Skip to main content
SpringerLink
Log in

Pharmacotherapy for Adolescent Social Phobia

  • Chapter
Social Anxiety and Phobia in Adolescents

  • 4642 Accesses

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • American Academy of Child and Adolescent Psychiatry (2007). Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry 46(2):267–283.

    Article  Google Scholar 

  • American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, fourth edition, text revision: DSM-IV-TR, 4th edn. American Psychiatric Pub, Washington, DC

    Book  Google Scholar 

  • American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Pub, Arlington

    Google Scholar 

  • Beidel DC, Turner SM, Morris TL (1999) Psychopathology of childhood social phobia. J Am Acad Child Adolesc Psychiatry 38(6):643–650

    Article  CAS  PubMed  Google Scholar 

  • Beidel DC, Turner SM, Sallee FR, Ammerman RT, Crosby LA, Pathak S (2007) Sertraline in children and adolescents with social anxiety disorder: an open trial. J Am Acad Child Adolesc Psychiatry 46(12):1622–1632

    Article  PubMed  Google Scholar 

  • Benjamin CL, Harrison JP, Settipani CA, Brodman DM, Kendall PC (2013) Anxiety and related outcomes in young adults 7 to 19 years after receiving treatment for child anxiety. J Consult Clin Psychol 81(5):865

    Article  PubMed  Google Scholar 

  • Birmaher B, Axelson DA, Monk K, Kalas C, Clark DB, Ehmann M et al (2003) Fluoxetine for the treatment of childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry 42(4):415–423

    Article  PubMed  Google Scholar 

  • Black B, Uhde TW (1995) Psychiatric characteristics of children with selective mutism: a pilot study. J Am Acad Child Adolesc Psychiatry 34(7):847–856

    Article  CAS  PubMed  Google Scholar 

  • Bridge JA, Iyengar S, Salary CB, Barbe RP, Birmaher B, Pincus HA et al (2007) Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA 297(15):1683–1696

    Article  CAS  PubMed  Google Scholar 

  • Burstein M, He JP, Kattan G, Albano AM, Avenevoli S, Merikangas KR (2011) Social phobia and subtypes in the National Comorbidity Survey–adolescent supplement: prevalence, correlates, and comorbidity. J Am Acad Child Adolesc Psychiatry 50(9):870–880

    Article  PubMed Central  PubMed  Google Scholar 

  • Canadian Psychiatric Association (2006) Clinical practice guidelines. Management of anxiety disorders. Can J Psychiatry 51(8 Suppl 2):9S

    Google Scholar 

  • Canton J, Scott KM, Glue P (2011) Optimal treatment of social phobia: systematic review and meta-analysis. Neuropsychiatr Dis Treat 8:203–215

    Google Scholar 

  • Chavira DA, Stein MB (2002) Combined psychoeducation and treatment with selective serotonin reuptake inhibitors for youth with generalized social anxiety disorder. J Child Adolesc Psychopharmacol 12(1):47–54

    Article  PubMed  Google Scholar 

  • Chavira DA, Stein MB, Bailey K, Stein MT (2004) Child anxiety in primary care: prevalent but untreated. Depress Anxiety 20(4):155–164

    Article  PubMed  Google Scholar 

  • Clark DB, Birmaher B, Axelson D, Monk K, Kalas C, Ehmann M et al (2005) Fluoxetine for the treatment of childhood anxiety disorders: open-label, long-term extension to a controlled trial. J Am Acad Child Adolesc Psychiatry 44(12):1263–1270

    Article  PubMed  Google Scholar 

  • Compton SN, Grant PJ, Chrisman AK, Gammon PJ, Brown VL, March JS (2001) Sertraline in children and adolescents with social anxiety disorder: an open trial. J Am Acad Child Adolesc Psychiatry 40(5):564–571

    Article  CAS  PubMed  Google Scholar 

  • Connolly SD, Suarez L, Sylvester C (2011) Assessment and treatment of anxiety disorders in children and adolescents. Curr Psychiatry Rep 13(2):99–110

