How effective is pharmacotherapy for social anxiety disorder (SAnD) in adults?
Compared with placebo, SSRIs (paroxetine, fluvoxamine, sertraline, fluoxetine and citalopram) were the only medication class that demonstrated consistent evidence of reductions in functional disability across a number of domains (very low to moderate-quality evidence). Treatment with SSRIs and reversible inhibitors of monoamine oxidase A (RIMAs) was also associated with a reduction in depression symptoms. Tolerability of SSRIs was lower than for placebo, but absolute withdrawal rates were low. There was also evidence for an effect of SSRIs in preventing relapse (moderate-quality evidence). Most SSRI studies lasted at least 12 weeks. There was a response to long-term (20–24 weeks) treatment for the SSRIs (low-quality evidence), for the monoamine oxidase inhibitors (MAOIs; very low-quality evidence) and the RIMAs (moderate-quality evidence).
While a small number of trials did report treatment efficacy for benzodiazepines, anticonvulsants, MAOIs and RIMAs, this finding should be considered in the context of potential for abuse or unfavourable side effects.
Recognition is growing that SAnD is a chronic and disabling disorder, and data from early trials demonstrate that medication may be effective in its treatment.
Cochrane Systematic Review
Williams T et al. Pharmacotherapy for social anxiety disorder (SAnD). Cochrane Reviews, 2017, Issue 10. Art. No.: CD001206.DOI: 10.1002/14651858. CD001206.pub3. This review contains 66 studies involving 11,597 participants, aged 18 to 70.