Good question — Social Anxiety Disorder (SAD) has been studied extensively with antidepressants. Here’s the evidence-based summary:
✅ Antidepressants with Strong Evidence for SAD
SSRIs (Selective Serotonin Reuptake Inhibitors)
These are first-line medications in all major guidelines (APA, NICE, Canadian CANMAT).
- FDA-approved for SAD:
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- Other SSRIs effective (off-label):
- Escitalopram (Lexapro)
- Fluvoxamine (Luvox)
- Fluoxetine (Prozac) — some mixed results, but supportive RCTs exist.
Evidence: Large RCTs and meta-analyses show SSRIs significantly reduce SAD symptoms, with response rates around 50–70% (vs ~30–40% placebo).
SNRIs (Serotonin–Norepinephrine Reuptake Inhibitors)
- Venlafaxine XR (Effexor XR)
- FDA-approved for SAD.
- RCTs show efficacy comparable to SSRIs.
- Duloxetine (Cymbalta)
- Some positive studies, but less robust evidence; not FDA-approved for SAD.
⚖️ Antidepressants with Limited or Negative Evidence
- Tricyclics (TCAs): Generally ineffective for SAD; poorly tolerated.
- MAOIs (e.g., phenelzine): Proven effective, but due to diet/drug restrictions, used only when first-line meds fail.
- Mirtazapine: Mixed results, not guideline-recommended as first-line.
- Bupropion: Evidence does not support its use in SAD.
📝 Summary Table
|
Class |
Effective Antidepressants for SAD |
FDA status (US) |
|
SSRIs |
Paroxetine, Sertraline, Escitalopram, Fluvoxamine, Fluoxetine |
Paroxetine, Sertraline approved |
|
SNRIs |
Venlafaxine XR, Duloxetine (less evidence) |
Venlafaxine XR approved |
|
MAOIs |
Phenelzine (effective but not first-line) |
Not approved |
|
Others |
Mirtazapine (mixed), Bupropion (ineffective) |
Not approved |
✅ Clinical Takeaway
- First-line choices: Paroxetine, Sertraline, Venlafaxine XR (all FDA-approved).
- Alternatives: Escitalopram, Fluvoxamine, Fluoxetine (good evidence but off-label).
- Rescue/second-line: Phenelzine (MAOI), or augmentation strategies if resistant.
Would you like me to also include a comparison of medication vs. CBT outcomes in SAD (head-to-head RCTs, relapse rates), since treatment planning often needs both perspectives?
