Given the evidence that social anxiety disorder may predict subsequent development of other psychiatric disorders such as depression, early diagnosis and treatment is important. Social anxiety disorder remains under-recognized in primary care practice, with patients often presenting for treatment only after the onset of complications such as clinical depression or substance use disorders. Medications
SSRIs
Selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants, are the first choice of medication for generalized social phobia but a second-line treatment. : 191   Compared to older forms of medication, there is less risk of tolerability and drug dependency associated with SSRIs.Paroxetine and paroxetine CR, Sertraline, Escitalopram, Venlafaxine XR and Fluvoxamine CR (luvox CR) are all approved for SAD and  are all effective for it, especially paroxetine. All SSRIs are somewhat effective for social anxiety except fluoxetine which was equivalent to placebo in all clinical trials. Paroxetine was able to change personality and significantly increase extraversion.In a 1995 double-blind, placebo-controlled trial, the SSRI paroxetine was shown to result in clinically meaningful improvement in 55% of patients with generalized social anxiety disorder, compared with 23.9% of those taking placebo. An October 2004 study yielded similar results. Patients were treated with either fluoxetine, psychotherapy, or a placebo. The first four sets saw improvement in 50.8 to 54.2 percent of the patients. Of those assigned to receive only a placebo, 31.7% achieved a rating of 1 or 2 on the Clinical Global Impression-Improvement scale. Those who sought both therapy and medication did not see a boost in improvement.
Hepatic porphyrias is a form of porphyria in which toxic porphyrin molecules build up in the liver. Hepatic porphyrias can result from a number of different enzyme deficiencies.Examples include (in order of synthesis pathway):
Acute intermittent porphyria
Porphyria cutanea tarda and Hepatoerythropoietic porphyria
Hereditary coproporphyria
Variegate porphyria

See also
Erythropoietic porphyria
Givosiran

References
External links

Porphyrias,+Hepatic at the US National Library of Medicine Medical Subject Headings (MeSH)
www.drugs-porphyria.com
www.porphyria-europe.com