Social phobia: everyone's disorder?

Several findings suggest that serotonin dysfunction may play at least a partial role in the etiology of social phobia. The cortisol response to fenfluramine, a serotonin agonist, is enhanced in patients with social phobia. Serotonin may be a common denominator between the blushing commonly seen in social phobics and the cutaneous flushing occurring in patients with carcinoid syndrome, although this is unlikely. Drugs that have demonstrated effectiveness in social phobia include the serotonin selective reuptake inhibitors (SSRIs), clonazepam (a benzodiazepine that potentiates serotonin function and synthesis), monoamine oxidase inhibitors (MAOIs) (which block the oxidative deamination of serotonin), and beta-adrenoceptor blockers (which control the synthesis of melatonin from serotonin). A variety of beta-blockers, some acting centrally and some peripherally, have been effective in the treatment of performance anxiety, a specific form of social phobia.