    Article  PubMed  Google Scholar 

  • Coyle JT (2001) Fluvoxamine for the treatment of anxiety disorders in children and adolescents. N Engl J Med 344(17):1326–1327

    Article  CAS  PubMed  Google Scholar 

  • Crawley SA, Beidas RS, Benjamin CL, Martin E, Kendall PC (2008) Treating socially phobic youth with CBT: differential outcomes and treatment considerations. Behav Cogn Psychother 36(4):379–389

    Article  Google Scholar 

  • da Costa CZG, de Morais RMCB, Zanetta DMT, Turkiewicz G, Neto FL, Morikawa M et al (2013) Comparison among clomipramine, fluoxetine, and placebo for the treatment of anxiety disorders in children and adolescents. J Child Adolesc Psychopharmacol 23(10):687–692

    Article  PubMed Central  PubMed  Google Scholar 

  • Food and Drug Administration, U.S. (2004) Suicidality in children and adolescents being treated with antidepressant medications. Available at: http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/drugsafetyinformationforheathcareprofessionals/publichealthadvisories/ucm161679.htm. Accessed 13 June 2014

  • Fairbanks JM, Pine DS, Tancer NK, Dummit ES III, Kentgen LM, Martin J et al (1997) Open fluoxetine treatment of mixed anxiety disorders in children and adolescents. J Child Adolesc Psychopharmacol 7(1):17–29

    Article  CAS  PubMed  Google Scholar 

  • Fedoroff IC, Taylor S (2001) Psychological and pharmacological treatments of social phobia: a meta-analysis. J Clin Psychopharmacol 21(3):311–324

    Article  CAS  PubMed  Google Scholar 

  • Franklin ME, Sapyta J, Freeman JB, Khanna M, Compton S, Almirall D et al (2011) Cognitive behavior therapy augmentation of pharmacotherapy in pediatric obsessive-compulsive disorder: the Pediatric OCD Treatment Study II (POTS II) randomized controlled trial. JAMA 306(11):1224–1232

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Geller DA, Hoog SL, Heiligenstein JH, Ricardi RK, Tamura R, Kluszynski S et al (2001) Fluoxetine treatment for obsessive-compulsive disorder in children and adolescents: a placebo-controlled clinical trial. J Am Acad Child Adolesc Psychiatry 40(7):773–779

    Article  CAS  PubMed  Google Scholar 

  • Geller DA, Wagner KD, Emslie G, Murphy T, Carpenter DJ, Wetherhold E et al (2004) Paroxetine treatment in children and adolescents with obsessive compulsive disorder: a randomized, multicenter, double-blind, placebo-controlled trial. J Am Acad Child Adolesc Psychiatry 43(11):1387–1396

    Article  PubMed  Google Scholar 

  • Gibbons RD, Brown CH, Hur K, Marcus SM, Bhaumik VK, Erkens JA (2007) Early evidence on the effects of regulators’ suicidality warnings on SSRI prescriptions and suicide in children and adolescents. Am J Psychiatry 164:1356–1363

    Article  PubMed  Google Scholar 

  • Ginsburg GS, Kendall PC, Sakolsky D, Compton SN, Piacentini J, Albano AM et al (2011) Remission after acute treatment in children and adolescents with anxiety disorders: findings from the CAMS. J Consult Clin Psychol 79(6):806–813

    Article  PubMed Central  PubMed  Google Scholar 

  • Gleason M, Egger HL, Emslie GJ, Greenhill LL, Kowatch RA, Lieberman AF et al (2007) Psychopharmacological treatment for very young children: contexts and guidelines. J Am Acad Child Adolesc Psychiatry 46(12):1532–1572

    Article  PubMed  Google Scholar 

  • Hamilton BE, Minino AM, Martin JA, Kochanek KD, Strobino DM, Guyer B (2007) Annual summary of vital statistics: 2005. Pediatrics 119:345–360

    Article  PubMed  Google Scholar 

  • Hammad TA, Laughren T, Racoosin J (2006) Suicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry 63(3):332–339

