[Expectancies and SSRI treatment of social anxiety disorder]

The efficacy of escitalopram in treating social anxiety disorder is significantly influenced by expectations shaped through communication, contributing to about half the improvement. Overt SSRI treatment with accurate information about its effectiveness doubled the clinical outcome compared to covert treatment with misinformation about the therapeutic effect. Clinical improvements are not solely due to serotonin reuptake inhibition, as indicated by similar serotonin transporter occupancy in both treatment types, without correlation to anxiety reduction. There was, however, notable correlation between clinical improvement and reduced dopamine transporter availability in the overt SSRI group, possibly due to increased dopamine turnover. This was also observed in a study on combined CBT and  SSRI treatment. Conversely, clinical improvement after CBT combined with placebo showed an inverse correlation with dopamine transporters and did not inhibit serotonin transporters.