The most appropriate pharmacologic treatment for this patient with social anxiety disorder is a selective serotonin reuptake inhibitor (SSRI), such as sertraline. Social anxiety disorder is characterized by severe, persistent anxiety or fear of social or performance situations (public speaking, meeting unfamiliar people) lasting at least 6 months. In these situations, affected patients experience anxiety and physical symptoms such as palpitations, dyspnea, and flushing. Patients recognize their anxiety is excessive but nonetheless avoid trigger situations (or endure them with extreme anxiety), resulting in impairments at home, work, and other settings. SSRIs and the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine are first-line therapy for social anxiety disorder. In addition, cognitive-behavioral therapy (CBT) is very effective for social anxiety disorder.

Limited evidence suggests that benzodiazepines, such as clonazepam and diazepam, may be useful in patients with social anxiety disorder and are commonly used in patients with social anxiety disorder who cannot tolerate or do not adequately respond to SSRIs or SNRIs. However, benzodiazepines are not first-line drugs for social anxiety disorder because of their side effects, including potential for dependency and withdrawal syndrome and potential for impairment when mental clarity is important (for example, during a speech).

β-Blockers are useful on an as-needed basis for performance anxiety (for example, propranolol, 10-20 mg, taken orally 60 minutes before a performance or speech). However, this patient's anxiety surrounding social interaction impairs her ability to function effectively in her workplace. Therefore, episodic therapy for performance anxiety would not be appropriate for this patient with an indication for treatment of a more extensive anxiety disorder.

CBT, which seeks to address maladaptive beliefs, anxious feelings, and avoidance behaviors, has been shown to be of benefit and is an alternative approach to pharmacologic therapy. There is limited evidence that combining pharmacologic therapy and CBT is superior to either treatment alone.