Defining an appropriate management strategy for social anxiety disorder

Social anxiety disorder is a chronic and disabling, yet treatable, condition. Effective treatment should alleviate the core domains of fear, anxiety and physiological symptoms, as well as reduce overall disability and improve social functioning. Response to treatment can, therefore, be assessed at a global level where overall improvement is considered, and at the level of individual symptoms. In considering the way in which response to treatment can be measured, this review also identifies several factors that may worsen the prognosis of social anxiety disorder. Clinical studies of monoamine oxidase inhibitors, selective serotonin reuptake inhibitors (SSRIs), and benzodiazepines for the treatment of social anxiety disorder are presented and discussed. The accumulation of evidence supports the use of SSRIs as first line therapy for social anxiety disorder, and the majority of data come from well controlled studies of paroxetine. In line with the recommendations of the International Consensus Group on Depression and Anxiety, a strategy for the management of social anxiety disorder is provided.