Social phobias - Medication

SSRIs
Selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants, are considered the first choice by doctors in defusing fears associated with social phobia and related anxiety disorders. These drugs are designed to elevate the level of the neurotransmitter serotonin. The first drug formally approved by the Food and Drug Administration was paroxetine, sold as Paxil. Compared to older forms of medication, there is little risk of tolerability and drug dependency. However, their efficacy and increased suicide risk has been subject to controversy.

In a 1995 double-blind, placebo-controlled trial, the SSRI paroxetine was shown to result in clinically meaningful improvement in 55% of patients with generalized social anxiety disorder, compared with 23.9% of those taking placebo. An October 2004 study yielded similar results. Patients were treated with either fluoxetine, psychotherapy, fluoxetine and psychotherapy, placebo and psychotherapy, and a placebo. The first four sets saw improvement in 50.8 to 54.2% of the patients. Of those assigned to receive only a placebo, 31.7 percent achieved a rating of 1 or 2 on the Clinical Global Impression-Improvement scale. Those who sought both therapy and medication did not see a boost in improvement.

General side-effects are common during the first weeks while the body adjusts to the drug. Symptoms may include headaches, nausea, insomnia and changes in sexual behavior. Treatment safety during pregnancy has not been established. In late 2004 much media attention was given to a proposed link between SSRI use and juvenile suicide. For this reason, the use of SSRIs in pediatric cases of depression is now recognized by the Food and Drug Administration as warranting a cautionary statement to the parents of children who may be prescribed SSRIs by a family doctor. Recent studies have shown no increase in rates of suicide. These tests, however, represent those diagnosed with depression, not necessarily with social anxiety disorder.

Other drugs
Although SSRIs are often the first choice for treatment, other prescription drugs are also commonly issued.

Benzodiazepines are a more potent alternative to SSRIs. The drug is often used for short-term relief of severe, disabling anxiety. Although benzodiazepines are prescribed for long-term use, there is much concern over the development of drug tolerance, dependency and recreational abuse. Benzodiazepines, such as Xanax augment the action of GABA, the major inhibitory neurotransmitter in the brain; effects may begin to appear within days or hours.

In 1985, before the introduction of SSRIs, anti-depressants such as monoamine oxidase inhibitors (MAOIs) were frequently used in the treatment of social anxiety by researchers such as Michael Liebowitz. Irreversible MAOIs, most notably phenlzine, has been more efficacious than benzodiazepines in the short-term (8-12 weeks). Relapse is common, which may result in long-term usage. Because of the dietary restrictions required, high toxicity in overdose, and incompatibilities with other drugs, its usefulness as a treatment for social phobics is limited. Reversible inhibitors of monoamine oxidase subtype A (RIMAs) also inhibit monoamine oxidase. In contrast with MAOIs, reversibility means that they can inhibit the enzyme only temporarily. Because their action is short-lived and selective, they have a better safety profile than the older MAOI drugs. A special diet does not need to be strictly adhered to.

Some people with a form of social phobia called performance phobia have been helped by beta-blockers, which are more commonly used to control high blood pressure. Taken in low doses, they control the physical shaking of anxiety and can be taken before a public performance.