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Pharmacotherapy for social phobia
D J Stein1, J C Ipser, A J Balkom
1University of Stellenbosch, PO Box 19063, Tygerberg, Cape Town, South Africa, 7505.
The Cochrane Database of Systematic Reviews
|October 21, 2004
Summary
Pharmacotherapy, particularly selective serotonin reuptake inhibitors (SSRIs), effectively treats social phobia (SP) in the short term. Continued medication is beneficial for responders long-term, though publication bias is a consideration.
Area of Science:
- Psychiatry
- Pharmacology
- Clinical Psychology
Background:
- Social phobia (SP), or social anxiety disorder, is a common and impairing condition.
- Neurobiological factors are implicated in SP, driving interest in pharmacotherapy.
- Medication's role in treating SP requires systematic evaluation.
Purpose of the Study:
- To assess the efficacy and acceptability of pharmacotherapy for social phobia.
- To compare the effectiveness of different medication classes for SP treatment.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) on SP pharmacotherapy.
- Searches included specialized registers (CCDAN), MEDLINE, PsycLit, and requests to researchers/companies.
- Data extraction and quality assessment were performed by two independent raters; analyses were stratified by medication class (SSRIs, MAOIs, RIMAs).
Main Results:
- 36 RCTs (4268 participants) were analyzed, showing medication superiority over placebo in short-term treatment (RR=0.63).
- Selective serotonin reuptake inhibitors (SSRIs) demonstrated significant efficacy, outperforming reversible inhibitors of monoamine oxidase A (RIMAs).
- Medication effectively reduced SP symptoms, comorbid depression, and disability, with long-term benefits observed in responders.
Conclusions:
- Pharmacotherapy, especially SSRIs, is effective for short-term social phobia treatment.
- Sustained pharmacotherapy is supported for individuals responding to medication.
- Future research should address medication use in pediatric populations and those with comorbid disorders, acknowledging potential publication bias.