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By Melissa Tennen, HealthAtoZ writer
You walk into a room full of people. You feel like everyone is looking at you. Your heart pounds and your palms are sweaty. You can't wait to get out of there.
Could you have social phobia?
"This condition is pretty prevalent, but most people don't get treatment," says Michael R. Liebowitz, M.D., professor of clinical psychiatry at the College of Physicians and Surgeons at Columbia University in New York and director of the Anxiety Disorders Clinic at the New York State Psychiatric Institute.
"We need to get them to realize they need help," he says. "Twenty, 30 years ago, there was much less awareness about depression. In the past 10 years, there has been a growing acceptance of depression. But social phobia is a brand new concept."
He says most primary care doctors don't recognize the disorder.
Social phobia is characterized by an intense fear of situations, usually social or performance situations, where embarrassment may occur. People with the condition know the physical signs of palpitations, tremors, sweating, diarrhea, confusion and blushing. They fear others will notice, judge and think poorly of them.
As a result, people become extremely anxious about the activity. That feeling can manifest as a panic attack, or in total avoidance of an activity. Adults usually recognize that their fears are unfounded or excessive but suffer them nonetheless. Many experts believe social phobias, like other mental disorders, are caused by chemical imbalances in the brain.
"People know they have something, but they don't know it's a medical condition that can be treated," Liebowitz says. "When people do go to the doctor and say, 'I think I have social anxiety disorder,' they often get dismissed. 'Oh, you're just shy,' the doctor might say. Then the patient feels devastated and invalidated."
Most doctors prefer selective serotonin reuptake inhibitors (SSRIs) drugs to treat depression and related disorders because of their low rate of side effects. Zoloft® (sertraline) along with Prozac® (fluoxetine) and Paxil® (paroxetine) are in this class. Even though all these drugs are used, Paxil, Zoloft and Effexor® (venlafaxine) all have been approved by the Food and Drug Administration (FDA) specifically for social anxiety disorder. Often people with anxiety disorders such as social phobia also have depression.
 Children, teens and adults being treated with antidepressants, particularly anyone being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns immediately with a doctor.
Paxil may increase the risk for birth defects, particularly heart defects, when women take it during the first three months of pregnancy, according to a 2005 advisory from the FDA. The FDA is waiting for the results of recent studies to better understand the higher risk. Discuss with your doctor about the health risks of Paxil if you plan to become pregnant or are in the first three months of pregnancy. You may want to consider taking a different antidepressant. Do not stop taking the drug without first talking to your doctor.
This article was reviewed and updated June 2007.
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