Social Anxiety Medication

Psychological Treatment or  Medication for Social Anxiety?

Cognitive behavioral therapy can be effective as medication in the treatment of social anxiety. Psychological treatment should be the treatment of choice provided it is accessible, acceptable to the client and appropriate to the severity of the person’s condition.

Some people may choose not to use medication, others will choose to combine cognitive behavioral therapy or some other type of therapy with medication, and some people may only utilize medication.

Some Drugs that are NOT recommended for social anxiety:

• buspirone
• impramine
• propranolol
• St. John’s wort
• alcohol
• atenolol

Western Australian Psychotropic Drugs Committee

Anxiety Disorders Drug Treatment Guidelines August 2008

SSRIs and Social Anxiety Disorder

SRRIs are commonly used to treat social anxiety  as there is much evidence that they are efficacious,  are generally well tolerated by patients, and are unlikely to be lethal if taken as an overdose.

The major negatives of using SRRIs to treat social anxiety are that the drugs are slow to take effect, 4-12 weeks and may aggravate anxiety symptoms at first. SSRI drugs can interact with other medications so before taking any medication in addition to your SSRI you should check with your doctor that is safe to do so.

Side Effects
You may feel more anxious at first. Side effects may also include: poor sleep, fatigue and increased sweating. There may also be an adverse impact on one’s sexual functioning.

Seratonin Selective Reuptake Inhibitors (SSRIs) recommended for social anxiety disorder are:

• citalopram
• fluoxetine
• paroextine
• escitalopram
• fluvoxamine
• sertraline

Western Australian Psychotropic Drugs Committee

Anxiety Disorders Drug Treatment Guidelines August 2008

Other drugs less commonly used to treat social anxiety disorder

• Serotonin and noradrenaline reuptake inhibitors (SNRI)    e.g.venlafaxine
• Monoamine oxidase inhibitor (MAOI)  e.g.phenelzine
• Reversible inhibitors of monoamine oxidase (RIMA ) e.g. moclobemide
• Noradrenaline reuptake inhibitor (NRI) e.g.reboxetine
• Antipsychotics  (AP) e.g. olanzapine, quetiapine
• Benzodiazepines (BZD) e.g. clonazepam, bromazepam
• Anticonvulsants (AC) e.g. gabapentin, pregablain, topiramate

SERONTOIN & NORADRENALINE RE-UPTAKE INHIBITORS (SNRI’S)
SNRI antidepressants influence the levels of serotonin and norepinephrine in the brain. Venlafaxine(Effexor) is an example of a SNRI used to treat social anxiety disorder.

Side Effects
Side effects may include: nausea, sexual dysfunction, sweating, sleep disturbance and tremours, as well as an increase in blood pressure.

MONOAMINE OXIDASE INHIBITORS (MAOI’S)
These drugs are antidepressants and work by inhibiting the breakdown of serotonin and norepinephrine, therefore the levels of these neurotransmitters rise and cause a decrease in anxiety.

Limitations:
People taking this form of medication have to follow a strict diet. They must not eat certain foods which contain tyramine (e.g.most aged cheeses, most alcoholic beverages, sausage products & Marmite) as these foods can interact with the medication to suddenly increase blood pressure and cause symptoms such as headache and vomiting. Users of MAOIs also have to be careful about drugs they take in addition to their MAOI. A severe high blood pressure reaction, in response to inappropriate food, beverages or medication, left untreated can lead to stroke or death.

Side Effects:
Common side effects of MAOIS include: insomnia, fatigue or drowsiness, sexual dysfunction, and weight gain.

Benzodiazepines

Benzodiazepines include drugs such as Valium, Ducene, Serepax, Xanax, Kalma. Benzodiazepines work very quickly to calm you but their effects do not last long.

Side effects:
Single doses can cause fatigue and drowsiness and therefore can reduce your ability to think on your feet (e.g. in a job interview or oral exam).

Limitations
Benzodiazepines have some significant drawbacks. Firstly, people who take benzodiazepines on a daily basis for more than a few weeks may become physically dependent upon them. Therefore, these drugs should not be ceased abruptly as there is the risk of rebound anxiety and withdrawal effects. Please note: Anyone planning to reduce and or cease their benzodiazepines should do so in consultation with their doctor.

Secondly, these drugs may be abused; therefore people who have a history of substance abuse may be advised to avoid benzodiazepines.

Thirdly. alcohol should not be consumed when you are taking benzodiazepines as it increases the sedative effect of the medication.

Furthermore, people taking benzodiazpines need to exercise caution re driving or operating potentially dangerous machinery until they work out how they respond to the medication.

Side Effects
Side effects may include: poor memory, fatigue, sleeping longer, impaired coordination, and loss of interest in sex. Benzodiazepines may also worsen a sufferer’s depression.

Helping rid yourself of anxiety takes more than medication. Help is only a phone call away, ring now for an appointment with a trained clinical psychologists on 0429 88 3671

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