How Are SSRIs Used in the Treatment of Social Anxiety Disorder?

Selective Serotonin Reuptake Inhibitors (SSRIs) for SAD

SSRIs are a type of anxiety medication
SSRIs are used in the treatment of social anxiety disorder. Getty / Science Photo Library / Robert Brook

Selective serotonin reuptake inhibitors (SSRIs) are usually the first choice of medication for treating social anxiety disorder (SAD). SSRIs affect your brain chemistry by slowing re-absorption of the neurotransmitter serotonin, a chemical that we think helps to regulate mood and anxiety.

Types of SSRIs

There are several SSRIs that may be recommended in treating SAD including the following. Each medication is listed by the brand name followed by the generic name in parentheses:

Three SSRIs, Paxil, Zoloft, and Luvox have been approved by the FDA for treating social anxiety disorder. However, all have been shown in clinical studies to offer improvement of symptoms.

Paxil was the first SSRI to receive FDA approval and is still often prescribed. However, the medication that works for one person doesn't always work for another. So, your doctor will work with you to find the right prescription for you.

How Do I Take an SSRI?

Your doctor will give you specific instructions on how to take your medication. It is important that you follow these directions.

Generally, you will take an SSRI once a day, usually in the morning. Your doctor will usually prescribe a low dose at first, which will be increased gradually.

The dose that you require does not necessarily relate to the severity of your symptoms.

Sometimes it is simply a reflection of your unique metabolism. It may take several weeks for you to notice improvement of your symptoms.

What are the Side Effects?

SSRIs are generally the preferred medication for SAD because the side effects tend to be well-tolerated. However, several possible side effects include the following:

  • Sleep problems: drowsiness, fatigue or insomnia
  • Sexual dysfunction: decreased sex drive, delayed or absent orgasm, erectile dysfunction
  • Physical ailments: skin rashes, dry mouth, headaches, nausea, dizziness
  • Anxiety-like symptoms: irritability, nervousness, shaky hands, sweating
  • Eating problems: weight gain or loss, loss of appetite

If you have great difficulty with side effects, your doctor may decide to prescribe a different SSRI. In general, lower initial doses that are gradually increased reduce the chance that you will have bad side effects.

Advisories/Warnings

SSRIs should never be taken at the same time as monoamine oxidase inhibitors (MAOIs). The results of such a combination can be fatal. In addition, never start taking one of these medications within weeks of stopping the other.

In 2004, the FDA released an advisory concerning SSRIs and risk of suicidal thoughts and behaviors, particularly in children and adolescents. Although rare, it is possible during the initial phase of treatment for symptoms to worsen rather than improve.

It is important to monitor symptoms during this time and report any negative changes to your doctor.

In addition to the FDA advisory on suicidal thoughts, there has also been an advisory released regarding the use of triptans for migraine headaches in combination with SSRIs. In combination, there is a risk of serotonin syndrome, a potentially life-threatening condition. In general, it is important to inform your doctor of all medications, both prescription and nonprescription, that you are already taking.

Stopping Treatment

SSRIs should always be discontinued under the supervision of a medical professional. Abruptly stopping these medications can result in a relapse of anxiety symptoms and serotonin withdrawal symptoms including trouble with coordination, tingly sensations, vivid dreams, flu-like symptoms, anxiety, and depressed mood. To avoid these serotonin withdrawal symptoms and the possibility of relapse, SSRIs should always be gradually tapered off.

Sources:

Bezchlibnyk-Butler KZ, Jeffries, JJ, eds. Clinical Handbook of Psychotropic Drugs. Toronto, Canada: Hogrefe & Huber; 2003.

U.S. Food and Drug Administration. FDA. Antidepressant Use in Children, Adolescents and Adults. Accessed January 27, 2016.

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