March 21, 2024 by Angus Munro
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A How-To Guide for Choosing the Right Social Anxiety Medication

Key Takeaways

Social Anxiety Disorder (SAD) Definition: Characterised by extreme fear of social situations due to concerns about being judged, affecting up to 13% of individuals and leading to significant daily dysfunction.

Impact on Life: Profound effects on social and work functioning, with SAD sufferers often experiencing the lowest rates of treatment seeking and recovery among anxiety disorders.

Treatment Methods: Often combines psychotherapy, particularly cognitive-behavioural therapy (CBT), with medication, emphasising the need for personalised treatment plans to manage symptoms effectively.

Social Anxiety Medication Options:

Is there medication for social anxiety? Yes, there are a lot of options when it comes to medications for social anxiety.

SSRIs: SSRIs medications for social anxiety increase serotonin to improve mood and reduce anxiety, with paroxetine and sertraline being effective first-line treatments for SAD.

SNRIs: Target both serotonin and norepinephrine, useful for broader symptom relief including co-occurring depressive symptoms.

Benzodiazepines: Offer quick relief for acute anxiety symptoms but limited by risks of dependency and withdrawal.

Beta-Blockers: Manage physical symptoms of anxiety like rapid heartbeat, particularly in performance situations.

Understanding Social Anxiety Disorder

social anxiety disorder

Definition and Symptoms of SAD 

Social Anxiety Disorder (SAD) is characterised by extreme fear, avoidance, or both of one or more social and performance situations, due to concerns about being judged by others. This condition is common, with a lifetime prevalence of up to 13%, and significantly impacts the individual’s daily life and well-being, often leading to major dysfunction. Symptoms include, sweating, flushing, shaking, and sometimes physical symptoms such as chest pain, palpitations, or dizziness when exposed to social situations ( Zamorski & Ward, 2000)

Impact on Daily Life and Well-Being 

SAD has a profound effect on individuals’ social and work functioning. It can lead to severe outcomes and negatively affect multiple aspects of personality and social integration. It’s among the anxiety disorders with the lowest rates of treatment seeking, receipt of evidence-based treatments, and recovery, making it crucial to address effectively for improving individuals’ quality of life (Lampe, 2009)

The Necessity for Treatment: A Combination of Psychotherapy and Social Anxiety Medications

Treatment for SAD can involve a combination of psychotherapy and social anxiety disorder medication to manage symptoms effectively. Cognitive-Behavioural Therapy (CBT) is one of the most evidence-supported treatments for SAD, focusing on understanding and changing thought patterns and behaviours that contribute to social anxiety. Medications, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are often prescribed to help manage the symptoms. It’s important for treatment plans to be personalised, considering the efficacy, adverse effects, and patient preferences to ensure the best outcomes (Borwin Bandelow, Sophie Michaelis, & Dirk Wedekind, 2017)

Primary Social Anxiety Medications

impact of ocd on daily life

Overview of Medication Treatment as a Strategy for SAD

Social anxiety medication can be a key component in treating Social Anxiety Disorder (SAD) for some people, offering relief for many of the debilitating symptoms associated with this condition. These pharmacological treatments can significantly improve quality of life for those suffering from SAD, enabling them to engage more fully in social and professional activities.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective Serotonin Reuptake Inhibitors (SSRIs) are a class of social anxiety medications widely used to treat depression, anxiety disorders, and other mental health conditions by inhibiting the reuptake of serotonin in the brain, thereby increasing serotonin levels. This increase in serotonin levels is believed to have a positive effect on mood, emotion, and sleep.

Here are the main SSRIs, along with their brand and generic names:

  1. Fluoxetine: Brand names include Prozac, among others. Fluoxetine is one of the first SSRIs and is used to treat major depressive disorder, obsessive-compulsive disorder, bulimia nervosa, and panic disorder.
  2. Sertraline: Brand names include Zoloft, among others. Sertraline is an anxiety medication for social anxiety, major depressive disorder, obsessive-compulsive disorder, panic disorder, and social anxiety disorder.
  3. Paroxetine: Brand names include Paxil, Seroxat, among others. Paroxetine is used for the treatment of major depressive disorder, obsessive-compulsive disorder, panic disorder, social anxiety disorder, generalised anxiety disorder, and post-traumatic stress disorder.
  4. Fluvoxamine: Brand names include Luvox, among others. Fluvoxamine is primarily used for the treatment of obsessive-compulsive disorder.
  5. Citalopram: Brand names include Celexa, among others. Citalopram is used as medication to treat social anxiety and major depressive disorder.
  6. Escitalopram: Brand names include Lexapro, Cipralex, among others. Escitalopram is an enantiomer of citalopram and is used for the treatment of major depressive disorder and generalised anxiety disorder.

