The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions. Use each of these medications only as recommended by your doctor and according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
All of the medications used to treat
social anxiety disorder
require a prescription from your doctor. There are many options, some of which are listed below. Some of the medications are more appropriate for people who have the performance type of social anxiety disorder. These medications may be given just before an anxiety-provoking event. Other medications may be taken on a regular basis to treat the symptoms of a more generalized social anxiety disorder.
Medications are usually combined with some form of counseling.
Common names include: CitalopramFluvoxamineParoxetineFluoxetineSertraline
SSRIs effect the concentration of the neurotransmitter serotonin. Serotonin plays a role in
anxiety. Although they are considered antidepressants, SSRIs have been used effectively to treat anxiety disorders. They are considered the drugs of choice for this condition. Improvement is usually seen 4-6 weeks after beginning treatment. SSRIs are not addictive. Do not take an SSRI if you have taken a monoamine oxidase inhibitor (MAOI) in recent weeks.
These drugs should be used with caution in the elderly and those with liver or kidney diseases. During therapy, your doctor will be monitoring your heart rate, blood pressure, liver and kidney functions, and worsening depression, including increased suicide risk.
Possible side effects include: NauseaDiarrheaInsomniaLoss of appetite or weight lossWeight gainNervousnessSexual dysfunction (ranging from decreased arousal to erectile dysfunction and/or delayed time to orgasm)Risk of severe mood and behavior changes, including suicidal thoughts in some (young adults may be at a higher risk for this side effect.)
Common names include: LorazepamPrazepamFlurazepamClonazepamTriazolamChlordiazepoxideHalazepamTemazepamOxazepamClorazepateDiazepamAlprazolam
Benzodiazepines reduce symptoms of anxiety by enhancing the function of gamma aminobutyric acid (GABA). GABA is a neurotransmitter thought to be abnormal in people with social anxiety disorder. These drugs produce a sedative effect, reduce physical symptoms (such as muscle tension), and often cause drowsiness and lethargy. The advantage of benzodiazepines is that they are fast acting and useful for treating acute anxiety and
Benzodiazepines are usually used 30-60 minutes before an anxiety-provoking event in people with the performance type of social anxiety disorder.
These drugs can be habit-forming when used long-term or in excess. When discontinued, they may cause withdrawal symptoms such as anxiety, irritability, and insomnia. Withdrawal can be life threatening in some cases. Stopping this medication should be done slowly, over a period of weeks or months, and under a doctor’s supervision.
Do not take these drugs with alcohol or other sedating drugs. Do not take if you must drive a vehicle or operate equipment. Use with caution in the elderly, those with liver, lung, kidney diseases,
alcohol use disorder,
seizure disorder, or
porphyria. These drugs should not be taken in combination with certain oral antifungal medications and in people with certain types of
The doctor will monitor your blood pressure, heart rate, respiratory rate, and liver function tests.
Possible side effects include: Drowsiness or lethargyConfusionLightheadedness, particularly in elderly personsSlow reaction time, impaired coordination
Common names include: PropanololAtenolol
Beta-blockers have been used effectively to reduce symptoms of social anxiety. They reduce the production of hormone called adrenaline. They also affect the response of certain nerve impulses in the body.
Beta-blockers are usually used 30-60 minutes before an anxiety-provoking event in people with the performance type of social anxiety disorder.
Beta-blockers are contraindicated with
and certain heart problems. They should be used cautiously with many medical disorders. Withdrawal should be done slowly, under a doctor’s supervision.
Possible side effects include: Fatigue, weaknessLightheadednessDrowsinessNausea or vomitingSlow heart rateTrouble breathingDepressionDecreased sexual arousalDifficulty sleeping
Common names include: DoxepinClomipramineNortriptylineAmitriptylineImipramineMaprotilineDesipramineNortriptylineDesipramineDoxepinTrimipramineImipramineProtriptyline
Tricyclic antidepressants regulate serotonin and/or noradrenalin in the brain. They have been used effectively to treat social anxiety disorder. However, they are not used as often because they are associated with more adverse effects than SSRIs and do not have any added benefits. Improvement is usually seen 2-6 weeks after beginning treatment. Tricyclic antidepressants are not addictive. These drugs should be used with caution in the elderly and those with liver or kidney disease. Do not take this medication if you have glaucoma, are recovering from a
heart attack, or are also taking MAOIs. During therapy, your doctor will be monitoring your heart rate, blood pressure, body weight, liver function, and blood count.
