What medications treat social anxiety, and which is best for me? 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Medications such as antianxiety drugs, antidepressants, and beta-blockers can help people manage the symptoms and prevent severe complications. Many people feel some level of anxiety in social situations. This is usually temporary and is likely to resolve after the interaction. However, if a person feels persistently anxious and self-conscious about everyday social interactions for 6 months or longer, they may have social anxiety disorder. People with this disorder may avoid interacting with friends, colleagues, or strangers as a result of a fear of rejection or humiliation. They may also have an intense fear of others watching or judging them. According to the Anxiety and Depression Association of America (ADAA), 15 million adults in the United States have social anxiety disorder. This article discusses the various medications that can help treat social anxiety disorder, as well as other treatment options. Antidepressants Share on PinterestMidnight Blue/EyeEm/Getty ImagesDoctors may prescribe various antidepressants to treat social anxiety disorder, including: Selective serotonin reuptake inhibitors SSRIs SSRIs are usually the first choice of medication for treating social anxiety disorder because they are safe and effective and because people generally tolerate them better than other antidepressants. SSRIs block serotonin transporter (SERT) from reabsorbing serotonin released by serotonergic neurons. This activity helps relieve a person’s anxiety by increasing serotonin levels to stimulate the receptors in the brain for longer periods. The table below shows examples of SSRIs and the recommended dosage. Generic name / brand nameRecommended dosagefluoxetine (Prozac, Sarafem)20–60 mg once per daysertraline (Zoloft)50–200 mg once per dayparoxetine (Paxil, Paxil CR)20–60 mg per day citalopram (Celexa)20–40 mg once per dayescitalopram (Lexapro)10–20 mg once per day SSRIs are available only in oral forms such as tablets, capsules, and liquid solutions. Depending on the brand name prescription drug and the severity of a person’s symptoms, a person can take 1–3 tablets once per day, either in the morning or at night. While it can take 2–4 weeks before a person starts noticing significant improvements, they should contact a doctor if they have not noticed any changes after 4–6 weeks of using SSRIs. The doctor can change a person’s dose or try another type of antidepressant. Some common side effects of SSRIs are:anxietydizzinessheadachedry mouth, or xerostomiasleep disturbancesweight changesgastrointestinal issueslow libido and other sexual dysfunctions Serotonin-norepinephrine reuptake inhibitors SNRIs SNRIs increase the amount of serotonin and norepinephrine in the brain by blocking their reuptake. Doctors may recommend SNRIs as an effective treatment for people who have unsuccessful treatments with SSRIs. Increasing serotonin and norepinephrine levels can help regulate a person’s mood and relieve anxiety. SNRIs are available as oral tablets or capsules that a person can take daily. The table below shows examples of SNRIs and the recommended dosage.Generic name / brand nameRecommended dosagedesvenlafaxine (Pristiq, Khedezla)50 mg once per dayvenlafaxine (Effexor, Effexor XR) 75–225 mg once per dayduloxetine (Cymbalta)60 mg once per daylevomilnacipran (Fetzima)40–120 mg once per day Various SNRIs can exert different pharmacological effects. For this reason, the doctor may consider several factors before prescribing SNRIs, such as: severity of symptomspossible drug interactionsdrug-specific precautionsunderlying conditions If a person cannot tolerate a particular brand of SNRI, the doctor will prescribe another one that the person’s body can tolerate. According to the United Kingdom’s National Health Service (NHS), SNRIs share common side effects with SSRIs. These include: headacheloss of appetiteinsomniastomachachediarrhea Monoamine oxidase inhibitors MAOIs If a person’s social anxiety is so severe that they experience panic attacks, a doctor can prescribe MAOIs. MAOIs can also effectively treat social anxiety disorder when other medications are ineffective in treating a person’s symptoms. MAOIs prevent the enzyme monoamine oxidase from removing the neurotransmitters serotonin, dopamine, tyramine, and norepinephrine from the brain. As a result, these neurotransmitters remain in the brain to improve neural communication. These medications are available in oral forms. The table below shows examples of MAOIs and the recommended dosage.Generic name / brand nameRecommended dosagephenelzine (Nardil)15–30 mg three times per daytranylcypromine (Parnate)30 mg per day in divided dosesisocarboxazid (Marplan)20–60 mg per day in divided doses Doctors consider MAOIs a third-line treatment option because of the dietary restrictions and severe side effects associated with these medications. Common side effects include:nauseaconstipationdry mouthskin tinglingweight gainlightheadednesshigh blood pressure Health experts recommend that, to prevent potentially fatal drug interactions, people should avoid using MAOIs if they are using other antidepressants, sympathomimetic amines, some types of pain relievers, or St. John’s wort. To reduce the risk of high blood pressure, people should also avoid consuming tyramine-rich foods such as meat, fish, turkey, sausage, and salami while taking MAOIs. Beta-blockers Although beta-blockers have approval from the Food and Drug Administration (FDA) to treat cardiovascular conditions, doctors may prescribe them off-label as a first-line treatment for the performance anxiety type of social anxiety disorder. Beta-blockers can help ease symptoms of social anxiety disorders such as stage fright, shaking, sweating, and rapid heartbeat. They act by blocking the release of the stress hormones adrenaline and noradrenaline. This action slows down the heart rate. They are available in oral, intravenous, and ophthalmic forms. The table below shows examples of beta-blockers and the recommended dosage. Generic name / brand nameRecommended dosagepropranolol (Inderal)40 mg twice per dayatenolol (Tenormin)50 mg twice per day Potential side effects of beta-blockers include:slow heart ratelow blood pressureconstipationerectile dysfunctionmemory losscold hands and feetdifficulty sleepingdepression Antianxiety medications Benzodiazepines are a typical class of antianxiety medications that enhance the action of the neurotransmitter gamma-aminobutyric acid (GABA). Benzodiazepines bind to GABA receptors in the brain to slow down the central nervous system and produce a calming effect that improves anxiety symptoms. They are available in oral tablet form. The table below shows examples of benzodiazepines and the recommended dosage.Generic name / brand nameRecommended dosagealprazolam (Xanax) 0.25–0.5 mg three times daily(A doctor may increase a person’s dose to 4 mg daily in divided doses.)clonazepam (Klonopin)0.25 mg twice per day Benzodiazepines have many side effects, including: drowsinessfatigueslurred speechmood changesblurred visionloss of balance Diagnosing social anxiety disorder To diagnose social anxiety disorder, a doctor can perform a physical examination and order a laboratory test to rule out any underlying health conditions. They can then refer a person to a mental health practitioner. Mental health practitioners use the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) to diagnose mental health conditions, including social anxiety. The diagnostic criteria for social anxiety include:avoiding situations that can cause social anxietyenduring social interactions with intense fear or anxietyhaving persistent, intense fear concerning social situations that might involve observation and scrutiny from others, such as conversations, eating or drinking in public places, and performing in front of othersexperiencing social anxiety symptoms that affect social life and daily living for 6 months or longer Other treatments for social anxiety and social anxiety disorder When devising a treatment plan for social anxiety disorder, doctors may recommend talking therapies alongside or instead of medication. Psychotherapy Psychotherapy can be effective in treating social anxiety disorder in combination with medications. Psychotherapy can equip people with coping skills to become more confident in social settings. Types of psychotherapy include cognitive behavioral therapy (CBT), interpersonal therapy, psychodynamic therapy, and family therapy. CBT is one of the most effective types of therapy for social anxiety disorder. It aims to help people identify, examine, and change social anxiety triggers. In a 2014 review of 101 studies that involved 41 different treatment approaches, including psychotherapy, medications, and self-help, researchers found that CBT offered more significant benefits to people with social anxiety than other treatment options. Other research has also found that people with social anxiety disorder respond better to CBT than to other psychotherapies. The authors note that while medications may have an effect more quickly, CBT has long lasting effects. When to consult a doctor It is important for anyone who is experiencing social anxiety disorder to contact a doctor so treatment can start as early as possible. Also, if a person is experiencing side effects from using their medications, they should discuss this with the doctor. The doctor will prescribe the lowest possible dose to improve a person’s symptoms. However, if the symptoms do not improve, the doctor can gradually increase the dose. Health experts recommend that a person continue taking their medications for 6 months even after their symptoms improve. This will help the person avoid a relapse. Outlook The ADAA notes that 33% of people with social anxiety disorder have symptoms for 10 years before they contact a healthcare professional. Evidence also suggests that many people with the condition are unaware they have it and do not seek treatment. Additionally, 90% of people with social anxiety disorder have other associated psychiatric disorders or comorbidities, such as major depressive disorder and alcohol use disorder. Without treatment, social anxiety disorder can negatively affect a person’s social life, daily routine, education, work, or intimate relationships, leading to lower quality of life. Summary Several medications can effectively treat social anxiety disorder. By working directly with a doctor, most people can find an effective treatment to manage their symptoms. People should note that almost all medications for social anxiety disorder have side effects. However, one of the keys to successful treatment is completing the drug regimen and following their doctor’s recommendations for how to take their medication. Anyone who experiences a severe reaction to their treatment should ask their doctor about alternative options. Last medically reviewed on August 15, 2022Mental HealthAnxiety / StressPsychology / Psychiatry 30 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed.) text revision. Arlington, VA: American Psychiatric Association.Chu, A., et al. (2022). Selective serotonin reuptake inhibitors.https://www.ncbi.nlm.nih.gov/books/NBK554406/Citalopram hydrobromide – citalopram tablet. 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(2019).https://elsevier.health/en-US/preview/serotonin-norepinephrine-reuptake-inhibitors-snrisSertraline (Zoloft). (2020).https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Sertraline-(Zoloft)Side effects - antidepressants. (2021).https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/antidepressants/side-effects/Sidhu, G., et al. (2022). Phenelzine.https://www.ncbi.nlm.nih.gov/books/NBK554508/Social anxiety disorder: More than just shyness. (n.d.).https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness/index.shtmlWhat is anxiety and depression? (2021).https://adaa.org/understanding-anxietyXanax, alprazolam tablets, USP. (2016).https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/018276s052lbl.pdfFEEDBACK:Medically reviewed by Nicole Washington, DO, MPH — By Oladimeji Ewumi on August 15, 2022 Latest newsWhat sets 'SuperAgers' apart? 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