Pharmacological Treatments for Social Anxiety

Propriate anxiety is a normal and necessary part of human existence. Social anxiety can at times be an appropriate and normal response to social situations.

It focuses us and keeps us motivated to perform necessary tasks. In a high-risk situation, anxiety can save our lives.

Anxiety is anxiety irrespective of the circumstances that provoke it.

One of the main chemicals in the brain that is being studied for effect on anxious mood is serotonin. Most anti-anxiety drugs that are used affect the brains turnover of serotonin in some way.

Benzodiazepines

Action: These are a class of medication that alter the turnover of a brain chemical called GABA,.  In effect, they increase activity of GABA and it is through this that they exert their anxiety reducing effect.

Chemical Name: Diazepam, Lorazepam,  Clonazepan, Alprazolam
Trade Name: Valium, Ativan,  Rivotril, Xanax

Advantages:

• The benzodizepines’ are very effective at reducing the symptoms of anxiety in the short term.

Disadvantages:

• Unfortunately, benzodizepines’ do cause dependency (or addiction). That means if you are taking them on a regular (e.g., daily) basis for more than four weeks and then discontinue using them they will cause a withdrawal state. This withdrawal state consists of increased anxiety and all the physical symptoms that come with this state.

They should not be used for the long-term treatment of social anxiety.

There are two good reasons for this:

1. They can induce a state of dependency,
2. People who use them can become tolerant of their effects over time. This means that they become less effective at controlling the symptoms of anxiety.

Antidepressants

Action: These are medications – that all, in some way – affect brain turnover of two chemicals serotonin and/or noradrenaline.

Selective Serotonin Re-Uptake Inhibitors:

Trade Name: Cipramil, Lexapro, Lustral, Flaverin, Seroxat, Effexor, Molipaxin, Anafranil
Chemical Name: Fluoxetine,  Citalapram, Escitalopram, Sertraline, Fluvoxamine, Paroxetine, Venlafaxine, Trazodone, Clomipramine

Advantages:

• They can reduce social anxiety and in addition treat depressive symptoms that have occurred secondary to the anxiety symptoms.
• They are not dependence producing in the same way as Benzodiazepines
• They can be used for long-term treatment.

Important to note about this class of medications

• They can take up to nine weeks – or more – to exert their anxiety reducing effect. so patience and persistence is often required

Disadvantages:

• There is a distinct risk of the return of symptoms of social anxiety when they are discontinued.
• Treatment with medications alone does not specifically target the causes of the social anxiety symptoms.
•  Individuals who have been prescribed a Selective Serotonin Re-Uptake Inhibitors can experience a temporary increase in anxiety in the first week of treatment.
•  Some antidepressants  – Paroxetine in particular – can produce a withdrawal syndrome if not discontinued gradually under medical supervision.

So to address the question of what are the effects of medications for social phobia? The evidence-based answer is that In adults, medications may improve the symptoms of social phobia in the short term,.  Unfortunately, their usefulness tends to be overstated because of publication bias. Selective serotonin reuptake inhibitors (SSRIs) have the strongest evidence of efficacy and the most favorable side-effect profile.

Summary of NICE Guidelines on Anxiety Disorders.

Website: www.nice.org.uk

1. Psychological Therapy should be tried as first line treatment.
2. Pharmacological Therapy is also an effective means of treatment particularly SSRI.`S (Selective Serotonin Re-Uptake Inhibitors)