What is the Best Medication for Social Phobia?

Social phobia, also known as social anxiety disorder, affects many people, as they literally are dying of embarrassment when people are around. Humans are social beings, and when you are fearful of socializing with others, then you will lead a very lonely and depressing existence. So people with social phobia may naturally ask- what is the best medication for social phobia? Indeed, your social anxiety may be so great that you may need to resort to medications, as the behavioral treatment for social anxiety, as with any anxiety, is to face your fears gradually. So for social phobia, the behavioral treatment entails exposing yourself to less fearful social situations, such as thinking about or seeing pictures of crowded places, then using relaxation techniques such as breathing or progressive muscle relaxation to help calm you after you are exposed to your feared social situation. Once you are able to calm yourself with these brief exposures to less-frightening social situations, then you are to gradually expose your to more and more fearful situations, until you are able to go to a crowded shopping mall and are able to stay at the mall without the thought that you may be embarrassing yourself. Eventually, you may even come to enjoy yourself at the mall, and even talk to people there!

However, your fear of being embarrassed in public may be so great that these facing-your-fears sessions may just make your anxiety worse and worse, as you are not able to calm yourself. If this is the case, then you may need to go to your doctor to see if you are a candidate for prescription medication treatment for social phobia. The best medications for social phobia are the SSRIs (selective serotonin reuptake inhibitors) and the SNRIs (serotonin norepinephrine reuptake inhibitors). SSRIs and SNRIs are second-generation antidepressants, and they are a significant improvement over the first-generation antidepressants, the TCAs (tricyclic antidepressants) and MAOIs (monoamine oxidase inhibitors), as these medications are not well tolerated and have numerous side effects, some of which are serious side effects. SSRIs and SNRIs also have advantages over benzodiazepines, as SSRIs and SNRIs are not addictive, whereas benzodiazepines can be quite addictive.

Although SSRIs and SNRIs are first line treatment for social phobia, I prefer SSRIs, as they have less side effects than the SNRIs, as the SNRIs have the worst withdrawal symptoms when trying to discontinue it or missing doses. Case in point, venlafaxine (Effexor) has the worst withdrawal symptoms (also known as Discontinuation Syndrome) of all the second-generation antidepressants.

So the SSRIs are the best medications for social phobia. Within the SSRIs family, it include the following medications: fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro). Of these SSRIs, I have prescribed a lot of sertraline, citalopram, and escitalopram, as these 3 medications seem to be the best tolerated with the least side effects. The problem with fluoxetine (Prozac) is that is can cause worsening agitation and anxiety when first starting it, so this makes a bad situation (social anxiety) worse (more anxiety), at least initially. Paroxetine (Paxil) is good at calming anxiety, but it has such a short duration of action, so it has to be dosed twice daily, and when you miss doses of paroxetine, the withdrawal symptoms can be bad. I tend not to prescribe fluvoxamine (Luvox) at all, as it has too many drug-drug interactions- so it is easy to just not prescribe it in the first place.

So there you have it- the best medications for social phobia are sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro).

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