The effect of niacin on facial blood flow in people with an elevated fear of negative evaluation

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Abstract

The vasodilator niacin may provoke greater facial flushing and other symptoms of anxiety in patients with social anxiety disorder than in non-anxious controls. To determine whether this also applies in non-clinical samples, niacin (100 mg) or placebo was administered double-blind to 33 young adults and flushing was investigated in relation to fear of negative evaluation (a cardinal feature of social anxiety). Increases in facial blood flow were greater in people with high than low fear of negative evaluation in the niacin condition, but were similar in both groups in the placebo condition. However, changes in pulse rate and ratings of embarrassment, anxiety, blushing and facial heat were similar in both groups in both drug conditions. These findings suggest that the facial vessels of people with a heightened fear of negative evaluation are particularly responsive to niacin under conditions of low anxiety and embarrassment.

Introduction

Blushing is one of the hallmarks of social anxiety (Voncken and Bögels, 2009). To investigate its basis, Bouwer and Stein (1998) administered a low dose of niacin (100 mg) to six male patients who attended an anxiety disorders clinic for treatment of generalized social phobia and to six healthy male controls. Increases in anxiety, facial temperature, blood pressure and facial flushing were greater in the social phobia patients than in the healthy controls. This result is particularly striking because vasodilatation to methyl nicotinate (a niacin ester), applied topically to the forearm, was found to be attenuated rather than enhanced in generalized social phobia patients (Katzman et al., 2003). However, it is not known whether the excessive flushing observed by Bouwer and Stein was a specific effect of niacin or was due to nonspecific factors (e.g., anxiety triggered by interoceptive sensations or environmental cues), because their study was not placebo controlled. In addition, it is uncertain whether niacin evokes excessive flushing in socially anxious people who do not seek treatment.

To explore these issues, niacin (100 mg) or placebo was administered double-blind to a non-clinical sample of young adults, and flushing was investigated in relation to fear of negative evaluation (a cardinal feature of social anxiety). It was hypothesized that low-dose niacin would evoke greater increases in facial blood flow and anxiety in participants with high than low fear of negative evaluation.

Section snippets

Participants

The sample consisted of 33 undergraduate university students aged between 18 and 41 years (nine men and 24 women with a mean age of 24 ± 7 years). None of the participants were pregnant, diabetic, had kidney or liver disease or took prescribed medication for any general medical or psychiatric condition. Before beginning the experiment, participants were informed that niacin could evoke facial flushing. Each participant provided informed consent for the procedures, which were approved by the Murdoch

Group characteristics

Fear of negative evaluation scores averaged 15.7 ± 8.6 (mean ± standard deviation) in the niacin condition and 20.2 ± 6.0 in the placebo condition (difference not significant). Six participants in the niacin condition and seven participants in the placebo condition had scores of 22 or above. Participants with an elevated fear of negative evaluation had high blushing propensity and social interaction anxiety scores but normal social phobia scores (Table 1).

Effects of niacin on physiological activity

Increases in facial blood flow were greater

Discussion

The primary aim of this study was to determine whether a low dose of the vasodilator niacin would augment flushing and anxiety in people with an elevated fear of negative evaluation. Consistent with the findings of Bouwer and Stein (1998), 100 mg niacin evoked greater flushing in participants with high than low fear of negative evaluation. However, pulse rate did not change after drug administration and participants did not report somatic symptoms of flushing or increases in anxiety. Flushing

Role of the funding source

None.

Contributors

Both authors were involved in the design of the study, analysis and discussion of data, and contributed to and approved the final version of the manuscript. Peter Drummond wrote the initial draft.

Conflict of interest

There were no conflicts of interest with the work reported in this paper.

Acknowledgements

We wish to thank the participants who volunteered for this study.

References (25)

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