    Article  CAS  PubMed  Google Scholar 

  • Haug TT, Blomhoff S, Hellstrøm K, Holme I, Humble M, Madsbu HP et al (2003) Exposure therapy and sertraline in social phobia: 1-year follow-up of a randomised controlled trial. Br J Psychiatry 182(4):312–318

    Article  PubMed  Google Scholar 

  • Hedges DW, Brown BL, Shwalb DA, Godfrey K, Larcher AM (2007) The efficacy of selective serotonin reuptake inhibitors in adult social anxiety disorder: a meta-analysis of double-blind, placebo-controlled trials. J Psychopharmacol 21(1):102–111

    Article  CAS  PubMed  Google Scholar 

  • Henry A, Kisicki MD, Varley C (2012) Efficacy and safety of antidepressant drug treatment in children and adolescents. Mol Psychiatry 17(12):1186–1193

    Article  CAS  PubMed  Google Scholar 

  • Huang X, Li C, Li WH, Luo YL, Wang B, Zhang W et al (2013) Clinical evaluation of the efficacy and safety of tandospirone versus sertraline monotherapy for social anxiety disorder: a randomized open label trial. Hum Psychopharmacol 28(6):594–599

    Article  CAS  PubMed  Google Scholar 

  • Isacsson G, Rich CL (2014) Antidepressant drugs and the risk of suicide in children and adolescents. Pediatr Drugs 16(2):115–122

    Article  Google Scholar 

  • Isacsson G, Holmgren P, Ahlner J (2005) Selective serotonin reuptake inhibitor antidepressants and the risk of suicide: a controlled forensic database study of 14 857 suicides. Acta Psychiatr Scand 111(4):286–290

    Article  CAS  PubMed  Google Scholar 

  • Isolan L, Pheula G, Salum GA Jr, Oswald S, Rohde LA, Manfro GG (2007) An open-label trial of escitalopram in children and adolescents with social anxiety disorder. J Child Adolesc Psychopharmacol 17(6):751–760

    Article  PubMed  Google Scholar 

  • Katz LY, Kozyrskyj AL, Prior HJ, Enns MW, Cox BJ, Sareen J (2008) Effect of regulatory warnings on antidepressant prescription rates, use of health services and outcomes among children, adolescents and young adults. CMAJ 178(8):1005–1011

    Article  PubMed Central  PubMed  Google Scholar 

  • Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):593–602

    Article  PubMed  Google Scholar 

  • Kristensen H (2000) Selective mutism and comorbidity with developmental disorder/delay, anxiety disorder, and elimination disorder. J Am Acad Child Adolesc Psychiatry 39(2):249–256

    Article  CAS  PubMed  Google Scholar 

  • Leonard HL, Swedo SE, Rapoport JL, Koby EV, Lenane MC, Cheslow DL et al (1989) Treatment of obsessive compulsive disorder with clomipramine and desipramine in children and adolescents. A double-blind crossover comparison. Arch Gen Psychiatry 46(12):1088

    Article  CAS  PubMed  Google Scholar 

  • Leonard HL, Swedo SE, Lenane MC, Rettew DC, Cheslow DL, Hamburger SD et al (1991) A double-blind desipramine substitution during long-term clomipramine treatment in children and adolescents with obsessive-compulsive disorder. Arch Gen Psychiatry 48(10):922–927

    Article  CAS  PubMed  Google Scholar 

  • Liebowitz MR, Heimberg RG, Schneier FR, Hope DA, Davies S, Holt CS et al (1999) Cognitive-behavioral group therapy versus phenelzine in social phobia: long term outcome. Depress Anxiety 10(3):89–98

    Article  CAS  PubMed  Google Scholar 

  • Manassis K, Fung D, Tannock R, Sloman L, Fiksenbaum L, McInnes A (2003) Characterizing selective mutism: is it more than social anxiety? Depress Anxiety 18(3):153–161

    Article  PubMed  Google Scholar 

  • Mancini C, Van Ameringen M, Oakman JM, Farvolden P (1999) Serotonergic agents in the treatment of social phobia in children and adolescents: a case series. Depress Anxiety 10(1):33–39

