Pharmacotherapy for Adolescent Social Phobia

Social anxiety disorder (SAD) is an anxiety disorder characterized by excessive fear of exposure to situations that involve potential scrutiny by others. This disorder is one of the most common psychiatric conditions in children and adolescents and often presents with comorbid anxiety and mood disorders. Although the onset of SAD is typically in late childhood or early adolescence, most afflicted individuals go undiagnosed for years, not seeking treatment until adulthood. Evidence-based first-line treatment of SAD in adults includes the use of both pharmacotherapy and cognitive–behavioral therapy. There is emerging data in adolescents with SAD which supports the use of similar treatments in this population. This chapter will review the epidemiology, clinical characteristics, diagnosis and comorbid disorders including selective mutism and avoidant personality disorder, as well as the pharmacological treatment of SAD in youth. Randomized controlled trials examining selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, as well as other antidepressants in youth with SAD will be reviewed. Issues related to safety and tolerability of these agents and risk of suicide will be discussed. Response and long-term efficacy of pharmacotherapy as well as practical guidelines for clinicians who treat children and adolescents are also presented.