Treatment of social phobia with clonidine

The essential feature of social phobia is a persistent fear and compelling avoidance of situations in which the individual may be exposed to the scrutiny of others. The patients suffering from this disorder are usually fearful that others will detect signs of anxiety in their appearance or behavior in the fear-inducing situations. A vicious cycle may be created in which the fear generates anxiety, impairing performance, thus providing an apparent justification for avoiding the phobic situations (APA 1980). There are only a small number of controlled studies of pharmacological treatment for social phobia. They suggest that antidepressants of the monoamine-inhibitor class and padrenergic receptor blockers may be effective for social phobia (Liebowitz et al. 1985). This article describes a young man who presented with severe incapacitating social phobia, precipitated and perpetuated by his tendency to blush. He did not respond to treatment with alprazolam, phenelzine, or propranolol, which had been administered successively. He responded remarkably well, however, to treatment with clonidine hydrochloride, an cr-adrenergic agonist. The possible theoretical and practical implications are discussed.