These social anxiety medications are known for their efficacy, safety profile, and tolerability, making them a first-line treatment for many psychiatric conditions. However, SSRIs can have side effects, including gastrointestinal disturbances, sexual dysfunction, and increased risk of bleeding, particularly when taken with other medications affecting serotonin levels or blood clotting.

Mechanism of Action 

SSRIs work by increasing levels of serotonin in the brain, a neurotransmitter associated with mood and social behaviour. By preventing the reuptake of serotonin, SSRIs enhance the overall mood and reduce anxiety, particularly effective in the treatment of SAD (Nardi, 2001)

Common SSRIs for SAD

Paroxetine and Sertraline are among the most commonly prescribed SSRIs for SAD. These social anxiety medications have been proven to be effective in reducing the symptoms of social anxiety, with research supporting their use as a first-line treatment option (Mandrioli, Mercolini, & Raggi, 2013)

Efficacy and Research Findings

Does social anxiety medication work: Studies have demonstrated that SSRIs can significantly reduce the symptoms of SAD, improving social functioning and decreasing the fear of social interactions. SSRIs like paroxetine and sertraline are backed by a solid evidence base, showing both efficacy and tolerability in treating SAD (Ipser, Kariuki, & Stein, 2008)

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are a class of antidepressants that act by inhibiting the reuptake of serotonin (5-HT) and norepinephrine (NE) in the brain, leading to increased availability of these neurotransmitters in the synaptic cleft. This mechanism is thought to contribute to their antidepressant and analgesic effects. The SNRIs are used in the treatment of major depressive disorder, anxiety disorders, and chronic pain syndromes.

The following are the main SNRIs, along with their brand and generic names:

  1. Venlafaxine (Brand names include Effexor, among others) is one of the first SNRIs introduced and has a higher selectivity for serotonin reuptake inhibition compared to norepinephrine reuptake inhibition. Venlafaxine is effective anxiety medication for social anxiety disorders and is known for its dose-dependent increase in blood pressure at higher doses.
  2. Duloxetine (Brand names include Cymbalta, among others) has a balanced inhibitory effect on both serotonin and norepinephrine reuptake. This social anxiety medication is also used in the treatment of major depressive disorder, generalised anxiety disorder, and is particularly noted for its efficacy in treating chronic pain conditions, such as diabetic neuropathy and fibromyalgia.
  3. Milnacipran (Brand names include Savella, Ixel, among others) blocks the reuptake of serotonin and norepinephrine with equal affinity. Milnacipran is used in various countries for the treatment of major depressive disorder and fibromyalgia.
  4. Desvenlafaxine (Brand names include Pristiq, Khedezla, among others) is an active metabolite of venlafaxine and has similar pharmacological properties. It is used as social phobia medication and treatment for major depressive disorder.
  5. Levo milnacipran (Brand name Fetzima) is the more active enantiomer of milnacipran and has a higher selectivity for norepinephrine reuptake inhibition over serotonin. It is used for the treatment of major depressive disorder.
  6. Sibutramine (Brand names included Meridia, Reductil, among others) was initially introduced as an SNRI but later was predominantly used as an appetite suppressant for obesity management before being withdrawn from the market in several countries due to cardiovascular risk concerns (Caldiroli et al., 2022)

Benzodiazepines

Use in Treating SAD

Benzodiazepines are sometimes used as social anxiety medication in the treatment of Social Anxiety Disorder (SAD) for their anxiolytic effects. These drugs can reduce the intensity of anxiety symptoms and are particularly useful in acute anxiety situations. However, their role in treating SAD is limited by concerns about dependence, withdrawal symptoms, and the potential for misuse (Posternak & Mueller, 2001)

They work by enhancing the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABAA receptor in the brain, leading to sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant properties. Despite their clinical benefits, benzodiazepines have potential for dependence and withdrawal symptoms.

Here is a list of some commonly used social anxiety medication benzodiazepines, along with their generic and brand names:

  1. Diazepam: Known under the brand name Valium, among others, diazepam is the best anxiety medication for social anxiety, alcohol withdrawal syndrome, benzodiazepine withdrawal syndrome, muscle spasms, seizures, trouble sleeping, and restless legs syndrome.
  2. Clonazepam: Sold primarily under the brand name Klonopin, clonazepam is used to prevent and treat seizures, panic disorder, and for the movement disorder known as akathisia.
  3. Alprazolam: Marketed as Xanax, among other names, alprazolam is used to manage anxiety disorders, anxiety associated with depression, and panic disorder.
  4. Lorazepam: Available under the brand name Ativan, lorazepam is used for the treatment of anxiety disorders, trouble sleeping, active seizures including status epilepticus, alcohol withdrawal, and chemotherapy-induced nausea and vomiting.
  5. Temazepam: Sold under the brand names Restoril and others, temazepam is used to treat trouble sleeping. Such use should generally be for less than ten days.
  6. Midazolam: Midazolam, available under the brand name Versed, among others, is used for anaesthesia, procedural sedation, trouble sleeping, and severe agitation.

