Social anxiety disorder (social phobia; SAnD) is a chronic, impairing disorder characterised by embarrassment and fear relating to public scrutiny and social performance. In its generalised form it may seem to be a type of extreme shyness or variant of avoidant personality disorder and thus enduring and resistant to change. A discrete subtype has been seen as akin to simple phobia and potentially responsive to behavioural therapies. In this article we critically evaluate the pharmacological regimens that have been used to treat social anxiety disorder. An extensive search was conducted from 1980 through to June 2006. Electronic databases were used including Medline and PsycInfo using search terms including anxiety or phobia with social or treatment or therapeutics, restricted to English language manuscripts. The results of this search are presented by drug category, sorted according to both common clinical practice and strength of evidence. There are effective, well-tolerated, and powerful drug treatments of social anxiety disorder. A significant evidence base supports this assertion. Medication therapy should be considered as a first line treatment of this condition.