Recent advances in the psychopharmacology of social phobia

1. The last two decades have witnessed an upsurge in the interest in anxiety disorders. Much research effort has been dedicated to panic disorder and obsessive compulsive disorder. However, it is only very recently that we have begun to understand some of the basic principles about the psychopharmacology of social phobia. 2. Drug classes sofar studied include beta-blockers, nonselective and irreversible MAO-inhibitors (MAOI's) and benzodiazepines. 3. Beta blockers appear to be of use in specific social phobias, like public speaking. There is considerable evidence suggesting that MAOI's are effective in reducing both social anxiety as well as social avoidance. A disadvantage of the conventional irreversible MAOI's is their risk for hypertensive crises when combined with dietary tyramine. So far only a small number of studies with selective MAOI-A inhibitors such as moclobemide and brofaromine have been conducted in social phobia, and the results indicate that both compounds are effective. 4. Drugs exerting selective and specific actions on certain compounds of e.g. the serotonergic system can now be studied and it is hoped that the role of 5-HT and other neuronal systems in social phobia can be elucidated. 5. In order to gain more information about selective serotonergic drugs the first double blind placebo controlled study with fluvoxamine in social phobia is here reported. Preliminary results indicate a reduction of social anxiety. 6. Finally the role of peptides in the treatment of social phobia is critically reviewed. The MSH/ACTH analog Org 2766 was investigated in patients suffering from social phobia. No anxiolytic effects of this peptide could be observed.