Social anxiety can be incredibly challenging. Whether it’s a constant dread of saying something wrong in a meeting, or a fear that everyone is judging you in social settings, these feelings can be overwhelming, and unfortunately, there’s still stigma surrounding treatment—especially when it comes to medication. Some people see medication as an easy way out. Others think it’s a sign of giving up on yourself. Neither view is accurate, but it’s easy to let those opinions affect your choices.
Despite stigma, it’s crucial to focus on your own mental health—you owe it to yourself to find the treatment that’s best for you. Remember, everyone’s experience with social anxiety is different. Evidence-based treatments like Exposure and Response Prevention Therapy (ERP) and medication are both just tools to help you out. They can be used together or separately, but the most important thing is that you feel comfortable with your treatment plan. Keep an open mind, have conversations with your therapist about all your options, and know that there’s no “right” way to manage social anxiety—only what works best for you.
Whether with therapy, medication, or both, you can learn to manage social anxiety. Book a free call to learn more.
What is Social Anxiety Disorder?
It’s normal to feel nervous in certain social situations, like going on a first date, presenting a work project in front of a crowd, or doing karaoke at a crowded bar. But when that nervousness becomes overwhelming and constant, making it hard to function on a daily basis, it may be something more than normal stresses or anxieties. You may be crossing into the threshold of social anxiety disorder.
“The main hallmarks of social anxiety disorder, also called social phobia, are a chronic, intense and debilitating fear of being negatively judged or embarrassed in front of others,” says April Kilduff, MA, LCPC, LMHC. It is important to emphasize that social anxiety can be very debilitating, instead of just a normal fear of being socially rejected or feeling judged. For example, someone with social anxiety might be too afraid to interact with a cashier at the grocery store even though they are running late for dinner, so they instead wait in the long line for self checkout just to avoid that interaction— even if it means losing the reservation to the restaurant they waited weeks for.
If you live with social anxiety, you might even find yourself worrying about how anxious you appear to others. You may stress about people noticing signs like blushing or shaking, fearing they’ll judge you. Physical symptoms like increased heart rate, sweaty palms, or tense muscles are common with anxiety disorders. Because of these symptoms and feelings, you might avoid new or uncomfortable social situations, which is one of many responses known as safety-seeking behaviors.
It’s important to remember that social anxiety isn’t the same as introversion or shyness—these fears can consume one’s life and make it impossible for them to do simple tasks like take public transport or ask for help when needed.
Is medication necessary for Social Anxiety treatment?
The short answer? Not necessarily. Whether or not someone needs medication for social anxiety really depends on the individual. Plenty of people see progress through therapy alone, but for others, medication makes a tremendous difference, especially if therapy isn’t quite enough. Some others find success in using medication without therapy—it all depends on who you are and where you are on your journey with overcoming social anxiety.
A licensed therapist with experience treating social anxiety will be able to guide you towards what good options for you look like. “The role or need for medication differs from person to person,” Kilduff shares. She adds that whether medication is appropriate depends on the severity of symptoms, whether or not therapy has proven to be ineffective on its own, and personal preference.
If you’re unsure about psychiatric medication, that’s totally normal. Unfortunately, there is still a lot of stigma surrounding it. Some people are wary of side effects, some don’t want to rely on taking pills, and others prefer to try to fight their symptoms through therapy alone. The key is having an open conversation with your therapist and remembering that medication is not bad—it can be a tremendous tool for recovery.
Taking medication for social anxiety doesn’t mean you’re failing or that therapy isn’t working. Quite the opposite: if your therapist suggests medication, it’s because they believe it could help you succeed in making progress through therapy. And at the end of the day, the choice is always yours, and there’s no shame in using what works for you.
Medications for Social Anxiety
There are many different specific social anxiety medications, and it is important to note that one medicine will not work the same for everyone. The professional you work with will help ensure they make the right choice for you, even if it requires some trial and error. Here are some of the common meds that are prescribed for social anxiety:
- Antidepressants: If you do decide to go forward with medication, it will most likely be an SSRI, also known as a selective serotonin reuptake inhibitor. This category of drug is classified as an antidepressant, but is very commonly used to treat anxiety disorders and other mental health conditions, such as obsessive-compulsive disorder (OCD).
- Common SSRIS include:
- Anti-anxiety medications (Benzodiazepines): These work quickly to reduce anxiety, but are usually for short-term use due to potential habit-forming properties.
- Clonazepam
- Alprazolam
- Lorazepam
- Beta blockers: These help with physical symptoms like a racing heart or shaking, and are often used for specific situations like public speaking, rather than everyday treatment.
- Atenolol
- Metoprolol tartrate
- Metoprolol succinate
Again, please remember that each medication varies in efficacy depending on the person taking it—and on the form of therapy that’s used to treat social anxiety along with medication. The medication that works for your friend may not work for you at all. Rely on your doctor and clinician to decide which medication could be right for you.
Work with a therapist who has training in ERP
Therapy for Social Anxiety: Exposure and Response Prevention (ERP)
Kilduff mentions that treating social anxiety with medication alone is not likely to be as effective as pairing it with ERP therapy, which helps you change your behaviors in order to better manage the thoughts and feelings that come with social anxiety. On the other hand, medication alone can alleviate symptoms, but it doesn’t address the key cognitive patterns that characterize social anxiety.
ERP therapy is the gold standard treatment for social anxiety disorder. “ERP helps you face your fears and give up the behaviors that reinforce your anxiety,” says Kilduff. It works by slowly and safely putting you in situations with your triggers or anxiety points. Over time, you learn how to sit in the discomfort you feel and overcome it instead of trying to find a fast way out.
“People with social anxiety often assume that things are much worse than they are, like everyone is paying attention to them and thinking bad things about them,” Kilduff says. “With ERP, we can sort of test that. Are people really paying attention? And if they are, how much does that really matter in your life? Does it affect anything or is it just uncomfortable in the moment? The goal of ERP is about getting people to be more comfortable with discomfort. And ultimately, your discomfort and anxiety will decrease as a result.”
The goal of ERP is to avoid using safety behaviors and let uncomfortable thoughts and feelings pass on their own. This helps train your brain to stop treating discomfort as an emergency. By not feeding into your anxiety, you slowly start to break the cycle. Eventually, your mind learns that those intense feelings don’t need to set off your internal alarms all the time, and your anxiety eases off over time.
“Once you face that fear in real life and realize your world isn’t going to fall apart if someone doesn’t like you, or if you embarrass yourself, it’s easier to retain that information and move forward with less social anxiety,” Kilduff explains.
The bottom line
Social anxiety can feel overwhelming, making even the simplest interactions feel like a challenge. But getting help is an important factor toward reclaiming your life and managing those anxious feelings. Whether it’s through therapy, medication, or both, working with a licensed provider is the best way to find relief and get back to living fully.