Pharmacotherapy for social anxiety disorder: a systematic review

Abstract

Social anxiety disorder (SAD) is a prevalent, disabling disorder. We aimed to assess the effects of pharmacotherapy for SAD and to determine whether particular classes of medication are more effective and/or better tolerated than others. A systematic review and meta-analysis was conducted of all published and unpublished placebo-controlled randomized controlled trials (RCTs) undertaken between 1966 and 2007. A rigorous search, which included searching the Cochrane CCDANTR, MEDLINE and PsycINFO electronic databases, yielded a total of 51 RCTs (9914 participants) considered eligible for inclusion in the review. On average, over half of trial participants responded to medication, as assessed with the improvement item of the Clinical Global Impressions scale (55.2%), with approximately four participants having to be treated for an average of 12 weeks before an additional person responded to medication, relative to placebo (number needed to benefit = 4.19). There was substantial variation across medication classes in the number of dropouts due to adverse events, with an average number needed to harm of 14.4. Maintenance and relapse prevention studies confirm the value of longer-term medication in treatment responders. Medication was also effective in reducing SAD symptoms, comorbid depressive symptoms and associated disability. However, evidence for the efficacy of beta-blockers in treating performance anxiety was lacking. Taken together, trials of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors provide the largest evidence base for agents that are both effective and well tolerated. This review is an updated version of a Cochrane Review in The Cochrane Library, Issue 4, 2004. Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review.

A PET Study of Tiagabine Treatment Implicates Ventral Medial Prefrontal Cortex in Generalized Social Anxiety Disorder

“…As the average placebo response rate across randomized controlled trials in SAD has been reported to be approximately 30% (Ipser et al, 2008), the measured differential brain activity associated with treatment response in the present study could reflect a combination of medication and expectancy/ placebo responses inherent to the open pharmacotherapy trial. This limitation may be mitigated partially by the fact that the pre-to posttreatment midline vmPFC finding observed in the present study is anatomically distinct from a common mediating anatomy that has been observed for placebo responses in pain, depression, and anxiety (eg dorsolateral/ventrolateral PFC, rostral and dorsal ACC) (Mayberg et al, 2002;Benedetti et al, 2005).…”

Social Anxiety in Online and Real-Life Interaction and Their Associated Factors

“…2,3 Early onset of the disorder often results in a chronic course and functional disability. 4 Although both pharmacotherapy and psychotherapy are reportedly effective for social anxiety, 5,6 studies indicate that only about half of people with social anxiety ever seek treatment. 7 The disorder-specific fear of meeting a therapist may prevent them from seeking counseling from mental health professionals.…”

Social Anxiety Disorder

“…Several longterm studies (double-blind and open-label) have been conducted to examine the issue of relapse prevention. [13] These studies have evaluated moclobemide, phenelzine and CBT, sertraline and exposure therapy, fluvoxamine, paroxetine and escitalopram and venlafaxine ER. Response rates in these studies range from 58% for venlafaxine ER to 88% for escitalopram.…”