Social anxiety: Medication treatment
Medication is one of the conventional forms of treatment for social anxiety disorder. The other conventional treatment is cognitive behavioural therapy CBT.
There are a variety of medications that can be used for social anxiety disorder. The main type of medications used are called Selective Serotonin Reuptake Inhibitors SSRIs. These are a class of drugs called anti-depressants, which also have anti-anxiety effects.
Whether to use medication or not, and what type, will depend on your personal wishes and the advice of your doctor. These medications must be prescribed and monitored by an appropriately qualified doctor. This is because of the potential of the medication for side effects. And the potential for the medication to interact badly with other medications. And the potential of the medication to interact badly with other medical conditions.
Selective Serotonin Reuptake Inhibitors SSRIs
Examples of SSRIs include:
- paroxetine (brand names: seroxat, paxil)
- escitalopram (brand name: cipralex)
- citalopram (brand names: cipramil, celexa)
- sertraline (brand names: lustral, zoloft)
Their therapeutic effect usually takes at least 2 weeks to be noticed.
Side effects from SSRIs can include:
Nausea, vomiting, dyspepsia, abdominal pain, diarrhoea, constipation, anorexia with weight loss, increased appetite and weight gain also reported, rash, urticaria, angioedema, anaphylaxis, arthralgia, myalgia, photosensitivity, dry mouth, nervousness, anxiety, headache, insomnia, tremor, dizziness, asthenia, hallucinations, drowsiness, convulsions, galactorrhoea, sexual dysfunction, urinary retention, sweating, hypomania or mania, movement disorders, dyskinesias, suicidal behaviour, visual disturbances, possible link to suicidal behaviour, hyponatraemia, ecchymoses, purpura, angle-closure glaucoma. (source= British National Formulary BNF)
If you are taking a SSRI medication, it is important you do not stop it suddenly. This is particularly true if you have been taking it for more than eight weeks. This is because of the risk of withdrawal reactions. These reactions may occur up to 5 days after stopping the treatment. Withdrawal reaction symptoms can include headache, anxiety, dizziness, nausea and sleep disturbance. Paroxetine is the SSRI most likely to cause this. Ideally, when you are stopping the drug it should be done slowly over a few weeks.
Other medications that may be used in social anxiety disorder include:
- Monoamine oxidase inhibitor (MAOI)
- Beta blockers
Venlafaxine (Selective Serotonin and Noradrenaline Reuptake Inhibitor SSNRI)
Venlafaxine (brand name: effexor or efexor) can be used to treat social anxiety disorder. It is also used as an anti-depressant.
Like the SSRI class of drugs, venlafaxine takes some weeks to reach its full effect. Also the drug needs to be withdrawn slowly because of the high risk of withdrawal symptoms.
Side effects of venlafaxine can include:
Constipation, nausea, anorexia, weight changes, vomiting; hypertension, palpitation, vasodilatation, changes in serum cholesterol, chills, yawning, dizziness, dry mouth, insomnia, nervousness, drowsiness, asthenia, headache, abnormal dreams, anxiety, confusion, hypertonia, sensory disturbances, tremor, difficulty with micturition, sexual dysfunction, menstrual disturbances; visual disturbances, mydriasis, very rarely angle-closure glaucoma, sweating, bruxism, diarrhoea, taste disturbance, postural hypotension, arrhythmias, agitation, apathy, incoordination, hallucinations, myoclonus, angioedema, urinary retention, ecchymosis, gastro-intestinal haemorrhage, tinnitus, alopecia, photosensitivity, rash, mania, hypomania, suicidal behaviour, seizures, extrapyramidal symptoms including akathisia, urinary incontinence, hepatitis, pancreatitis, hypotension, QT-interval prolongation, aggression, neuroleptic malignant syndrome, delirium, vertigo, syndrome of inappropriate anti-diuretic hormone secretion, hyperprolactinaemia, blood dyscrasias, rhabdomyolysis, pruritus, urticaria, Stevens-Johnson syndrome. (source= British National Formulary BNF)
Duloxetine (inhibits the re-uptake of both serotonin and noradrenaline)
Duloxetine (brand name: cymbalta, yentreve) is similar to venlafaxine as it also inhibits the re-uptake of both serotonin and noradrenaline. It can be used to treat depression and anxiety.
