Psychopharmacology

An Experimental Medication to Treat Social Anxiety Disorder

Why is this medication administered as a nasal spray?

Posted Oct 03, 2014

Many people don’t enjoy giving talks in front of an audience. Many don’t enjoy interacting with new people at social events. When a person’s anxiety is sufficiently severe that it leads to avoidant behaviors that are harmful to career or relationships, this person may be suffering from social anxiety disorder

There are treatments that can help. Various forms of psychotherapy can decrease symptoms. Certain antidepressant medications can also be effective, but only if taken chronically. There are a few medications that can help diminish acute anxiety, but they can have significant side effects and may only be partially effective. Benzodiazepines (Valium-type drugs) dampen anxiety acutely, but they can result in grogginess, cognitive impairment, and longer-term problems with drug dependence. 

A recent report by Michael Liebowitz and colleagues in the American Journal of Psychiatry describes the effects of an experimental medication for social anxiety disorder that is administered as a nasal spray. These investigators tested this new medication in a group of 90 women with social anxiety disorder under two scenarios: (1) a situation in which the study participant was asked to rapidly prepare and deliver a speech in front of 3 strangers and (2) a situation where the participant had to interact with people that she didn’t know. Stress was measured with a self-report questionnaire and recorded every minute before and during the stressor. Stress levels measured in these situations after treatment with active medication were compared to those experienced after treatment with a placebo nose spray. 

The active medication was effective at diminishing stress levels during both stressful situations. The investigators reported that 75% of those receiving the active drug noted substantial improvement versus 37% of those receiving placebo. Improvement occurred for both public speaking and social interactions. Improvement was noted just prior to the test events as well as during the test events.

This experimental medication was effective within minutes after administration and appeared to have few side effects. The number of persons who have tried this investigational drug is small, and information regarding its safety, as well as information about how long the effects last and the effects of repeated dosing, requires a much larger trial.

The investigational drug is a synthetic steroid that appears to work by stimulating a type of cell found in the nose (called vomeronasal receptor cells). Once stimulated, these “chemosensory” cells influence limbic regions of the brain involved in regulating emotional responses. In some animals, vomeronasal cells are stimulated by chemicals called pheromones and by certain neuroactive steroids made in the body and brain. Pheromones are chemicals that influence social behavior. The roles, if any, of pheromones in human interactions are controversial, although humans clearly have nasal chemosensory neurons and have social responses to odors (i.e., perfumes). 

It should be noted that several authors of this paper have financial relationships with the company that is developing and testing this drug. These investigators state that “the findings will need to be replicated to be considered established.” We agree that replication is essential. If these findings are reproduced by other investigators in carefully designed studies, such results would suggest the effectiveness of a new category of medications that influence the brain by regulating the activity of specific cells in the nose and, in turn, modulating acute emotional reactions.

This column was written by Eugene Rubin MD, PhD and Charles Zorumski MD.