Pharmacotherapy of social phobia

To review placebo-controlled medication trials in social phobia (SP).

Published and/or presented placebo-controlled trials of medication were reviewed and summarized.

Phenelzine is effective in 60-70% of patients with SP and always superior to placebo. Although reversible inhibitors of monoamine oxidase type A (RIMAs) are safer, their benefits are unpredictable. SSRIs, fluvoxamine, paroxetine and sertraline are superior to placebo in generalized SP. Gabergic drugs are useful, e.g. clonazepam, gabapentin and pregabalin. Promising effects have been found with venlafaxine, a serotonin-norepinephrine reuptake inhibitor, and the results of larger studies should be forthcoming in the next 2 years. Drugs such as buspirone, tricyclics and beta-blockers are either ineffective or have limited use. SP is a chronic disorder, and early termination of successful pharmacotherapy is associated with a greater likelihood of relapse. Studies with paroxetine, clonazepam, sertraline and brofaromine show that continued treatment is associated with better maintenance of response. Special populations that require further study include children, those with comorbid Axis I disorders and the population with discrete (non-generalized) SP.

MAOI and SSRI are most uniformly effective in treating SP. Clonazepam and gabapentin may also be useful. Other drugs are of more limited value. Long-term treatment is recommended to reduce rates of relapse.