Tuesday, June 3, 2025

Which antidepressants are effective for social anxiety disorder? (ChatGPT, 2025-6-3)

Several antidepressants have demonstrated effectiveness in treating Social Anxiety Disorder (SAD), especially those that modulate serotonin and/or norepinephrine. Here’s a summary of the most effective classes and specific agents:





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First-Line Treatments



These are the most well-studied and often recommended due to efficacy and tolerability:



1. SSRIs (Selective Serotonin Reuptake Inhibitors)



  • Paroxetine – FDA-approved for SAD; robust evidence.
  • Sertraline – Effective; commonly used off-label.
  • Escitalopram and Fluoxetine – Often used, though not formally approved for SAD.
  • Fluvoxamine – Occasionally used; more side effects in some.




2. SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)



  • Venlafaxine XR (Extended Release) – FDA-approved for SAD; considered equivalent in efficacy to SSRIs.






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Second-Line or Adjunctive Options



Used when first-line options fail or are not tolerated.



3. MAOIs (Monoamine Oxidase Inhibitors)



  • Phenelzine – Highly effective but with dietary restrictions and side effects. Useful in treatment-resistant SAD.
  • Moclobemide (a reversible MAOI) – Used in some countries; not FDA-approved in the U.S.




4. Atypical Antidepressants



  • Bupropion – Not effective for SAD; may worsen anxiety in some cases.
  • Mirtazapine – Limited and mixed evidence; may help with comorbid depression or insomnia.






🧠 Other Pharmacological Options (Non-Antidepressants but Relevant)



While not antidepressants per se, these are sometimes used:


  • Pregabalin or Gabapentin – Some efficacy; off-label.
  • Beta-blockers (e.g., propranolol) – Effective for performance anxiety, not generalized SAD.
  • Benzodiazepines (e.g., clonazepam) – Rapid symptom relief but concerns about dependency; not first-line.






🧪 Summary Table

Class

Drug

Status for SAD

Notes

SSRI

Paroxetine

 FDA-approved

Effective, but sedating

SSRI

Sertraline

麱 Not approved

Common off-label use

SSRI

Escitalopram

麱 Not approved

Favorable tolerability

SNRI

Venlafaxine XR

 FDA-approved

Good efficacy

MAOI

Phenelzine

麱 Not approved

Effective but last-resort

Atypical

Bupropion

 Not effective

May worsen anxiety

Atypical

Mirtazapine

𩤃 Mixed evidence

Sedating; may help sleep




Would you like a comparison of side effect profiles or typical titration schedules for these agents?