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Anxiety and Stress Disorders

Seeking a Diagnosis and Explanation

06/14/2006

Question:

I have just started getting help for my problems... I was sent to one doctor who said I have PTSD which caused Social Anxiety Disorder and Depression. When he heard I was put on Prozac in the past for Social Anxiety he said he had never heard of that before... Couple of weeks later I see my doctor for the first time... He doesn't say what he thinks is wrong with me but puts me back on Prozac? Should I take the Prozac or find another doctor?

Answer:

Well, I don't blame you for being confused.  It is frustrating when you tend to get different responses and suggestions from different physicians about the same problem.  However, medicine is an Art, as well as a Science, and you are a person who is also changing with time.

As you talk to your doctors about your problems be sure and have a few questions ready to ask.  For example,

"What do you think is wrong with me?  What diagnosis seems right to you?

"If you don't know what is wrong with me now, what more do you need to help me?  More time?  More tests?   A trial of medication or therapy?"

"What therapy or medication do you suggest?  How long will it take to show some improvement?  What side effects can I expect?  How long will I need to take this therapy or medication?"

It is always appropriate to get a second opinion when you are uncertain about the diagnosis or treatment suggested to you by a physician.  Even a THIRD opinion, if you get conflicting advice.  Keep in mind that mental health diagnoses are not as easy to make as, say, a diagnosis of strep throat.  There is no quick and easy test to tell the doctor what is wrong, and often there is no single treatment or medication that is guaranteed to work better than anything else.  Both diagnosis and treatment may take several visits over weeks or months.

That said, PTSD and social anxiety are both commonly treated with the selective serotonin reuptake inhibitor (SSRI) medications, which include Prozac (fluoxetine).  These types of medications, especially when used along with cognitive behavioral therapy (CBT, a kind of thinking and acting therapy) have shown good success for people with both PTSD and social anxiety.  It is not unusual for social anxiety to develop in people who have experienced traumatic life events, so I wish you good luck in your ongoing treatment.

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Response by:

Nancy   Elder, MD Nancy Elder, MD
Associate Professor
College of Medicine
University of Cincinnati