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.(Received March 9 2003)
(Reviewed July 18 2003)
(Revised July 23 2003)
(Accepted July 27 2003)
Key Words: Pharmacological treatment; social anxiety disorder (SAD); social phobia.
c1 Dr C. Blanco, New York State Psychiatric Institute, Box 69, 1051 Riverside Drive, New York, NY 10032, USA. Tel.: (212) 543-6533 Fax: (212) 543-6515. E-mail: [email protected]