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 so
cial phobia. Serotonin may be a common denominator between the blushin
g 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 ser
otonin selective reuptake inhibitors (SSRIs), clonazepam (a benzodiaze
pine that potentiates serotonin function and synthesis), monoamine oxi
dase inhibitors (MAOIs) (which block the oxidative deamination of sero
tonin), and beta-adrenoceptor blockers (which control the synthesis of
melatonin from serotonin). A variety of beta-blockers, some acting ce
ntrally and some peripherally, have been effective in the treatment of
performance anxiety, a specific form of social phobia.