Social anxiety disorders and social phobia cause excessive fear and worry in social interactions that are usually not life threatening. Medications such as antianxiety drugs, antidepressants, and beta-blockers can help people manage the symptoms and prevent severe complications.
Many people feel some level of anxiety in social situations. This is usually temporary and is likely to resolve after the interaction.
However, if a person feels persistently anxious and self-conscious about everyday social interactions for
People with this disorder may avoid interacting with friends, colleagues, or strangers as a result of a fear of rejection or humiliation. They may also have an intense fear of others watching or judging them.
According to the Anxiety and Depression Association of America (ADAA), 15 million adults in the United States have social anxiety disorder.
This article discusses the various medications that can help treat social anxiety disorder, as well as other treatment options.
Doctors may prescribe various antidepressants to treat social anxiety disorder, including:
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs
SSRIs block serotonin transporter (SERT) from reabsorbing serotonin released by serotonergic neurons. This activity helps relieve a person’s anxiety by increasing serotonin levels to stimulate the receptors in the brain for longer periods.
The table below shows examples of SSRIs and the recommended dosage.
| Generic name / brand name | Recommended dosage |
|---|---|
| fluoxetine (Prozac, Sarafem) | 20–60 mg once per day |
| sertraline (Zoloft) | 50–200 mg once per day |
| paroxetine (Paxil, Paxil CR) | 20–60 mg per day |
| citalopram (Celexa) | 20–40 mg once per day |
| escitalopram (Lexapro) | 10–20 mg once per day |
SSRIs are available only in oral forms such as tablets, capsules, and liquid solutions.
Depending on the brand name prescription drug and the severity of a person’s symptoms, a person can take 1–3 tablets once per day, either in the morning or at night.
While it can take 2–4 weeks before a person starts noticing significant improvements, they should contact a doctor if they have not noticed any changes after 4–6 weeks of using SSRIs. The doctor can change a person’s dose or try another type of antidepressant.
Some common side effects of SSRIs are:
- anxiety
- dizziness
- headache
- dry mouth, or xerostomia
- sleep disturbances
- weight changes
- gastrointestinal issues
- low libido and other sexual dysfunctions
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
SNRIs
Increasing serotonin and norepinephrine levels can help regulate a person’s mood and relieve anxiety.
SNRIs are available as oral tablets or capsules that a person can take daily.
The table below shows examples of SNRIs and the recommended dosage.
| Generic name / brand name | Recommended dosage |
|---|---|
| desvenlafaxine (Pristiq, Khedezla) | |
| venlafaxine (Effexor, Effexor XR) | 75–225 mg once per day |
| duloxetine (Cymbalta) | 60 mg once per day |
| levomilnacipran (Fetzima) | 40–120 mg once per day |
Various SNRIs
- severity of symptoms
- possible drug interactions
- drug-specific precautions
- underlying conditions
If a person cannot tolerate a particular brand of SNRI, the doctor will prescribe another one that the person’s body can tolerate.
According to the United Kingdom’s National Health Service (NHS), SNRIs share common side effects with SSRIs. These include:
Monoamine oxidase inhibitors (MAOIs)
If a person’s social anxiety is so severe that they experience panic attacks, a doctor can prescribe MAOIs. MAOIs
These medications are available in oral forms.
The table below shows examples of MAOIs and the recommended dosage.
| Generic name / brand name | Recommended dosage |
|---|---|
| phenelzine (Nardil) | |
| tranylcypromine (Parnate) | |
| isocarboxazid (Marplan) | 20–60 mg per day in divided doses |
Doctors consider MAOIs a third-line treatment option because of the dietary restrictions and severe side effects associated with these medications. Common side effects include:
- nausea
- constipation
- dry mouth
- skin tingling
- weight gain
- lightheadedness
- high blood pressure
Health experts recommend that, to prevent potentially fatal drug interactions, people should avoid using MAOIs if they are using other antidepressants, sympathomimetic amines, some types of pain relievers, or St. John’s wort. To reduce the risk of high blood pressure, people should also avoid consuming tyramine-rich foods such as meat, fish, turkey, sausage, and salami while taking MAOIs.