    Article  CAS  PubMed  Google Scholar 

  • Mancini C, Van Ameringen M, Bennett M, Patterson B, Watson C (2005) Emerging treatments for child and adolescent social phobia: a review. J Child Adolesc Psychopharmacol 15(4):589–607

    Article  PubMed  Google Scholar 

  • March JS, Biederman J, Wolkow R, Safferman A, Mardekian J, Cook EH et al (1998) Sertraline in children and adolescents with obsessive-compulsive disorder: a multicenter randomized controlled trial. JAMA 280(20):1752

    Article  CAS  PubMed  Google Scholar 

  • March JS, Entusah AR, Rynn M, Albano AM, Tourian KA (2007) A randomized controlled trial of venlafaxine ER versus placebo in pediatric social anxiety disorder. Biol Psychiatry 62(10):1149–1154

    Article  CAS  PubMed  Google Scholar 

  • Masi G, Pfanner C, Mucci M, Berloffa S, MagazĂą A, Parolin G et al (2012) Pediatric social anxiety disorder: predictors of response to pharmacological treatment. J Child Adolesc Psychopharmacol 22(6):410–414

    Article  CAS  PubMed  Google Scholar 

  • Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L et al (2010) Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Study-Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 49(10):980–989

    Article  PubMed Central  PubMed  Google Scholar 

  • Mohatt J, Bennett SM, Walkup JT (2014) Treatment of separation, generalized, and social anxiety disorders in youths. Am J Psychiatry 171(7):741–748

    Article  PubMed  Google Scholar 

  • Mrakotsky C, Masek B, Biederman J, Raches D, Hsin O, Forbes P et al (2008) Prospective open-label pilot trial of mirtazapine in children and adolescents with social phobia. J Anxiety Disord 22(1):88–89

    Article  PubMed  Google Scholar 

  • Murphy TK, Segarra A, Storch EA, Goodman WK (2008) SSRI adverse events: how to monitor and manage. Int Rev Psychiatry 20(2):203–208

    Article  PubMed  Google Scholar 

  • National Institute for Health and Care Excellence (2013) Social anxiety disorder: recognition, assessment and treatment of social anxiety disorder. Clinical guideline 159. http://guidance.nice.org.uk/CG159

  • Piacentini J, Bennett S, Compton SN, Kendall PC, Birmaher B, Albano AM et al (2014) 24-and 36-week outcomes for the child/adolescent anxiety multimodal study (CAMS). J Am Acad Child Adolesc Psychiatry 53(3):297–310

    Article  PubMed Central  PubMed  Google Scholar 

  • Reich J (2009) Avoidant personality disorder and its relationship to social phobia. Curr Psychiatry Rep 11(1):89–93

    Article  PubMed  Google Scholar 

  • Reinblatt SP, Riddle MA (2007) The pharmacological management of childhood anxiety disorders: a review. Psychopharmacology (Berl) 191(1):67–86

    Article  CAS  Google Scholar 

  • Research Units on Pediatric Psychopharmacology Anxiety Study Group (2001) Fluvoxamine for the treatment of anxiety disorders in children and adolescents. N Engl J Med 344(17):1279–1285

    Article  Google Scholar 

  • Research Units on Pediatric Psychopharmacology Anxiety Study Group (2002) Treatment of pediatric anxiety disorders: an open-label extension of the research units on pediatric psychopharmacology anxiety study. J Child Adolesc Psychopharmacol 12(3):175–188

    Article  Google Scholar 

  • Reynold S, Wilson, Austin J, Hooper L (2012) Effects of psychotherapy for anxiety in children and adolescents: a meta-analytic review. Clin Psychol Rev., 32:251–262

    Google Scholar 

  • Riddle MA, Scahill L, King RA, Hardin MT, Anderson GM, Ort SI et al (1992) Double-blind, crossover trial of fluoxetine and placebo in children and adolescents with obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry 32(6):1062–1069

    Article  Google Scholar 

  • Riddle MA, Reeve EA, Yaryura-Tobias JA, Yang HM, Claghorn JL, Gaffney G et al (2001) Fluvoxamine for children and adolescents with obsessive-compulsive disorder: a randomized, controlled, multicenter trial. J Am Acad Child Adolesc Psychiatry 40(2):222–229

