anxiety Disorder:Medication Action

Facial Blushing, Redness of the Face, Ears and Neck

Psychoses, Shyness and Social Phobia


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