Pharmacological treatment of social anxiety disorder: a meta-analysis.
Placebo-controlled trials have evaluated the efficacy of several medications in the treatment of social anxiety disorder but information regarding their relative efficacy is lacking. We compared the efficacy of medications systematically studied for the treatment of social anxiety disorder using meta-analytic techniques. The methodology included a database search of articles published between January 1980 and June 2001 and manual searches of bibliographies in published manuscripts. Trials were included if they reported outcome data on the Liebowitz Social Anxiety Scale (LSAS) or a categorical measure of responder status. Data were extracted independently by two authors. The Q statistic was used to assess homogeneity across trials. All analyses were conducted using intent-to-treat data. There was substantial heterogeneity across trials. The medications with largest effect sizes were phenelzine [effect size, 1.02; 95% Confidence Interval (CI), 0.52-1.52], clonazepam (effect size, 0.97; 95% CI, 0.49-1.45), gabapentin (effect size, 0.78; 95% CI, 0.29-1.27), brofaromine (effect size, 0.66; 95% CI, 0.38-0.94), and the selective serotonin reuptake inhibitors (SSRIs; effect size, 0.65; 95% CI, 0.50-0.81). There were no statistically significant differences between medications or medication groups. However, formal methods of interim monitoring adapted for meta-analyses suggested strongest evidence of efficacy for SSRIs and brofaromine. Several medications are efficacious for the treatment of social anxiety disorder. The stability of the SSRI effect size estimate in conjunction with other evidence for safety and tolerability and their ability to treat comorbid conditions supports the use of SSRIs as the first-line treatment. Direct comparisons of SSRIs vs. other promising medications deserve consideration.
Blanco
Carlos
C
Department of Psychiatry of Columbia College of Physicians and Surgeons, Madrid, Spain. cb255@columbia.edu
Schneier
Franklin R
FR
Schmidt
Andrew
A
Blanco-Jerez
Carmen-Rosa
CR
Marshall
Randall D
RD
Sánchez-Lacay
Arturo
A
Liebowitz
Michael R
MR
D000085:Acetates / Q000627:therapeutic use; D000588:Amines; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000188:drug therapy; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002998:Clonazepam / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use; D005260:Female; D018757:GABA Modulators / Q000627:therapeutic use; D000077206:Gabapentin; D006801:Humans; D008297:Male; D008996:Monoamine Oxidase Inhibitors / Q000627:therapeutic use; D010624:Phenelzine / Q000627:therapeutic use; D010698:Phobic Disorders / Q000188:drug therapy*; D010880:Piperidines / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid
D000085:Acetates; D000588:Amines; D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D018692:Antimanic Agents; D002121:Calcium Channel Blockers; D002998:Clonazepam; D003509:Cyclohexanecarboxylic Acids; D018691:Excitatory Amino Acid Antagonists; D018757:GABA Modulators; D000077206:Gabapentin; D008996:Monoamine Oxidase Inhibitors; D010624:Phenelzine; D010880:Piperidines; D017367:Selective Serotonin Reuptake Inhibitors; D005680:gamma-Aminobutyric Acid; C038213:brofaromine