Phobia Medication: Treating Specific Phobias With Medication

Phobias are intense, irrational fears of specific objects or situations. While cognitive-behavioral therapy (CBT) is typically the first-line treatment, phobia medication is sometimes used in conjunction with therapy.

Medication is more commonly used for social phobia and agoraphobia than for specific phobias.

People with social phobia, also known as social anxiety disorder, experience intense self-consciousness and tend to avoid social interactions.

People with agoraphobia fear places or situations where they may feel trapped, alone, or helpless.

Specific phobia is a fear of a specific object or situation (e.g., fear of dogs or thunder).

All phobias are forms of anxiety disorders, so most medications used to treat them target anxiety.

FDA-Approved Medications

No medications are currently approved by the U.S. Food and Drug Administration (FDA) to treat specific phobias. While medications are generally not prescribed for this condition, they may be used to treat co-occurring conditions, such as anxiety or depression.

Antidepressants (SSRIs) for Social Phobia

Selective serotonin reuptake inhibitors (SSRIs) are a group of antidepressants that are effective in treating anxiety, social phobia, and agoraphobia. They work by altering serotonin levels in the brain, which plays a role in regulating mood.

Examples of SSRIs that a physician may prescribe for social anxiety disorder include:

• Celexa (citalopram)
• Paxil (paroxetine)
• Lexapro (escitalopram oxalate)
• Zoloft (sertraline)
• Prozac (fluoxetine)

Possible side effects of SSRIs include:

• Headaches
• Nausea
• Sleep problems

MAOIs for Social Phobia

Monoamine oxidase inhibitors (MAOIs) may be prescribed for social phobia, although they are often considered a second-tier treatment. They inhibit the enzyme monoamine oxidase, which breaks down certain neurotransmitters in the brain.

Commonly prescribed MAOIs include:

• Nardil (phenelzine)
• Manerix (moclobemide)
• Parnate (tranylcypromine)

Possible side effects of MAOIs include:

• Agitation
• Dizziness
• Stomach problems

It is important to note that MAOIs should not be taken within 14 days of taking other antidepressants, such as SSRIs, SNRIs, or tricyclics, as this combination can lead to serotonin syndrome.

Benzodiazepines for Social Phobia

Benzodiazepines are mild tranquilizers that can be effective against phobias by reducing associated anxiety. They are typically prescribed short-term at the lowest possible dosage.

Commonly prescribed benzodiazepines include:

• Valium (diazepam)
• Xanax (alprazolam)
• Klonopin (clonazepam)
• Ativan (lorazepam)

Side effects of low doses include:

• Impaired memory
• Depression
• Drowsiness
• Feeling hungover the next day

Benzodiazepines can cause physical dependence, especially if taken at high doses for long periods. Abruptly stopping these medications can also lead to withdrawal symptoms, which can be potentially dangerous. Therefore, it is crucial to consult a doctor before stopping benzodiazepines. Gradually tapering the dosage can minimize the risk of withdrawal complications.

Beta-Blockers for Short-Term Relief

Beta-blockers work by suppressing the effects of epinephrine (adrenaline) in the body. They also block associated physical effects of high adrenaline, such as sweating and heart palpitations. A commonly prescribed beta-blocker is Inderal (propranolol).

Some beta-blockers can provide short-term phobia relief by slowing the heart rate and decreasing blood pressure. They may be useful for individuals with social phobia who need to give a speech or perform in front of an audience.

Possible side effects of beta-blockers include:

• Cold fingers
• Sleep problems and fatigue
• Stomach problems

Beta-blockers also lower heart rate and blood pressure. Therefore, they should not be taken by individuals with certain types of heart arrhythmias, low blood pressure, slow heart rate, hypoglycemia, or moderate to severe asthma.

Other Phobia Medications

Other medications that have been studied for the treatment of social phobia include:

• Antiepileptic drugs: gabapentin, Lyrica (pregabalin), Keppra (levetiracetam)
• Tricyclic antidepressants: Tofranil (imipramine) and Anafranil (clomipramine)

Discontinuing Phobia Medication

Consulting with a physician is necessary before decreasing the dosage or stopping phobia medication. Abruptly stopping certain medications can lead to unexpected emotional and physical side effects.

There are various reasons why people might choose to stop taking medication. Phobia medications, like other medications, can be expensive. Additionally, some people may not like how certain drugs make them feel.

The risks of discontinuation vary depending on the type of medication being taken. Therefore, it is essential to consult a doctor before making any changes to the medication regimen.

Interactions and Warnings

To ensure safety and maintain good health, it is important to inform the physician of any other prescription or over-the-counter medications, as well as any health supplements being taken. If multiple doctors are involved, keeping each one up to date is crucial.

Some phobia medications may interact with other medications, supplements, or substances, potentially leading to unpleasant or dangerous side effects and impacting the effectiveness of the medication.

It is important to read all medication inserts carefully and contact a doctor or pharmacist with any questions or concerns.