Risks of Dependency and Withdrawal

The use of benzodiazepines as social anxiety medication is often controversial due to the significant risk of dependency and withdrawal symptoms associated with long-term use. Dependency can develop even at therapeutic doses, and withdrawal symptoms can be severe, including anxiety, agitation, and, in extreme cases, seizures (Kaplan & Dupont, 2005)

Short-term vs. Long-term Use

Can you get medication for social anxiety for short-term use? Short-term use of benzodiazepines may be considered for managing acute episodes of anxiety in SAD, under careful medical supervision. Long-term use, however, is generally discouraged due to the risks of dependency, withdrawal, and the potential to worsen anxiety symptoms over time (Huh et al., 2011

Beta-Blockers

Beta-blockers are sometimes used off-label for managing symptoms of social anxiety, particularly for performance anxiety or “stage fright.” While they are not a first-line treatment for social anxiety disorder (SAD) in general, they can be effective in controlling physical symptoms of anxiety, such as tremors, palpitations, and sweating, without necessarily addressing the psychological aspects of anxiety. Beta-blockers do not have addictive potential and are not associated with cognitive impairment, making them an alternative option for patients concerned about the side effects of other social anxiety medications like benzodiazepines.

Here are some beta-blockers that have been studied or mentioned in the context of social anxiety:

  1. Propranolol (Inderal®) is often considered the best medication for social anxiety disorder, a beta-blocker for managing physical symptoms of anxiety in social or performance situations. It is known to effectively reduce heart rate, trembling, and the feeling of nervousness.
  2. Atenolol (Tenormin®) is another beta-blocker that may be used for social anxiety symptoms, particularly when physical manifestations of anxiety are prominent.

Despite their potential benefits, it’s important to remember that beta-blockers primarily address the somatic symptoms of anxiety and do not treat the underlying psychological aspects. They might be chosen for specific situations where physical symptoms of anxiety are the main concern, such as public speaking or performing in public.

For a comprehensive approach to treating social anxiety disorder, other treatment options like selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), cognitive-behavioural therapy (CBT), or a combination of these social phobia medications are generally recommended due to their broader efficacy on both the psychological and physical symptoms of anxiety.(Ipser, Kariuki, & Stein, 2008)

Examples and Usage

Propranolol is the most commonly used beta-blocker for the physical symptoms of anxiety. Its effectiveness in reducing the frequency of panic attacks and avoidance behaviour in patients with agoraphobia has been documented, as well as potential benefits in early intervention and treatment of posttraumatic stress disorder (Brudkowska et al., 2018)

Limitations and Effectiveness

While beta-blockers can be effective in managing the somatic symptoms of anxiety, they do not address the psychological aspects of social anxiety medication. Their use is therefore limited to specific situations or as an adjunct to other treatments. The evidence for their efficacy in SAD, particularly for performance anxiety, is not as strong as for other treatments, and more research is needed to establish their role in the treatment of SAD more broadly (Schneier, 2011)

Tailoring Medication to the Individual

Importance of a Personalized Approach

The treatment of Social Anxiety Disorder (SAD) emphasises the importance of a personalised approach. Individuals respond differently to social anxiety disorder medications based on a variety of factors, making it crucial to tailor treatment plans to each person’s unique needs and circumstances. This approach helps in optimising the effectiveness of treatment while minimising potential side effects (Schneier, 2011)

Factors Influencing Medication Choice

Several factors influence the choice of social anxiety medications, including the severity and specific symptoms of the disorder, the side effect profile of the medication, the individual’s personal medical history, and their response to any previous treatments. For example, SSRIs and SNRIs are generally considered first-line treatments due to their efficacy and tolerability, but the final choice may depend on individual patient factors (Bandelow, Michaelis, & Wedekind, 2017)

The Role of Healthcare Professionals in Managing Treatment

Healthcare professionals play a crucial role in managing SAD treatment by assessing the patient’s symptoms, medical history, and treatment preferences. They also monitor the effectiveness of the prescribed medication to treat social anxiety and make adjustments as necessary, ensuring that the treatment remains aligned with the patient’s needs and goals (Ipser, Kariuki, & Stein, 2008)

