Several medications have been found effective for social phobia (social anxiety disorder, SAD). The most commonly prescribed drug classes include:
1. Selective Serotonin Reuptake Inhibitors (SSRIs)
First-line treatment for long-term management due to effectiveness and tolerability.
Examples:
Paroxetine (Paxil)
Sertraline (Zoloft)
Fluvoxamine (Luvox)
Escitalopram (Lexapro)
Takes 48 weeks to show effects.
2. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Also first-line, especially if SSRIs are ineffective.
Example:
Venlafaxine XR (Effexor XR)
Can help with both psychological and physical symptoms (e.g., blushing, sweating).
3. Beta-Blockers
Used for performance anxiety (not generalized SAD).
Reduce physical symptoms (e.g., heart rate, tremors).
Examples:
Propranolol (Inderal)
Atenolol (Tenormin)
Taken 3060 minutes before a performance or social event.
4. Benzodiazepines
Short-term relief (used cautiously due to addiction risk).
Examples:
Clonazepam (Klonopin)
Alprazolam (Xanax)
Lorazepam (Ativan)
Work immediately, but cause sedation and dependence.
5. Monoamine Oxidase Inhibitors (MAOIs)
Reserved for severe cases or when other treatments fail.
Examples:
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Require dietary restrictions (avoid tyramine-rich foods).
6. Atypical Antidepressants
Mirtazapine (Remeron) sometimes used off-label.
Bupropion (Wellbutrin) less effective for anxiety but may help if depression is also present.
7. Anticonvulsants (Off-label)
Some evidence suggests benefit:
Gabapentin (Neurontin)
Pregabalin (Lyrica) more promising, particularly for physical symptoms.
Which One Should You Choose?
Generalized SAD: SSRIs or SNRIs first, with benzodiazepines for acute symptoms.
Performance anxiety: Beta-blockers like propranolol.
Severe, treatment-resistant cases: MAOIs (rarely used).
Rapid relief: Benzodiazepines (but not for long-term use).
Would you like recommendations based on specific symptoms or concerns?
