Medication treatment can decrease the frequency and intensity of anxiety and avoidance behavior for individuals with social anxiety disorder. Advantages of medication treatment include minimal effort — you just have to remember to take the medicine — and that it may relieve symptoms more quickly than behavior therapy. Medication may, however, cause side effects, and gains from medication may fade when medication is stopped.

What medications are used to treat social anxiety disorder?

Medications help reduce the frequency and intensity of anxiety in social situations, and also help decrease anticipatory anxiety and avoidance behaviors. Research results indicate that about 70% of social anxiety disorder patients achieve worthwhile gains from medication therapy. Less than 30% of social anxiety disorder patients receiving a placebo (sugar pill) improve. The amount of improvement with medication varies, but those who improve often find their gains so great that they want to continue the medication. Some actually become symptom-free. Obviously, some patients treated with medication do not benefit, and it is currently impossible to predict who will improve on a particular medication unless they have previously benefited from that medication.

There are five major categories of medications used to treat generalized social anxiety disorder and one additional category, beta-blockers, used to treat non-generalized social anxiety disorder (performance anxiety). All of these have been studied systematically and found helpful in controlled research trials.

As of March 2003, the U.S. Food and Drug Administration (FDA) has approved three medications for the treatment of social anxiety disorder. Two of the medications, paroxetine (or Paxil) and sertraline (or Zoloft) are selective serotonin reuptake inhibitors (SSRIs). Paroxetine was the first medication to receive FDA approval for social anxiety disorder. Sertraline is the only medication that has approval for long-term treatment of generalized social anxiety disorder. The third medication approved for the treatment of generalized social anxiety disorder is venlafaxine (or Effexor) which is a serotonin-norepinephrine reuptake inhibitor (SNRI). FDA approval is based on successful results in multicenter, double-blind studies. To learn more about one of the paroxetine studies, read an abstract "Paroxetine treatment of treatment of generalized social phobia (social anxiety disorder): a randomized controlled trial," JAMA 280(8):708-713, 1998 or read a summary of the study by one of its authors. To learn more about a sertraline study read an abstract of the study, Sertraline treatment of generalized social phobia: a 20-week, double-blind, placebo-controlled study. To learn more about venlafaxine studies, read a summary of two clinical trials upon which FDA approval was based.

Which medication to use first is a matter of patient and physician preference. Paroxetine (Paxil), sertraline (Zoloft) and venlafaxine (Effexor XR) are the three medications that the FDA has approved for treatment of generalized social anxiety disorder and are generally considered medications of first choice. Although only sertraline is approved by the FDA for long-term use, evidence suggests that paroxetine and venlafaxine are also effective for long-term treatment. These medications have side effect profiles that make them quite tolerable for most patients. Each class of medication has advantages and disadvantages that can be explained by your doctor to help you make an informed choice. For information on how these medications can affect an unborn or breast-feeding child, please visit the Frequently Asked Questions section.

Medication Classifications

The six major categories of medications used to treat social anxiety disorder are:

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin norepinephrine reuptake inhibitor (SNRI)
• Benzodiazepines
• Monoamine oxidase inhibitors (MAOIs)
• Gabapentin
• Beta-blockers

Selective Serotonin Reuptake Inhibitors (SSRIs)

Paroxetine (Paxil) and sertraline (Zoloft) have FDA approval for treatment of social anxiety disorder and are generally considered SSRI medications of first choice. Clinical evidence suggests that all the above SSRIs may be helpful in treating social anxiety disorder. Other than fluvoxamine, the SSRIs are also approved for the treatment of depression.

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Serotonin-Nonrepinephrine Reuptake Inhibitor (SNRI)

Venlafaxine has been approved for the treatment of generalized social anxiety disorder and is the only SNRI currently available. Like the SSRIs, it increases levels of serotonin. It also increases norepinephrine levels. Venlafaxine is also approved for the treatment of depression, so it is a good choice for patients with generalized social anxiety disorder and depression.

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Benzodiazepines (BDZs)

Clonazepam (Klonopin) is the most extensively studied benzodiazepine for social anxiety disorder and has been shown to have significant beneficial effects. Benzodiazepines have the advantage of decreasing anxiety faster than the other medications. Benzodiazepines have the disadvantage of not treating depression and long-term use can cause physical dependency.

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Monamine Oxidase Inhibitors (MAOIs)

Until recently, monoamine oxidase inhibitor medications were the most studied and probably the most effective medications for treating social anxiety disorder. However, because of the possibility of dangerous as well as annoying side effects. MAOI treatment requires a special diet low in tyramine. MAOIs are no longer widely prescribed for social anxiety disorder. MAOIs are still used for individuals who have not responded to other medications.

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Gabapentin

Another useful medication called gabapentin (Neurontin), an antiepilepsy medication, was shown to be an effective treatment for social anxiety disorder in a controlled research trial. Unlike the SSRIs and SNRI medications, gabapentin is not an antidepressant.

Beta-blockers

The final medication class are the beta-adrenergic receptor blocking agents, or beta-blockers. While beta-blockers have not been found to be helpful for treating generalized social anxiety disorder, they do have a role to play in treating performance anxiety. They seem to work on some of the bodily symptoms of anxiety by slowing down heart rates, and reducing tremors and sweating, and thereby indirectly reducing anxiety. The beta-blocker most commonly used for performance anxiety is propranolol (Inderal). Unlike the SSRIs and SNRI medications, beta-blockers are not antidepressants.

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