Which medications are commonly used to treat social anxiety
Social anxiety (also called social phobia) is the third most common mental health problem in United States, being surpassed by depression and alcoholism. This psychological disorder is related to the individual’s excessive fear to interact with other people, to be evaluated, criticized, or even watched in various social situations.
Social anxiety negatively influences one’s daily activities such as work, school, and relationships.
Medications used in the treatment of social anxiety
There are several main categories of medications prescribed for people dealing with social anxiety.
Benzodiazepines are efficient in managing anxiety for the short term. Their role is to decrease the tension in the muscular system and induce relaxation. Long term treatment sometimes leads to dependence or tolerance issues.
Alprazolam is marketed under the name of Xanax and is a FDA (Food and Drug Administration) approved medication for social anxiety and panic disorders. Xanax acts as a depressant of the central nervous system so that people experience a quick sedative effect.
Alprazolam can affect the speed of reacting to different situations (especially when driving a car). This is the reason why Xanax should not be taken in combination with narcotic painkillers and alcohol. Another thing to consider is avoiding the consumption of grapefruit juice during the treatment because grapefruit boosts Xanax side effects like disorientation and drowsiness.
Clonazepam is traded under different brands such as Klonopin, Rivotril, Clonex, Kriadex, Petril, or Paxam. It slows down the brain’s activity decreasing nervous tension.
Clonazepam comes in two forms as regular tablets, tablets with quick disintegration in the mouth (wafers), drops, and solution for injection. Differently from Xanax, clonazepam takes longer to obtain an effect but it lasts more.
- Selective Serotonin Reuptake Inhibitors (SSRIs)
Serotonin, usually called the “happy hormone” due to its positive influence on a person’s mood, works as a neurotransmitter that enhances the communication between the brain cells. SSRIs block the reabsorption (reuptake) of serotonin so that a higher amount of available serotonin will give a feeling of well being.
Fluoxetine, mostly known as Prozac, is one of the most prescribed medicines in the United States for various mental disorders, including social anxiety. The dosage starts with 10 mg taken in the morning and increases according to the medical prescription. Higher doses (more than 20 mg per day) are divided into two portions for morning and noon. In general, a night-time fluoxetine dose needs to be avoided because it often causes insomnia.
Sertraline (traded as Zoloft, Lustral, Deprax, Seretral, and others) is recommended for treating social anxiety in adults, as well as in children. Medical studies indicate that results become visible at higher doses that exceed 50 mg per day. Sertraline ameliorates physiological symptoms like palpitations and blushing.
Paroxetine (found in drugstores as Paxil, Rexetin, Pexeva) is a powerful antidepressant that diminishes fear, improves the energy level, and restores the person’s interest in self-care tasks and daily activities.
Fluvoxamine sold as Luvox, Faverin, Fevarin, and Floxyfral is another drug approved by FDA prescribed for social phobia. It has a long term therapeutic efficiency (at least one year).
Common side effects of SSRIs:
- loss of appetite
- weight gain or weight loss
- sexual dysfunctions
- sleep problems
- decreased libido
- Serotonin- Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs operate on two directions: it increases both the level of serotonin and norepinephrine (another neurotransmitter responsible for the ability to concentrate) at the expense of inhibiting their reuptake inside the brain cells.
Venlafaxine (brands: Efexor, Trevilor) is used for treating social anxiety. When taken along with St. John’s wort products, caution is required.
Duloxetine (brand name: Cymbalta) prevents the reabsorption of serotonin and norepinephrine helping to maintain the mental balance at its best parameters.
Side effects that might occur during the treatment with SNRIs:
- increase of blood pressure
- urinary difficulties
- liver problems
- gastrointestinal bleeding
- Tricyclic Antidepressants (TCAs)
TCAs such as imipramine, amitriptyline, and nortriptyline have been the doctors’ first option in the treatment of anxiety disorders for a long time (since the 1950s). In the past few years, they were considerably replaced by the new generations of medications (SNRIs and SSRIs), which have fewer side effects.
Many physicians go for beta-blockers because they have positive impact on controlling symptoms like trembling, blushing, and heartbeats provoked by stressful situations.
Propranolol (brand name: Inderal) provides relief by reducing sweating, stage fright, and tachycardia. It is a short term choice and has few side effects (lethargy, slow pulse, cold hands and feet).
Atenolol (brand name: Tenormin) works longer than propranolol. Once dose a day has calming effects and reduces sweat, shakes, and palpitations.