The evidence-based pharmacological treatment of social anxiety disorder.
Social anxiety disorder (SAD) is a highly prevalent and often disabling disorder. This paper reviews the pharmacological treatment of SAD based on published placebo-controlled studies and published meta-analyses. It addresses three specific questions: What is the first-line treatment of SAD? How long should treatment last? What should be the management of treatment-resistant cases? Based on their efficacy for SAD and common comorbid disorders, tolerability, and safety, SSRIs should be considered as the first-line treatment for most patients. Less information is available regarding the optimal length of treatment, although individuals who discontinue treatment after 12-20 wk appear more likely to relapse than those who continue on medication. Even less empirical evidence is available to support strategies for treatment-resistant cases. Clinical experience suggests that SSRI non-responders may benefit from augmentation with benzodiazepines or gabapentin, or from switching to MAOIs, RIMAs, benzodiazepines or gabapentin. Cognitive-behavioural therapy may also be a helpful adjunct or alternative.
Blanco
Carlos
C
Department of Psychiatry of Columbia College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY, USA. cb255@columbia.edu
Raza
Muhammad S
MS
Schneier
Franklin R
FR
Liebowitz
Michael R
MR
D014151:Anti-Anxiety Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018849:Controlled Clinical Trials as Topic; D019317:Evidence-Based Medicine; D006801:Humans; D015201:Meta-Analysis as Topic; D010698:Phobic Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D016896:Treatment Outcome
D014151:Anti-Anxiety Agents