Possible side effects include: LightheadednessDry mouthConstipationDifficulty urinatingWeight gainLow blood pressureSexual dysfunctionRisk of severe mood and behavior changes, including suicidal thoughts in some (young adults may be at a higher risk for this side effect.)
Common names include: TrazodoneVenlafaxineNefazodone
Atypical antidepressants affect the concentration of the neurotransmitter serotonin. They can be effective in treating social anxiety. Improvement is usually seen 4-6 weeks after beginning treatment.
Possible side effects include: NauseaNervousnessReduced sex driveRisk of severe mood and behavior changes, including suicidal thoughts in some (young adults may be at a higher risk for this side effect.)
Common names include: IsocarboxazidPhenelzineTranylcypromine
Monoamine oxidase inhibitors (MAOIs) are a type of antidepressant that reduces symptoms of social anxiety disorder. They prevent the breakdown of dopamine, epinephrine, norepinephrine, serotonin, and noradrenalin. Improvement is usually seen 2-6 weeks after beginning treatment. MAOIs are not addictive. These antidepressants are used to treat generalized social anxiety disorder. They are considered a last choice.
There is a risk of serious reactions when taking MAOIs. There are many medications, both prescribed and over-the-counter, that you will need to avoid. Examples of medications to avoid include: Other MAOIs
Antidepressants—increased risk of hypertensive emergency (dangerously high blood pressure) and
serotonin syndromeSympathomimetics (drugs that stimulate the sympathetic nervous system)SedativesNarcotics, such as
meperidine, and other pain medications, such as
tramadolAnestheticsAntihypertensive drugsDiureticsAntihistaminesBuspirone—anti-anxiety medicationOver-the-counter decongestantsHerbal weight loss products
Certain herbs and supplements (such as
St. John’s wort,
(such as Robitussin Maximum Strength, Vicks 44 Cough Medicine)—cough suppressant
Ask your doctor for a complete list of medications to avoid. Also, talk to your doctor before taking any new medication, including over-the-counter medications and herbs and supplements.
When taking MAOIs, there is the risk of a life-threatening side effect, called serotonin syndrome. This occurs when MAOIs interact with other antidepressant medications, such as serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). In serotonin syndrome, levels of serotonin in the brain get dangerously high. This can cause confusion, hallucinations,
seizures, and other symptoms. This is an emergency. To avoid interactions, it is generally recommended to wait 2-5 weeks before stopping MAOIs and starting another antidepressant. Ask your doctor about the specific medication you are taking.
Because of the risk of serious reactions, there are also dietary restrictions when taking MAOIs. Avoid eating foods with high tyramine content. Tyramine is an amino acid that helps regulate blood pressure. If you have too much tyramine and are taking MAOIs, your blood pressure may become dangerously high. This is called hypertensive crisis. In some cases, this can lead to a
stroke. Examples of foods with high tyramine content include:
CheeseAlcoholOrgan meatsNutsPeanut butterFava beansOnionsAvocadosCanned figsChocolateExcessive amounts of caffeineFoods containing monosodium glutamate (MSG)Foods that are pickled, marinated, smoked, cured, or fermented
Ask your doctor for a complete list of foods and drinks to avoid.
During therapy, your doctor will monitor your heart rate, blood pressure, liver and kidney functions, and worsening depression, including increased suicide risk. MAOIs should be used with caution in the elderly and those with liver and kidney diseases.
MAOIs can cause birth defects. They should not be taken by pregnant women. Also, the medication should not be taken if you have certain conditions, such as stroke,
coronary artery disease, or pheochromocytoma (tumor in the adrenal gland).
There are many side effects, some severe, that can be caused by MAOIs. Because of this, doctors will usually try other medications before prescribing MAOIs. Some side effects include: Changes in blood pressure, including hypertensive crisisSerotonin syndromeWeight gainReduced sexual responseDrowsinessInsomniaNausea, stomach upsetDiarrheaIncreased sweatingConstipationBlurred visionShakiness, weakness, trembling, lightheadednessHeadaches, muscle achesHeart rhythm changesRisk of severe mood and behavior changes, including suicidal thoughts in some (young adults may be at a higher risk for this side effect.)