Social Anxiety Disorder Treatment and Therapy How SSRIs Are Used to Treat Social Anxiety Disorder By Arlin Cuncic, MA Arlin Cuncic, MA Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety." She has a Master's degree in psychology. Learn about our editorial process Updated on March 25, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print Science Photo Library / Robert Brook / Getty Images Table of Contents View All Table of Contents Types Usage Side Effects Advisories/Warnings Stopping Treatment 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 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: Celexa (Citalopram) Lexapro (Escitalopram) Luvox (Fluvoxamine) Paxil (Paroxetine) Prozac (Fluoxetine) Zoloft (Sertraline) Three SSRIs, Paxil, Zoloft, and Luvox CR have been approved by the FDA for treating social anxiety disorder. All three medications 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. Treating Social Anxiety Disorder Usage 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 an improvement in your symptoms. Side Effects SSRIs are generally the preferred medication for SAD because the side effects tend to be well-tolerated. However, there are several possible side effects. Here's an overview of what you could experience. Anxiety-like symptoms: irritability, nervousness, shaky hands, sweating Eating problems: weight gain or loss, loss of appetite Physical ailments: skin rashes, dry mouth, headaches, nausea, dizziness Sexual dysfunction: decreased sex drive, delayed or absent orgasm, erectile dysfunction Sleep problems: drowsiness, fatigue or insomnia 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. Curbing the Side Effects of Antidepressants 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. 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 2004, the FDA released an advisory concerning SSRIs and risk of suicidal thoughts and behaviors, particularly in children and adolescents. 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. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see our National Helpline Database. 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. You also can experience 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. How to Stop Taking SSRI Antidepressants Safely 4 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Ferguson JM. SSRI Antidepressant Medications: Adverse Effects and Tolerability. Prim Care Companion J Clin Psychiatry. 2001;3(1):22-27. doi:10.4088/pcc.v03n0105 Bartlett D. Drug-Induced Serotonin Syndrome. Crit Care Nurse. 2017;37(1):49-54. doi:10.4037/ccn2017169 Orlova Y, Rizzoli P, Loder E. Association of Coprescription of Triptan Antimigraine Drugs and Selective Serotonin Reuptake Inhibitor or Selective Norepinephrine Reuptake Inhibitor Antidepressants With Serotonin Syndrome. JAMA Neurol. 2018;75(5):566-572. doi:10.1001/jamaneurol.2017.5144 Gabriel M, Sharma V. Antidepressant discontinuation syndrome. CMAJ. 2017;189(21):E747. doi:10.1503/cmaj.160991 Additional Reading 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. By Arlin Cuncic, MA Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety." She has a Master's degree in psychology. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for Social Anxiety Disorder Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.