For adults with Social Anxiety Disorder who decline cognitive behavioural interventions and express a preference for medication, the first-line pharmacological treatment is a selective serotonin reuptake inhibitor (SSRI) NICE CG159. Specifically, escitalopram or sertraline should be offered NICE CG159. Before prescribing any pharmacological intervention, it is important to discuss treatment options and any concerns the person has about taking medication NICE CG159. This discussion should include the likely benefits, potential side effects, discontinuation syndromes, drug interactions, and the risk of early activation symptoms with SSRIs (such as increased anxiety or agitation) NICE CG159. Patients should also be informed that the full anxiolytic effect develops gradually over two weeks or more, and that treatment should continue after remission to prevent relapse NICE CG159.
What pharmacological treatments are considered first-line for managing Social Anxiety Disorder?
Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.
Posted: 22 August 2025Updated: 22 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX