Biology, Social Anxiety and Medication

Social Anxiety Help

Larry Cohen, LICSW

Biology, Social Anxiety and Medication

All aspects of the anxiety response–thoughts, feelings, physiology and behavior–are controlled by our nervous systems, especially our brains. In addition, there is evidence that the anxiety mechanism of some people is oversensitive for biological reasons. It may be helpful to think of the analogy of the anxiety mechanism as a smoke detector that is intended to warn and prepare us when there is the potential danger of fire. Some smoke detectors are set too sensitively, however, so that their alarm goes off frequently when there is no actual danger.

There are various medications available that help many people with different anxiety problems, including social anxiety. Medications have certain key advantages over psychotherapy: drugs are often easier and quicker. But there are important disadvantages, too.

Drugs often have side effects. For example, the Selective Serotonin Reuptake Inhibitors (SSRIs, such as Paxil, Prozac, Zoloft, Luvox, Celexa and Lexapro), which are commonly prescribed for social anxiety, very often cause sexual side effects (eg. difficulty or inability to achieve orgasm, and lessened sexual desire), as well as other side effects.

It’s important to note that not everyone experiences side effects, and some people experience side effects only temporarily. In addition, the side effects for some people are minor and well worth the benefits of the medication.

Some medications used for anxiety (benzodiazepines or tranquilizers such as Xanax, Ativan, Restoril, Klonopin and Valium) are potentially addictive when used long term. Many medications sometimes used for social anxiety have important alcohol or food restrictions that must be adhered to strictly.

Nonetheless, various medications have helped many people with social anxiety and other anxiety problems greatly. It is usually recommended that, if you take a medication, that you do so in conjunction with psychotherapy, especially cognitive-behavioral therapy (CBT). The positive effects of medications for social anxiety tend to be short-lived after you stop using the drug. The positive effects of cognitive-behavioral therapy, however, are likely to be much longer-lived. The two together are an ideal combination for many people. If your symptoms are severe, medication may speed up the progress you make in CBT. In addition, CBT may help you progress to a point that you may be able to go off of medication and continue making progress.

If you are considering medication, it is important that you consult with a psychiatrist or other medical doctor who has an expertise in helping people with anxiety disorders. It’s crucial that you consult with your medical doctor whenever you consider going off a medication that you are already on. Going off various anxiety medications too quickly could trigger a return of the anxiety problems, sometimes with greater severity than you used to have.

For more information, please read:

How Thinking Can Change the Brain (The Wall Street Journal),

CBT Alone More Effective for Social Anxiety Than Medication , or Medication + CBT —and— CBT for Social Anxiety Changes the Brain

Genetic Links to Social Anxiety Disorder

Verbal Suggestions Greatly Enhance Effectiveness of Medication for Social Anxiety

The Purpose of Anxiety

Perception is the Starting Point

Fight, Flight or Freeze

When Dangers are Social

Social Anxiety Does Not Equal Introversion

Social Anxiety Triggers

Biology, Social Anxiety and Medication

Cognitive-Behavioral Therapy for Social Anxiety


If you have any questions or comments, please email Larry Cohen, LICSW, with offices in Washington, DC.

Social Anxiety Help is a founding regional clinic of the National Social Anxiety Center (NSAC):