title: The evidence-based pharmacotherapy of social anxiety disorder.
abstract: 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 pharmacological 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 co-morbid disorders, tolerability and safety, selective serotonin reuptake inhibitors (SSRIs) and venlafaxine should be considered 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 monoamine oxidase inhibitors, reversible inhibitors of monoamine oxidase A, benzodiazepines or gabapentin. Cognitive-behavioural is a well-established alternative first line therapy that may also be a helpful adjunct in non-responders to pharmacological treatment of SAD.
authors.affiliation: Department of Psychiatry of Columbia College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY 10032, USA. cb255@columbia.edu
authors.forename: Carlos
authors.initials: C
authors.lastname: Blanco
authors.forename: Laura B
authors.initials: LB
authors.lastname: Bragdon
authors.forename: Franklin R
authors.initials: FR
authors.lastname: Schneier
authors.forename: Michael R
authors.initials: MR
authors.lastname: Liebowitz
mesh_terms: D000818:Animals; D000928:Antidepressive Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000188:drug therapy / Q000523:psychology; D018849:Controlled Clinical Trials as Topic / Q000639:trends; D019317:Evidence-Based Medicine / Q000639:trends*; D006801:Humans; D008996:Monoamine Oxidase Inhibitors / Q000627:therapeutic use; D010698:Phobic Disorders / Q000188:drug therapy* / Q000523:psychology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D008996:Monoamine Oxidase Inhibitors; D017367:Selective Serotonin Reuptake Inhibitors