Beta-blockers
Although beta-blockers have approval from the Food and Drug Administration (FDA) to treat cardiovascular conditions, doctors
Beta-blockers can help ease symptoms of social anxiety disorders such as stage fright, shaking, sweating, and rapid heartbeat. They act by blocking the release of the stress hormones adrenaline and noradrenaline. This action slows down the heart rate. They are available in oral, intravenous, and ophthalmic forms.
The table below shows examples of beta-blockers and the recommended dosage.
| Generic name / brand name | Recommended dosage |
|---|---|
| propranolol (Inderal) | 40 mg twice per day |
| atenolol (Tenormin) |
Potential side effects of beta-blockers include:
- slow heart rate
- low blood pressure
- constipation
- erectile dysfunction
- memory loss
- cold hands and feet
- difficulty sleeping
- depression
Benzodiazepines bind to GABA receptors in the brain to slow down the central nervous system and produce a calming effect that improves anxiety symptoms. They are available in oral tablet form.
The table below shows examples of benzodiazepines and the recommended dosage.
| Generic name / brand name | Recommended dosage |
|---|---|
| alprazolam (Xanax) | 0.25–0.5 mg three times daily (A doctor may increase a person’s dose to 4 mg daily in divided doses.) |
| clonazepam (Klonopin) | 0.25 mg twice per day |
Benzodiazepines have many side effects,
- drowsiness
- fatigue
- slurred speech
- mood changes
- blurred vision
- loss of balance
To diagnose social anxiety disorder, a doctor can perform a physical examination and order a laboratory test to rule out any underlying health conditions. They can then refer a person to a mental health practitioner.
Mental health practitioners use the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) to diagnose mental health conditions, including social anxiety.
The diagnostic criteria for social anxiety include:
- avoiding situations that can cause social anxiety
- enduring social interactions with intense fear or anxiety
- having persistent, intense fear concerning social situations that might involve observation and scrutiny from others, such as conversations, eating or drinking in public places, and performing in front of others
- experiencing social anxiety symptoms that affect social life and daily living for 6 months or longer
When devising a treatment plan for social anxiety disorder, doctors may recommend talking therapies alongside or instead of medication.
Psychotherapy
Psychotherapy can be effective in treating social anxiety disorder in combination with medications. Psychotherapy can equip people with coping skills to become more confident in social settings.
Types of psychotherapy include cognitive behavioral therapy (CBT), interpersonal therapy, psychodynamic therapy, and family therapy.
CBT is one of the most effective types of therapy for social anxiety disorder. It aims to help people identify, examine, and change social anxiety triggers.
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It is important for anyone who is experiencing social anxiety disorder to contact a doctor so treatment can start as early as possible.
Also, if a person is experiencing side effects from using their medications, they should discuss this with the doctor.
The doctor will prescribe the lowest possible dose to improve a person’s symptoms. However, if the symptoms do not improve, the doctor can gradually increase the dose.
Health experts recommend that a person continue taking their medications for 6 months even after their symptoms improve. This will help the person avoid a relapse.
The ADAA notes that 33% of people with social anxiety disorder have symptoms for 10 years before they contact a healthcare professional.
Additionally,
Without treatment, social anxiety disorder can negatively affect a person’s social life, daily routine, education, work, or intimate relationships, leading to lower quality of life.
Several medications can effectively treat social anxiety disorder.
By working directly with a doctor, most people can find an effective treatment to manage their symptoms.
People should note that almost all medications for social anxiety disorder have side effects. However, one of the keys to successful treatment is completing the drug regimen and following their doctor’s recommendations for how to take their medication.
Anyone who experiences a severe reaction to their treatment should ask their doctor about alternative options.