Providers are finally beginning to dip our toes in the waters which have flowed from the realization that psychiatric and psychological disorders are brain disorders.  Case in point: social anxiety.

I don’t know whether we see quite a few eating disordered patients with social anxiety because these diagnoses frequently run together or because social anxiety is so prevalent in the general population, but we do. And now comes an article by Michael Liebowitz and colleagues from Columbia University published in the American Journal of Psychiatry about a nasal spray named PH94B being tested for the resolution of social anxiety.  Just to get the questions out front, the experiment was single blinded (the patients did not know whether they got the placebo spray or the “real stuff”) and the significance was reported to be P=0.002.  In other words, “significant”.  All 91 participants were women between the ages of 19 and 60.  There were no dangerous or serious side effects seen.  The patients who received PH94B reported that they felt “improved” or “much improved” vis a vis their symptoms of social anxiety in two settings: one, public speaking and two, social gatherings including strangers. For those of you who do have some social anxiety—or a lot of social anxiety—imagine what this might mean.  You could carry your intranasal spray around, much as people do with decongestants and eventually be as relaxed and functional in your own particular anxiety-provoking situations as a person who did not have an anxiety disorder. What effect might something like this have in combat?  In the development of PTSD?  In anorexia nervosa, where anxiety around eating can be very difficult to overcome?  If it works PH94B would be better than CBT (which takes too long, a patient needs to leave home to do it, etc.); better than atypical anti-psychotics and/or SSRI’s (which have too many side effects and must be taken every day); and much better than potentially addictive anxiety reducing drugs such as the benzodiazepines or alcohol. I’m excited about this novel treatment and look forward to further studies.