Side Effects and Management

Common Side Effects of Medications for SAD

Social anxiety medications, such as SSRIs and SNRIs, can have side effects ranging from mild to severe, including gastrointestinal issues, insomnia, sexual dysfunction, and increased anxiety or agitation. The likelihood and severity of these side effects can vary widely among individuals (Robinson & Hood, 2007)

Strategies for Managing Side Effects

Managing side effects involves a combination of strategies, such as dose adjustment, switching to a different medication, or adding another treatment to counteract the side effects. In some cases, the side effects may diminish over time as the body adjusts to the social anxiety disorder medication (Lampe, 2009)

The Importance of Communication with Healthcare Provider 

Effective management of side effects requires open communication between patients and their healthcare providers. Patients should report any side effects they experience and discuss their concerns and treatment preferences with their provider to find the most suitable management strategy (Andrews et al., 2018).

Integrating Social Anxiety Medication with Other Treatments

The Complementary Role of Psychotherapy

Psychotherapy, particularly cognitive-behavioural therapy (CBT), plays a complementary role in the treatment of SAD. Integrating medication with psychotherapy can address both the biological and psychological aspects of the disorder, often leading to better outcomes than either treatment alone (Foa, Franklin, & Moser, 2002)

Lifestyle Adjustments and Self-care Measures

In addition to medication to treat social anxiety and psychotherapy, lifestyle adjustments and self-care measures can also support the treatment of SAD. These may include regular exercise, mindfulness practices, healthy eating, and adequate sleep, which can all contribute to reducing anxiety levels and improving overall well-being (Jayakody, Gunadasa, & Hosker, 2013)

The Holistic Approach to Treating SAD

A holistic approach to treating SAD involves combining anxiety medication for social anxiety, psychotherapy, lifestyle adjustments, and self-care measures. This comprehensive strategy aims to address the disorder from multiple angles, offering the best chance for long-term management and recovery (Bertie & Hudson, 2021)

Many of the clients that visit us in our clinic in Sydney ask us “can you take medication for social anxiety?”. We have found over the years that many of our clients have been able to overcome social anxiety with just therapy alone. However, short-term medication can be useful for some people to “bring the temperature down” so they can use psychological tools more effectively to overcome their social anxiety.

Conclusion 

The comprehensive management of Social Anxiety Disorder (SAD) necessitates a tailored approach that incorporates psychotherapy, particularly cognitive-behavioural therapy, alongside social anxiety disorder medication such as SSRIs and SNRIs, to effectively address both the psychological and physical aspects of the disorder. A holistic treatment plan also emphasises the importance of lifestyle adjustments and self-care measures, underpinned by the critical role of healthcare professionals and Social Anxiety medications in personalising treatment to optimise outcomes while minimising side effects.

Get in touch with clinical Psychologist in Sydney! Check out our blogs to gain deeper understanding about social anxiety medication.

References 

Andrews, G., Bell, C., Boyce, P., Gale, C., Lampe, L., Marwat, O., Rapee, R., & Wilkins, G. (2018). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder. *Australian & New Zealand Journal of Psychiatry, 52*, 1109-1172.

Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. *Dialogues in Clinical Neuroscience, 19*, 93-107.

Bertie, L.-A., & Hudson, J. (2021). CBT for Childhood Anxiety: Reviewing the State of Personalised Intervention Research. *Frontiers in Psychology, 12*.

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Foa, E., Franklin, M., & Moser, J. (2002). Context in the clinic: how well do cognitive-behavioral therapies and medications work in combination? *Biological Psychiatry, 52*, 987-997.

Huh, J., Goebert, D., Takeshita, J., Lu, B. Y., & Kang, M. (2011). A comprehensive review of the literature for psychopharmacologic alternatives to newer antidepressants and benzodiazepines. *The Primary Care Companion for CNS Disorders, 13*(2).

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Mandrioli, R., Mercolini, L., & Raggi, M. A. (2013). Evaluation of the pharmacokinetics, safety and clinical efficacy of sertraline used to treat social anxiety. *Expert Opinion on Drug Metabolism & Toxicology, 9*, 1495-1505.

Nardi, A. (2001). Antidepressants in social anxiety disorder. *Arquivos de neuro-psiquiatria, 59 3-A*, 637-42.

Posternak, M., & Mueller, T. (2001). Assessing the risks and benefits of benzodiazepines for anxiety disorders in patients with a history of substance abuse or dependence. *The American Journal on Addictions, 10*(1), 48-68.

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