Side effects of duloxetine include:
Nausea, vomiting, dyspepsia, constipation, diarrhoea, abdominal pain, weight changes, decreased appetite, flatulence, dry mouth, palpitation, hot flush, insomnia, abnormal dreams, paraesthesia, drowsiness, anxiety, headache, dizziness, fatigue, weakness, tremor, nervousness, anorexia; sexual dysfunction, visual disturbances, sweating, pruritus, gastritis, halitosis, hepatitis, bruxism, tachycardia, hypertension, postural hypotension, syncope, raised cholesterol, vertigo, taste disturbance, cold extremities, impaired temperature regulation, impaired attention, movement disorders, muscle twitching, musculoskeletal pain, thirst, stomatitis, hypothyroidism, urinary disorders, photosensitivity, mania, angle-closure glaucoma. Also reported: supraventricular arrhythmia, chest pain, hallucinations, suicidal behaviour, seizures, hypersensitivity reactions including urticaria, angioedema, rash, Stevens-Johnson syndrome, anaphylaxis, hyponatraemia. (source= British National Formulary BNF)
Monoamine oxidase inhibitor (MAOI)
This is another class of anti-depressant medications that can occasionally be used in social anxiety disorder.
In particular moclobemide (trade names: manerix, aurorix) is an MAOI with a licence to treat social anxiety disorder.
MAOI drugs can have dangerous interactions with a number of other drugs, and also with alcohol and some foods. Therefore it is not a first line treatment, and should only be prescribed by a doctor familiar with its use.
Side effects of moclobemide can include:
Sleep disturbances, dizziness, gastro-intestinal disorders, headache, restlessness, agitation; paraesthesia, dry mouth, visual disturbances, oedema, skin reactions, confusional states, raised liver enzymes, galactorrhoea, hyponatraemia. (source= British National Formulary BNF)
The drug can take three weeks or more to take effect. Like the other anti-depressant medications, it should be stopped slowly because of the risk of withdrawal reactions.
These are a class of drugs known as anxiolytics i.e. they have an anti-anxiety effect.
Diazepam (also known as valium), and alprazolam (also known as xanax) are examples of benzodiazepines.
One of the main problems with this type of drug, is dependency i.e. you become addicted to them. This is why they are not used much, except in acute cases and for short periods of time.
Stopping these drugs can be a problem, especially if used for any length of time, because of the dependency and addiction they can cause.
Side effects of diazepam can include:
Drowsiness, light headedness, confusion, ataxia, amnesia, dependence, paradoxical increase in aggression, muscle weakness, headache, vertigo, hypotension, salivation changes, gastro-intestinal disturbances, visual disturbances, dysarthria, tremor, changes in libido, incontinence, urinary retention, blood disorders, jaundice, skin reactions. (source= British National Formulary BNF)
The most commonly used beta blocker for anxiety is propranolol (brand name: inderal-la).
Beta blockers can be used to help control the physical symptoms of anxiety e.g. tremor, racing heart etc. They work by blocking the effect of adrenaline on the body.
They are not used as commonly as SSRIs. They can sometimes be useful in helping someone cope in a performance situation such as giving a presentation, or playing a musical instrument.
The side effects of propranolol can include:
Gastro-intestinal disturbances, bradycardia, heart failure, hypotension, conduction disorders, peripheral vasoconstriction, exacerbation of intermittent claudication and Raynaud’s phenomenon, bronchospasm, dyspnoea, headache, fatigue, sleep disturbances, paraesthesia, dizziness, vertigo, psychoses; sexual dysfunction; purpura, thrombocytopenia, visual disturbances, exacerbation of psoriasis, alopecia, rashes, dry eyes. (source= British National Formulary BNF)
Some drugs can cause problems with medical conditions. For example, if a beta blocker, like propranolol, is used in a person who also has asthma, it can precipitate an asthma attack.
Should you use medication or not?
Firstly, if you are on medication and you think you may be suffering from a side effect from it, you should consult your doctor immediately.
The list of the above potential side effects can appear very alarming. In a medical context, it is always the “risk versus benefit” when deciding whether to prescribe or not. There is always the “risk” of side effects from medication. But the medication might provide a useful benefit. Also, your personal medical history and other medication needs to be taken into account.
The decision as to whether to use medication or not, will depend on your personal wishes, and the assessment of your doctor who knows your personal medical history.
Medication has helped some people with social anxiety disorder.
However, the main disadvantages of using medication for social anxiety disorder are:
- It might not help you at all.
- You might experience side effects, some of which can be serious.
- There is the possibility that the drug used for social anxiety will interact badly with another drug you take, or interact badly with another medical condition you have.
- The drug can mask the symptoms of social anxiety disorder. But, the drug by itself, does not treat the underlying cause.