Help - Best meds for profound social anxiety?

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My son is 21 (diagnosed with ASP at 20), and struggles but manages well enough except for socially.

He suffers from anxiety to varying degrees 24/7, even alone. But when any other people are involved his anxiety is profound. He was put on Paxil two weeks ago and was just given atavan to take PRN. I had high hopes for the atavan PRN but he says the atavan either does nothing or makes him high. The Dr said the Paxil was great for social anxiety but I doubt it will enough to cut it.

Suggestions on meds that might help please?!
Thanks much!

You are given a combination of counseling, antidepressants, and tranquilizers. The meds by themselves will not do the whole job, counseling is an extremely large component of coping/recovery.

There are different antidepressants and tranquilizers you can try. People who don't respond to one will often respond to another one better. My personal favourite combination is Cymbalta and Xanax.

Natural complementary therapies can include things like yoga, meditation, or tai-chi to learn relaxation. Some herbal remedies may help, if you're into naturopathy. It's best to seek professional advice if you go the herbal route, because it's difficult to determine the potency of herbs sold on the shelf, and their possible interactions with medications he's already on.

And I don't need to tell you that every possible stressor should be decreased or removed from his life until he can cope a little better. You have probably done that already.

He has been in therapy for many years, that was finally how he came to be diagnosed at 20...all previous psychologists labeled it social anxiety and ADHD. He feels therapy (a number of different therapists) doesn't help him. He is 21, I cannot make him go...nor can I make him try yoga etc... been there, done that. Won't go to groups etc etc.

Perhaps eventually he'll consider counseling again, and other relaxation methods.

Thanks for the info and med suggestions. 8^)

I would send him a link to these forums. Learning that there are other people like you and talking with them is a far better therapy then most therapists can provide.

I think its an individual thing. What works for one person will not work for another. I have a friend who has Aspergers as well and she had very severe anxiety. She started taking Zoloft and she is like a different person now. I can not take SSRI's so I have to take a low dose of valium when I have really bad days or feel an anxiety attack coming on. I typically get really agitated and my sensory system is more off than usual....like every noise and sensation is stabbing me.

Medication is not the best way to deal with social anxiety with Asperger syndrome.

The best way to overcome a paranoia of social interaction - which is to say, unwillingness to answer the phone, make phone calls, pay a human clerk for a purchase, etc. - is support and facilitation. Go with them and provide moral support as they go through the process once or twice, being ready to step in if they panic.

For deeper social interactions - boyfriends or girlfriends, things like that - social groups that are structured around activities they are interested in is often best.

my SO has classic autism and suffers from severe social anxiety as well. he just recently started taking fluoxetine (prozac) on a daily basis, and also has a prescription for alprazolam (xanax) for occasional use. the prozac helps keep his emotions more level, so he has less drastic swings, and the xanax mellows him out when he gets into situations where his stress level is very high (xanax can be addictive tho so for occasional use only). they have made a marked difference in his ability to socially interact, i can actually tell when he has taken the xanax. meds are pretty controversial. it is always great to try less dangerous means, like therapy or support, but there are some who dont find those things effective and meds may be the best option for them.

i have been the support person for my SO for over 12 years, and while my presence may make it easier for him to go to the doctor (all 4 times he has done so in those 12 years) or grocery shopping at that time, it does nothing to lessen the anxiety the next time if i am not there. it is not a reasonable anxiety, it cant be reasoned away with logic and experience. its much more like a phobia, unreasonable and uncontrollable.

likewise with therapy. for my SO, and likely others with such severe social anxiety, the absolute last thing in the world he wants to do is have to talk to someone. he would rather have his fingernails pulled off with pliers than sit with a therapist and talk about himself. i suppose it could be considered aversion therapy, to force someone who has anxiety about talking to people to talk to a therapist, kind of like making someone afraid of spiders hold a tarantula. but i think ultimately it would be much less effective since the whole basis of therapy relies on verbal communication and thats a problem itself for those with asd. this would also be the reasoning behind the OP's son rejecting groups; they would increase anxiety rather than decrease it.

there are some simple things to try to reduce the anxiety in social situations. scripts can help, have a prepared list of verbal options for upcoming interactions, a plan of what he is going to say in a given situation. a "buffer" person is great, even if they arent there to speak for you, it can help to simply not be alone (my SO takes one of the kids with him sometimes if i cannot go). limit the time spent in the social environment, be aware of how loud/active/bright it is and adjust the length of time accordingly. try to find something he can use to ground himself when stressed, a stim or something else; for instance my SO has audiobooks on his phone with earbuds, and when he starts feeling stressed he puts them in and it helps him self calm. do required shopping or outings at less busy times, early morning or late night hours; even walmart is quiet at 2 am =)

also make sure he knows its ok to just leave when its too much. we have turned around and walked out of places because they were too crowded or busy. we cut trips short when the stress level of my SO or 5 yo autie is escalating. rarely do you ever find a situation where leaving is not an option. you can almost always go back later or reschedule.

ok, thats more than just meds suggestions =P but i think the goal should never be to just medicate away the issues, and certainly not to make any given person more "normal". the goal should be finding ways to make social interaction more comfortable and achievable for the person with social anxiety, whether thats by meds, therapy, support, avoidance, etc. rarely will you find one thing is going to be all you need, and its possible the anxiety will never be actually gone, but will hopefully be reduced to interfere less with life.

I know a lot of people learn to get along with just therapy or learning to live with it but some people need medication to be able to function. Im sure if I wanted to I could find a better combination than what I use now but I have an auto immune disease and I take a lot of medications right now and Ive had to push my Asperger's and a lot of those issues aside. Not that they do not exist but I already feel like a walking pharmacy. Also I dont need to be social right now, Im nearly an invalid so my social anxiety is limited to having to go to physiotherapy or to the doctor (for that I can take a valium). I understand how your son feels, its very hard to function when you feel like a prey animal and other people remind you of lions and tigers. I kind of stole this analogy from Temple Grandin who says she could not function without her medication and she says she would never change her medication even though there are newer types out there. Its like you dont fix what is not broken. She always says when finding a medication to make sure that the doctor starts you off on the very lowest dosage and does not raise it too much because Autistic's have bad reactions to high levels of medications. Sometimes you have to play around and try different ones until you find what works for you. Just work with your doctor and remember....low dose!

I wish I had been diagnosed earlier....I loved the medical field and I did work for many years but I suffered with such extreme anxiety that I had to quit or was fired from my jobs. I sometimes wonder what I could have done had I known earlier!

Thank you all for your suggestions.

I understand that the ideal way to go is a holistic approach, but he was diagnosed at 21 and is an adult and is only willing to do what he is willing to do. Had he been diagnosed earlier, taking a holistic approach would have been so much easier and much more beneficial. Unfortunately he was misdiagnosed for years by many psychiatrists/psychologists/school staff. Right now, as an adult, and per his insistence, it is his ballgame; it is not okay with him to do anything more than be supportive.

I asked specifically about meds because the paralyzing social anxiety is what is most in his way in life and he wants to try medication.

Again, thank you all for your suggestions and for sharing about yourself. I wish you all well!