For many adults, social anxiety disorder shapes daily life in quiet but damaging ways, affecting work, relationships, and even routine social interactions. Fear of judgement, embarrassment, or negative evaluation can become so persistent that people avoid situations essential to their well-being and livelihoods. The findings were published in Expert Review of Neurotherapeutics.
New research reviewing the past decade of clinical trials suggests that medication remains an important option for adults with social anxiety disorder, especially when talking therapies are unavailable or difficult to access. The findings reinforce the idea that treatment works best when tailored to individual needs rather than relying on a single standard approach.
The review examined randomised controlled trials published since 2015, focusing on pharmacological treatments for adults diagnosed with social anxiety disorder. Eighteen trials met strict criteria, offering an up to date snapshot of how medications perform both alone and alongside psychological therapies.
Across the studies, selective serotonin reuptake inhibitors emerged as the most consistently supported option. These drugs were tested more often than any other treatment and generally showed clear reductions in social anxiety symptoms compared with placebo or no treatment. However, response rates varied widely, with some individuals improving substantially while others saw limited benefit.
The review highlights that medication is rarely a simple solution. Side effects such as nausea, fatigue, and sleep disturbance were common in several trials, and in some cases benefits faded over longer follow up periods. This reinforces concerns often raised by patients about tolerability and long term effectiveness.
Researchers also explored newer or less conventional options. Substances such as cannabidiol, ketamine, and neurosteroids were tested in small trials, sometimes showing short term improvements in anxiety during specific situations like public speaking. However, these effects were inconsistent, and evidence remains limited compared with established antidepressants.
Combining medication with psychological therapy was another major focus. Several studies examined whether adding medication to cognitive behavioural therapy improved outcomes. Results were mixed, with some showing modest short term gains while others found little difference compared with therapy alone. In many cases, any added benefit did not persist over time.
A key message from the review is the importance of personalisation. Social anxiety disorder is not a uniform condition, and factors such as symptom severity, previous treatment response, access to therapy, and patient preference all appear to influence outcomes. The authors argue that clinicians should move away from one size fits all prescribing and instead work collaboratively with patients to choose the most suitable option.
The findings also have implications for access to care. Waiting lists for psychological therapy remain long in many countries, including the UK. In such cases, medication may offer a practical alternative or a starting point for people who might otherwise receive no treatment at all.
The research suggests that medication continues to play a valuable role in treating social anxiety disorder, but only when used thoughtfully. Future studies are expected to focus on identifying who benefits most from specific drugs and how treatments can be better matched to individual profiles.