Based on the 2023 National Health and Wellness Survey, social anxiety disorder affects approximately 30 million American adults, with onset typically in the mid-teens or earlier, and is diagnosed slightly more frequently in females than males. Social anxiety disorder can be viewed as a series of acute, socially stressful events in which patients exhibit excessive fear of embarrassment, humiliation, scrutiny, evaluation, or rejection by others¹. The avoidance, fear, or anxious anticipation of these situations interferes significantly with the person’s daily routine, having a marked impact on occupational functioning and social life. In the absence of social or performance events, generally, individuals with social anxiety disorder are asymptomatic. Onset typically occurs in the mid-teens or earlier and is diagnosed slightly more frequently in females than males. Without treatment, social anxiety disorder can last for many years or a lifetime and lead to avoidance and opportunity costs that can significantly impact a person's employment, social activities, and relationships, and be very disruptive to overall quality of life.

Social anxiety disorder typically does not resolve naturally, oftentimes leading to alcohol use disorder and major depressive disorder as sequalae². A key psychotherapy mechanism by which individuals with social anxiety disorder overcome this condition, or lessen their symptoms, is believed to be by exposing themselves to feared or avoided situations. This is the basis of cognitive-behavioral therapy (CBT) for social anxiety disorder³. However, it is difficult for most individuals with social anxiety disorder to even consider entering stressful, anxiety-provoking social situations, preventing initiation and gradual increase in exposure to stress, which is necessary for successful CBT.

There is a small number of chronic oral antidepressant drugs (ADs) approved by the FDA specifically for treatment of social anxiety disorder. These FDA-approved chronic oral ADs have slow onset of effect (often many weeks or months) and significant side effects that may make them inadequate or inappropriate treatment alternatives for many individuals affected by acute social anxiety disorder episodes.

While not FDA-approved for treatment of social anxiety disorder, benzodiazepines, often referred to as “benzos,” and beta blockers are prescribed on an off-label basis by psychiatrists and other physicians to individuals with social anxiety disorder. Benzodiazepines have a rapid-onset effect by potentiating GABA-A and slowing the nervous system to induce a calming effect that can last up to twelve hours. However, the safety concerns, including risk of abuse and misuse, and side effects of benzodiazepines, many of which are similar to the side effects of alcohol, also can appear rapidly. Due to the risk profile of benzodiazepines, in September 2020 the FDA issued an update to its 2016 Drug Safety Communication requiring that benzodiazepines display a “black box” label on bottles to warn against their potential for dangerous interactions with opioids, as well as potential risk of abuse, misuse, overuse, and addiction.

_{1 Liebowitz, Gorman, Fyer, & Klein, 1985}

_{2 Oliveira LM, 2018}

_{3 Juster & Heimberg, 1995}