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?