γ-Hydroxybutyrate Dependence With Social Phobia

Mr. A was a 24-year-old highly educated European man who became psychiatrically ill with symptoms of social phobia at age 15 without having any other psychiatric disorder, according to DSM-IV. Because of his symptoms, he feared and avoided a variety of social and performance duties required during his university studies. During a practical course in China 4 years before, he followed the advice of a French physician and self-administered GHB, finally in a dose of 20 g/day.

GHB was obtained by means of the Internet and applied every 90–120 minutes. According to Mr. A, his symptoms of social phobia completely vanished under GHB treatment. However, sleep disturbances appeared, and finally, a single sleep period did not exceed 4 hours. Two hours after each drug administration, he experienced withdrawal symptoms, such as agitation, insomnia, sweating, trembling, tachycardia, and overheating. Six attempts at self-managed abstinence were unsuccessful. Finally, he applied to our institute and was admitted to the ward. GHB withdrawal with transient administration of diazepam (up to 40 mg/day) was successfully accomplished without complications. We started treatment with paroxetine and cognitive behavior therapy. We applied the Liebowitz Social Anxiety Scale before and after withdrawal and observed 70% less total social anxiety than during GHB intake. This is well above the 39.1% mean reduction in score after paroxetine treatment, as reported by Stein et al. (3).