Fear of blushing (FB) is a form of social anxiety disorder (SAD) characterized by an intense and obsessive threat of blushing in front of other people. No data are available on the specific efficacy of antidepressants on FB. This open-label pilot study investigated whether the selective serotonin reuptake inhibitor escitalopram specifically improves symptoms of FB in SAD patients.

Thirty-nine patients meeting DSM-IV criteria for SAD and presenting a significant FB according to the Salpêtrière Erythrophobia Questionnaire (SEQ) were administered open-label escitalopram (10-30 mg/day) for 12 weeks. A systematic assessment, at baseline and at week 12, included the SEQ, the Liebowitz Social Anxiety Scale (LSAS) and the Hospital Anxiety and Depression (HAD) scale.

From the 39 patients included, 31 attended the week 4 visit, and 28 the week 12 visit. Significant reductions of fear of blushing were observed after 4 weeks of treatment, and were more pronounced at the end of the 12-week treatment since patients experienced a 60% decrease of their FB symptoms (p<0.001). Nineteen (67.8%) subjects reported a 50% decrease or more of their SEQ score, and 14 (50%) met criteria for remission of fear of blushing (SEQ score <7). The effect sizes of changes on SEQ, LSAS and HAD scales scores were high, with eta² ranging between 0.53 and 0.86.

Results of this open study suggest that escitalopram can be a useful treatment for fear of blushing associated with SAD, even if large controlled trials are now needed to further evaluate this result.