Treatments for social anxiety and panic attacks

Hi Alice,

I was wondering what types of SSRIs would work best for social anxiety and panic attacks so I can discuss with my general practitioner? I know different ones work better than others for this problem, but I'm not sure. I don't find that my current medication helps much. Thanks so much!

Dear Reader,

First off, you aren’t alone — millions of people live with anxiety disorders, which can include panic attacks and social anxiety. Thankfully, there are a number of different treatments that can be effective in treating these conditions, including the use of medications. Before beginning any sort of new regimen, it's a good idea to talk with a mental health professional who can help you identify what you’re experiencing and determine what sort of treatment might work best for you (more on that later).

Before getting into treatments, it can be helpful to understand more about these conditions. Generally, a panic attack is a sudden feeling of overwhelming fear that has no clear cause and immediately leads to intense physical reactions. There are a variety of symptoms associated with panic attacks — rapid heartbeat, shortness of breath, sweating, and trembling, to name a few. As far as treatments are concerned, psychotherapy, medicine, or a combination of the two is commonly recommended. Social anxiety disorder (or social phobia) is an intense anxiety or fear associated with social situations. Some common symptoms of social anxiety include physical sensations such as blushing or trembling when in social situations, or constantly worrying about embarrassing yourself in front of others. People with social anxiety tend to avoid common social situations such as going to parties or other social gatherings, dating, or even going to school or work. Similar to panic attacks, social anxiety can be treated with medication, psychotherapy, or a mix of both.

You referred to selective serotonin reuptake inhibitors (SSRIs), which are the most common class of medications used to treat anxiety disorders. SSRIs prevent the absorption of serotonin, a chemical in the brain that facilitates communication between the brain cells. Serotonin has also been shown to help boost a person’s mood, so an increase of available serotonin can often lessen anxiety and depression. There are many different types of SSRIs — a psychiatrist or other mental health professional can help you find the right fit if that's the route you choose. It’s difficult to say whether one medication will work better than another because every person reacts differently to medication. Two types of SSRIs are typically used to treat panic disorders — sertraline and fluoxetine. There are a few key distinctions between these two drugs. Sertraline is approved by the Food and Drug Administration (FDA) to treat social anxiety disorders, unlike fluoxetine. Both sertraline and fluoxetine take about two to six weeks to reach their full effectiveness, but they’re both equally effective in reducing anxiety for approximately the same cost. Common side effects of these drugs include insomnia, dizziness, rashes, and weight changes. However, fluoxetine is more likely to be associated with headaches, while sertraline may cause stomach issues and sexual side effects. If you’re taking antidepressants such as lithium, it’s recommended that you avoid taking sertraline or fluoxetine to avoid having too much serotonin in your body. A psychiatrist or other mental health professional can help you find the right fit if that's the route you choose. It’s difficult to say whether one medication will work better than another because every person reacts differently to medication.

Keep in mind that medication is just one type of treatment. If you’re seeing a health care provider, you may want to ask for a referral to a mental health professional who specializes in anxiety disorders. They might suggest cognitive behavioral therapy (CBT), which typically lasts 5 to 20 sessions, as a treatment option. CBT is a type of psychotherapy that can help patients cope with fears in a way that can also help reduce anxiety. In CBT, a mental health professional helps patients re-imagine a fearful situation and the physical symptoms that are associated with it. You may also be given homework assignments to practice coping mechanisms discussed during sessions. CBT isn’t the only type of psychotherapy available to those with anxiety disorders. Some psychotherapies that may be helpful in addressing panic attacks and social anxiety include:

  • Dialectical behavioral therapy (DBT): DBT offers ways to manage behaviors to regulate stress and relationships with others, a helpful technique in stressful social situations.
  • Acceptance and commitment therapy: This type of therapy acknowledges that feelings of anxiety exist, rather than trying to avoid them, increasing the ability to cope with stressful situations.
  • Supportive psychotherapy: This treatment affirms your ability to cope with stressful situations, empowering you to cope with panic attacks or intense anxiety.

Whatever treatment you and your health care provider decide on, remember that managing anxiety is a process, but with support, it may be achievable. It may be helpful to think about what is and isn't working with your current treatment and then use that to inform your conversations. If you feel that you aren't getting what you need, you may consider looking into other providers that may be able to provide a second opinion. Asking yourself some of these questions may help inform your next actions: How long have you been taking the medication you're currently taking? Are you taking it as prescribed? Are the side effects intolerable or disruptive to your day-to-day life? If so, what are they and for how long have you experienced them? Are you on any other medications or have any other conditions that may impact the way the medication works for you? The answers to these questions may help you figure out your next path forward. 

Best of luck,

Last updated Feb 05, 2021
Originally published Mar 07, 2014