    Article  CAS  PubMed  Google Scholar 

  • Stein MB, Stein DJ (2008) Social anxiety disorder. Lancet 371(9617):1115–1125

    Article  PubMed  Google Scholar 

  • Stein MB, Chavira DA, Jang KL (2001) Bringing up bashful baby. Psychiatr Clin North Am 24(4):661–675

    Article  CAS  PubMed  Google Scholar 

  • Stein DJ, Ipser JC, Balkom AJ (2004) Pharmacotherapy for social phobia. Cochrane Database Syst Rev (4):CD001206

    Google Scholar 

  • Strawn JR, Sakolsky DJ, Rynn MA (2012) Psychopharmacologic treatment of children and adolescents with anxiety disorders. Child Adolesc Psychiatr Clin N Am 21(3):527–539

    Article  PubMed  Google Scholar 

  • Van der Linden GJ, Stein DJ, Van Balkom AJ (2000) The efficacy of the selective serotonin reuptake inhibitors for social anxiety disorder (social phobia): A meta-analysis of randomized controlled trials. Int Clin Psychopharmacol 15(2):15–23

    Article  Google Scholar 

  • Wagner KD, Berard R, Stein MB, Wetherhold E, Carpenter DJ, Perera P et al (2004) A multicenter, randomized, double-blind, placebo-controlled trial of paroxetine in children and adolescents with social anxiety disorder. Arch Gen Psychiatry 61(11):1153–1162

    Article  CAS  PubMed  Google Scholar 

  • Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT, Kendall PC (2008) Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med 359(26):2753–2766

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Wergeland GJH, Fjermestad KW, Marin CE, Haugland BSM, Bjaastad JF, Oeding K et al (2014) An effectiveness study of individual vs. group cognitive behavioral therapy for anxiety disorders in youth. Behav Res Ther 57:1–12

    Article  PubMed  Google Scholar 

  • Whittington CJ, Kendall T, Fonagy P, Cottrell D, Cotgrove A, Boddington E (2004) Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data. Lancet 343(9418):1341–1345

    Article  Google Scholar 

  • Yeganeh R, Beidel DC, Turner SM, Pina AA, Silverman WK (2003) Clinical distinctions between selective mutism and social phobia: an investigation of childhood psychopathology. J Am Acad Child Adolesc Psychiatry 42(9):1069–1075

    Article  PubMed  Google Scholar 

  • Yeganeh R, Beidel DC, Turner SM (2006) Selective mutism: more than social anxiety? Depress Anxiety 23(3):117–123

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioural Neurosciences, McMaster University, MacAnxiety Research Centre, 1057 Main Street West, Hamilton, L8S 1B7, ON, Canada

    Michael Van Ameringen MD, FRCPC, Jasmine Turna BSc, Beth Patterson MSc, BEd & Chloe Lau

Authors
  1. Michael Van Ameringen MD, FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jasmine Turna BSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Beth Patterson MSc, BEd
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chloe Lau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael Van Ameringen MD, FRCPC .

Editor information

Editors and Affiliations

  1. Dept of Adolescent Psychiatry, Helsinki University Central Hospital, Helsinki, Finland

    Klaus Ranta

  2. University of Miami, Coral Gables, Florida, USA

    Annette M La Greca

  3. Department of Psychology, University of Jaen, Jaen, Spain

    Luis-Joaquin Garcia-Lopez

  4. Department of Mental Health and Substance Abuse, National Institute for Health and Welfare, Helsinki, Finland

    Mauri Marttunen

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Van Ameringen, M., Turna, J., Patterson, B., Lau, C. (2015). Pharmacotherapy for Adolescent Social Phobia. In: Ranta, K., La Greca, A., Garcia-Lopez, LJ., Marttunen, M. (eds) Social Anxiety and Phobia in Adolescents. Springer, Cham. https://doi.org/10.1007/978-3-319-16703-9_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-16703-9_14

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-16702-2

  • Online ISBN: 978-3-319-16703-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation