Medication Clasifications

The six major categories of medications used to treat social anxiety disorder are:

* Selective serotonin reuptake inhibitors (SSRIs)
* Serotonin norepinephrine reuptake inhibitors (SNRIs)
* Benzodiazepines
* Monoamine oxidase inhibitors (MAOIs)
* Gabapentin and Pregabalin
* Beta-blockers

Selective Serotonin Reuptake Inhibitors (SSRIs)
Generic Name Brand Name
citalopram Celexa
escitalopram Lexapro
fluoxetine Prozac, Prozac Weekly
fluvoxamine Luvox, *Luvox CR
paroxetine *Paxil, *Paxil CR
sertraline *Zoloft

*Approved by U.S. Food and Drug Administration for treatment of social anxiety disorder.

Fluvoxamine CR (Luvox CR), paroxetine (Paxil), paroxetine CR (Paxil CR), and sertraline (Zoloft) have FDA approval for treatment of social anxiety disorder and are generally considered SSRI medications of first choice.

Clinical evidence suggests that all the above SSRIs may be helpful in treating social anxiety disorder.

Other than fluvoxamine, the SSRIs are also approved for the treatment of depression.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Generic Name Brand Name
desvenlafaxine Pristiq
duloxetine Cymbalta
venlafaxine Effexor, *Effexor XR

Venlafaxine XR (Effexor XR), an SNRI, has been approved for the treatment of generalized social anxiety disorder.

Like the SSRIs, it increases levels of serotonin. It also increases norepinephrine levels.

Venlafaxine is also approved for the treatment of depression, so it is a good choice for patients with generalized social anxiety disorder and depression.

Benzodiazepines (BDZs)
Generic Name Brand Name
alprazolam Xanax, Xanax XR
chlordiazepoxide Librium
clonazepam Klonopin, Klonopin Wafers
clorazepate Tranxene
diazepam Valium
lorazepam Ativan
oxazepam Serax

Clonazepam (Klonopin) is the most extensively studied benzodiazepine for social anxiety disorder and has been shown to have significant beneficial effects.

Benzodiazepines have the advantage of decreasing anxiety faster than the other medications.

Benzodiazepines have the disadvantage of not treating depression and long-term use can cause physical dependency.

Monoamine Oxidase Inhibitors (MAOIs)

Monoamine oxidase inhibitor medications (MAOIs) were once the best studied and probably the most effective medications for treating social anxiety disorder.

Because of the possibility of dangerous as well as annoying side effects, MAOIs are not widely prescribed today (MAOI treatment requires a special diet low in tyramine).

MAOIs are still used for individuals who have not responded to other medications.

Gabapentin and Pregabalin

Another class of medications that may be useful includes gabapentin (Neurontin) and pregabalin (Lyrica).

Although FDA approved only for treatment of epilepsy and certain pain disorders, each has also been shown to be effective for social anxiety disorder in a small controlled research study.

Beta-blockers

The final medication class are the beta-adrenergic receptor blocking agents, or beta-blockers.

While beta-blockers have not been found to be helpful for treating generalized social anxiety disorder, they do have a role to play in treating performance anxiety.

They seem to work on some of the bodily symptoms of anxiety by slowing down heart rates, and reducing tremors and sweating, and thereby indirectly reducing anxiety.

The beta-blocker most commonly used for performance anxiety is propranolol (Inderal). Unlike the SSRI and SNRI medications, beta-blockers are not antidepressants.