Stein & colleagues found that compared to peers with no emotional disorders, young people with either SAD or depression at the beginning of the study were about three times as likely to develop depressive disorder over the follow-up period, which lasted over 4 years. But the biggest predictor of later depression was the combination of SAD & depression. Compared with young people with no emotional disorders, those with both SAD & depression were more than eight times more likely to have depressive disorder during follow-up. Youngsters with both SAD & depression at the beginning of the study were also at risk for more severe depression, the authors note in the March issue of the Archives of General Psychiatry. During the study, those with both conditions were more likely to contemplate or attempt suicide, had more symptoms of depression & a longer duration of major episodes of depression than other young adults. Although it is not clear that social anxiety disorder is the cause of depression, many factors link the two conditions, the report indicates. Social anxiety during adolescence can affect self-esteem & social isolation, both of which have been linked to the development of depression. Regardless of the relationship, Stein & colleagues conclude that the findings support the idea that intervening early with youngsters who show signs of social anxiety disorder may help prevent the development of major depression--especially among those who show some signs of depression as well

Teenagers with social anxiety disorder tend to suffer in silence. Michelle, a 16-year-old high-school student, has thought of herself as shy as far back as she can remember. As a child she was considered quiet and reserved, but still managed to make friends and do well in school. But things took a turn for the worse when Michelle became a teenager. She became overwhelmed with anxiety when confronted with social situations like parties or even talking with the other kids at school. She sometimes had panic attacks in anticipation of giving book reports or otherwise speaking up in class. Just thinking about dating made her extremely nervous. Eventually, she came to avoid most social situations, and attending school became a struggle. Although she felt like she was the only one in the world with such problems, Michelle is far from alone. About one in eight Americans suffers from social anxiety disorder (also known as social phobia) at some point in their lives, making it the third most common psychiatric disorder. According to psychologist James Herbert, Ph.D., associate professor and director of the Social Anxiety Treatment Program at MCP Hahnemann University in Philadelphia, scientists have made great strides over the past decade in understanding and treating social anxiety disorder in adults. But the disorder is rarely recognized among adolescents, even though the teenage years are typically when it first becomes a serious problem. Herbert remarks, “We have been shocked at how often this problem goes unrecognized among adolescents, even by doctors, school counselors and mental-health professionals.” The reason for this oversight, adds Herbert, is due in part to the nature of the disorder. “Teenagers with social anxiety disorder tend to suffer in silence. They keep to themselves and don’t bother anyone. Meanwhile, the schools are preoccupied with the kids who are disruptive, acting out and violent.” In addition, since a certain amount of social anxiety is normal, especially for adolescents, it is easy to overlook those whose anxiety is actually a problem. But there are important reasons to identify social anxiety disorder as early as possible. Researchers have found that the condition typically does not go away spontaneously without treatment. In fact, left untreated it tends to get worse over time. In addition to the negative impact the disorder has on one’s social and occupational functioning, it is associated with high risk for the development of depression, other anxiety disorders and alcohol abuse. The good news is that effective treatments are now available that can help most people with this problem. Last year, the Food and Drug Administration approved the use of the antidepressant Paxil, manufactured by SmithKlein Beecham pharmaceuticals, for the treatment of social anxiety disorder. Although helpful for many adults, the medication is limited by the fact that the anxiety almost always tends to return once the medication is stopped. In addition, Paxil and other antidepressants have not been tested with adolescents. Researchers have recently developed new forms of psychotherapy to treat social anxiety disorder, and these treatments have demonstrated excellent results with adults. Known as cognitive-behavior therapy, these treatments focus on developing new thinking and behavioral patterns. Unlike drug treatments, the improvements derived from these therapies are usually permanent. In fact, Herbert’s program recently completed a study that suggests that people continue to improve on their own even after treatments are completed. Unfortunately, almost all of the advances in the treatment of social anxiety disorder have been made with adults, leaving adolescents with the disorder as neglected as ever. But that may be changing. Herbert was recently awarded a grant from the National Institute of Mental Health to study the treatment of social anxiety disorder among adolescents. So far, the results are very promising. “We’ve been very pleased with how well these kids respond to the new therapy programs,” says Herbert. “Our biggest challenge is just getting the word out to these adolescents that help is available.” Interested adolescents, parents or professionals can call 215-762-FEAR or visit www.mcphu.edu/shp/fear for more information about the free treatment programs for social anxiety disorder offered by the MCP Hahnemann University Social Anxiety Treatment Program.