The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications only as recommended by your doctor and according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
All of the medications used to treat
social anxiety disorder
require a prescription from your doctor. There are many options, some of which are listed below. Some of the medications are more appropriate for people who have the performance type of social anxiety disorder; these medications may be given just before an anxiety-provoking event. Other medications may be taken on a regular basis to treat the symptoms of a more generalized social anxiety disorder.
***Please note FDA Public Health Advisory for Antidepressants:
The FDA advises that people taking antidepressants should be closely observed. For some, the medications have been linked to worsening symptoms and suicidal thoughts. These adverse effects are most common in young adults. The effects tend to occur at the beginning of treatment or when there is an increase or decrease in the dose.
Although the warning is for all antidepressants, of most concern are the SSRI class such as:
Selective serotonin reuptake inhibitors (SSRIs) affect the concentration of the neurotransmitter serotonin, which plays a role in anxiety. Although they are considered antidepressants, SSRIs have been used effectively for the treatment of anxiety disorders. In fact, they are considered the drugs of choice for this condition. Improvement is usually seen in 4-6 weeks after beginning treatment. SSRIs are not addictive. Do not take an SSRI if you have taken an mono-amine oxidase (MAO) inhibitor in recent weeks. SSRIs are usually used to treat generalized social anxiety disorder.
These drugs should be used with caution in the elderly and those with liver or kidney diseases. During therapy, your doctor will be monitoring the following: heart rate, blood pressure, liver and kidney functions, and worsening depression, including increased suicide risk.
Benzodiazepines reduce symptoms of anxiety by enhancing the function of gamma aminobutyric acid (GABA), a neurotransmitter thought to be abnormal in people with social anxiety disorder. These drugs produce a sedative effect, reduce physical symptoms (such as muscle tension), and often cause drowsiness and lethargy. The advantage of benzodiazepines is that they are fast-acting and useful for treating acute anxiety and
Benzodiazepines are usually used 30-60 minutes before an anxiety-provoking event in people with the performance type of social anxiety disorder.
These drugs can be habit-forming when used long-term or in excess. They may cause withdrawal symptoms such as anxiety, irritability, and insomnia when discontinued. Withdrawal should be done slowly, over a period of weeks or months, and under a doctor’s supervision.
Do not take these drugs with alcohol or other sedating drugs. Do not take if you must drive a vehicle or operate equipment. Use with caution in the elderly, those with liver, lung, kidney diseases,
. These drugs should not be taken in combination with certain oral antifungal medications and in people with certain types of
The doctor will monitor your blood pressure, heart rate, respiratory rate, and liver function tests.
Beta-blockers have been used effectively to reduce symptoms of social anxiety. They reduce the production of hormone called adrenaline and affect the response of certain nerve impulses in the body.
Beta-blockers are usually used 30-60 minutes before an anxiety-provoking event in people with the performance type of social anxiety disorder.
Beta-blockers are contraindicated with
and certain heart problems and should be used cautiously with many medical disorders. Withdrawal should be done slowly, under a doctor’s supervision.
Monoamine oxidase inhibitors (MAOIs) are a type of antidepressant that reduces symptoms of social anxiety disorder by preventing the breakdown of dopamine, epinephrine, norepinephrine, serotonin, and noradrenalin. Improvement is usually seen in 2-6 weeks after beginning treatment. MAOIs are not addictive. These antidepressants are usually used to treat generalized social anxiety disorder.
Because of the risk of serious reactions, there are many medications, both prescribed and over-the-counter, that you will need to avoid when taking MAOIs. Examples of medications to avoid include:
Antidepressants—increased risk of hypertensive crisis (dangerously high blood pressure) and
Sympathomimetics (drugs that stimulate the sympathetic nervous system)
Narcotics, such as
(Demerol, Meperitab), and other pain medications, such as
(Ultram, Ultram ER)
(eg, Robitussin Maximum Strength, Vicks 44 Cough Medicine)—cough suppressant
Ask your doctor for a complete list of medications to avoid. Also, talk to your doctor before taking any new medication, including over-the-counter medications and herbs and supplements.
When taking MAOIs, there is the risk of a life-threatening side effect, called serotonin syndrome. This occurs when MAOIs interact with other antidepressant medications, such as serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). In serotonin syndrome, levels of serotonin in the brain get dangerously high, which can cause confusion, hallucinations,
, and other symptoms. This is an emergency. To avoid interactions, it is generally recommended to wait 2-5 weeks before stopping MAOIs and starting another antidepressant. Ask your doctor about the specific medication you are taking.
Because of the risk of serious reactions, there are also dietary restrictions when taking MAOIs. Avoid eating foods with high tyramine content. Tyramine is an amino acid that helps regulate blood pressure. If you have too much tyramine and are taking MAOIs, your blood pressure may become dangerously high, called hypertensive crisis. In some cases, this can lead to a
. Examples of foods with high tyramine content include:
Excessive amounts of caffeine
Foods containing monosodium glutamate (MSG)
Foods that are pickled, marinated, smoked, cured, or fermented
Ask your doctor for a complete list of foods and drinks to avoid.
During therapy, your doctor will monitor your heart rate, blood pressure, liver and kidney functions, and worsening depression, including increased suicide risk. MAOIs should be used with caution in the elderly and those with liver and kidney diseases.
MAOIs can cause birth defects and should not be taken by pregnant women. Also, the medication should not be taken if you have certain conditions, such as stroke,
, or pheochromocytoma (tumor in the adrenal gland).
There are many side effects, some severe, that can be caused by MAOIs. Because of this, doctors will usually try other medications before prescribing MAOIs. Some side effects include:
Changes in blood pressure, including hypertensive crisis
Worsening depression, including increased suicide risk
Tricyclic antidepressants regulate serotonin and/or noradrenalin in the brain. They have been used effectively for the treatment of social anxiety disorder. However, since these drugs are associated with more adverse effects than SSRIs without any added benefits, they are not used as often. Improvement is usually seen in 2-6 weeks after beginning treatment. Tricyclic antidepressants are not addictive. These drugs should be used with caution in the elderly and those with liver or kidney disease. Do not take this medication if you have glaucoma, are recovering from a
, or are also taking MAOIs. During therapy, your doctor will be monitoring your heart rate, blood pressure, body weight, liver function, and blood count.
Atypical antidepressants affect the concentration of the neurotransmitter serotonin and can be effective in treating social anxiety. Improvement is usually seen in 4-6 weeks after beginning treatment.
Possible side effects include:
Diminished sex drive
Consultation with a specially trained provider is recommended if you do not respond to treatment with medications. The provider can help clarify the diagnosis and determine if another psychiatric disorder is present. The provider can also make recommendations about psychotherapy and changes in medications. Psychiatrists, psychologists, social workers, or specially trained doctors can treat social anxiety disorder. Ask your doctor if she has helped other people with social anxiety disorder. If your doctor doesn't have special training, ask for the name of a doctor or counselor who does.
Whenever you are taking a prescription medication, take the following precautions:
Take your medication as directed. Do not change the amount or the schedule.
Do not stop taking them without talking to your doctor.
Do not share them.
Know what the results and side effects. Report them to your doctor.
Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medication and herb or dietary supplements.
Plan ahead for refills so you don’t run out.
Davidson JR, Foa EB, Huppert JD, et al. Fluoxetine, comprehensive cognitive behavioral therapy, and placebo in generalized social phobia.
Arch Gen Psychiatry.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a