Medication Summary
No medications have been specifically tested or approved by the US Food and Drug Administration (FDA) for individuals with avoidant personality disorder. Selective serotonin reuptake inhibiters (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) have been found to be effective for social anxiety disorder. In addition, some studies have reported that benzodiazepines, monamine oxidase inhibitors (MAOIs), and the anticonvulsant gabapentin are effective in the treatment of social anxiety in adults with avoidant personality disorder.
Selective serotonin reuptake inhibitors
Class Summary
These agents initially block the presynaptic reuptake of serotonin, thereby allowing more of the neurotransmitter to be available in the synapse. Although no medications are approved by the FDA to treat avoidant personality disorder, the SSRIs paroxetine (Paxil) and sertraline (Zoloft) and the SNRI venlafaxine (Effexor) are FDA-approved to treat social anxiety disorder.
SSRIs are greatly preferred over the other classes of antidepressants. Because the adverse effect profile of SSRIs is less prominent, improved compliance is promoted. SSRIs do not have the cardiac arrhythmia risk associated with tricyclic antidepressants. Arrhythmia risk is especially pertinent in cases of overdose, and suicide risk must always be considered when treating a child or young adult with mood disorder.
Physicians are advised to be aware of the following information and use appropriate caution when considering treatment with SSRIs and SNRIs in the pediatric population.
All antidepressants now carry a black box warning regarding elevated rates of suicidal behavior (4% vs 2% on placebo) in short-term studies of children and young adults with depressive and anxiety disorders. Current recommendations include close monitoring of suicidality when starting or increasing any antidepressant. This potential risk is debated within the mental health community.
Sertraline (Zoloft)
Zoloft and other SSRI medications are considered first-line treatment for APD and social phobia. Benefits of SSRIs include relatively high tolerance, ease of administration, and relative safety in overdose.
Benzodiazepines
Class Summary
These agents bind to a specific benzodiazepine receptor on the gamma-aminobutyric acid (GABA) receptor complex, thereby increasing GABA affinity for its receptor. They also increase the frequency of chlorine channel opening in response to GABA binding. GABA receptors are chlorine channels that mediate postsynaptic inhibition, resulting in postsynaptic neuron hyperpolarization. The final result is a sedative-hypnotic and anxiolytic effect. High-potency benzodiazepines are likely to be effective in treating social phobia in adults.
Clonazepam (Klonopin)
Used clinically to treat social anxiety, although no controlled studies have been conducted in this population to document its efficacy. This medication is believed to work at the GABAa receptor in the brain, particularly the limbic areas.
