title: Cognitive therapy versus fluoxetine in generalized social phobia: a randomized placebo-controlled trial. Controlled-release paroxetine in the treatment of patients with social anxiety disorder. Paroxetine in social anxiety disorder: a randomized placebo‐controlled study Paroxetine treatment of generalized social phobia (social anxiety disorder): a randomized controlled trial. Venlafaxine extended release vs placebo and paroxetine in social anxiety disorder. Internet-Based Cognitive Behavior Therapy vs. Cognitive Behavioral Group Therapy for Social Anxiety Disorder: A Randomized Controlled Non-inferiority Trial Efficacy and tolerability of escitalopram in 12‐ and 24‐week treatment of social anxiety disorder: Randomised, double‐blind, placebo‐controlled, fixed‐dose study Fluvoxamine-Controlled Release Formulation for the Treatment of Generalized Social Anxiety Disorder Moclobemide in social phobia: a controlled dose-response trial. Fluoxetine, comprehensive cognitive behavioral therapy, and placebo in generalized social phobia. Exposure therapy and sertraline in social phobia: I-year follow-up of a randomised controlled trial. Cognitive-behavioral and pharmacological treatments of social phobia. A controlled study. Placebo-controlled trial of moclobemide in social phobia. Results of a naturalistic longitudinal study of benzodiazepine and SSRI use in the treatment of generalized anxiety disorder and social phobia. Treatment of social phobia with clonazepam and placebo. Residential cognitive therapy versus residential interpersonal therapy for social phobia: a randomized clinical trial. Efficacy of sertraline in severe generalized social anxiety disorder: results of a double-blind, placebo-controlled study. Mirtazapine in generalized social anxiety disorder: a randomized, double-blind, placebo-controlled study Moclobemide and cognitive behavioral therapy in the treatment of social phobia. A six-month controlled study and 24 months follow up. Fluvoxamine treatment of social phobia (social anxiety disorder): a double-blind, placebo-controlled study. Cognitive therapy vs interpersonal psychotherapy in social anxiety disorder: a randomized controlled trial. Levetiracetam in social phobia: a placebo controlled pilot study Psychopharmacological treatment of social phobia; a double blind placebo controlled study with fluvoxamine Sertraline treatment of generalized social phobia: a 20-week, double-blind, placebo-controlled study. Social phobia: the clinical efficacy and tolerability of the monoamine oxidase ‐A and serotonin uptake inhibitor brofaromine. A double‐blind placebo‐controlled study Treatment of social phobia with gabapentin: a placebo-controlled study. Efficacy of paroxetine for relapse prevention in social anxiety disorder: a 24-week study. Paroxetine in the treatment of generalized social phobia: open-label treatment and double-blind placebo-controlled discontinuation. Quetiapine as monotherapy for social anxiety disorder: A placebo-controlled study An open trial of topiramate in the treatment of generalized social phobia. A Randomized Controlled Trial of Atomoxetine in Generalized Social Anxiety Disorder Randomized trial of a meditation-based stress reduction program and cognitive behavior therapy in generalized social anxiety disorder. Efficacy of low and higher dose extended-release venlafaxine in generalized social anxiety disorder: a 6-month randomized controlled trial Mirtazapine Treatment of Social Phobia in Women: A Randomized, Double-Blind, Placebo-Controlled Study A pilot study of clonazepam versus psychodynamic group therapy plus clonazepam in the treatment of generalized social anxiety disorder. Prevention of relapse in generalized social phobia: results of a 24-week study in responders to 20 weeks of sertraline treatment. Cognitive behavioral group therapy vs phenelzine therapy for social phobia: 12-week outcome. Efficacy of pregabalin in generalized social anxiety disorder: results of a double-blind, placebo-controlled, fixed-dose study Duloxetine for the treatment of generalized social anxiety disorder: a preliminary randomized trial of increased dose to optimize response. Randomised controlled general practice trial of sertraline, exposure therapy and combined treatment in generalised social phobia. Fluoxetine in Social Phobia: A Double-Blind, Placebo-Controlled Pilot Study Escitalopram in the treatment of social anxiety disorder: analysis of efficacy for different clinical subgroups and symptom dimensions. Moclobemide is effective and well tolerated in the long-term pharmacotherapy of social anxiety disorder with or without comorbid anxiety disorder Discontinuation of clonazepam in the treatment of social phobia. Imipramine in the treatment of social phobia. Columbia atypical depression. A subgroup of depressives with better response to MAOI than to tricyclic antidepressants or placebo. A randomized controlled trial of venlafaxine extended release in generalized social anxiety disorder. Nefazodone in the treatment of generalized social phobia: a randomized, placebo-controlled trial. Brofaromine for social phobia: a multicenter, placebo-controlled, double-blind study. A placebo-controlled trial of phenelzine, cognitive behavioral group therapy, and their combination for social anxiety disorder. Effectiveness Randomized Controlled Trial of Face to Face Versus Internet Cognitive Behaviour Therapy for Social Phobia Levetiracetam in generalized social anxiety disorder: a double-blind, randomized controlled trial. Paroxetine in social phobia/social anxiety disorder. Randomised, double-blind, placebo-controlled study. Paroxetine Study Group. Double-blind, placebo-controlled assessment of combined clonazepam with paroxetine compared with paroxetine monotherapy for generalized social anxiety disorder. Psychopharmacological treatment of social phobia: clinical and biochemical effects of brofaromine, a selective MAO-A inhibitor Efficacy of the Novel Anxiolytic Pregabalin in Social Anxiety Disorder: A Placebo-Controlled, Multicenter Study Valproic acid for the treatment of social anxiety disorder A 24-week randomized, double-blind, placebo-controlled study of escitalopram for the prevention of generalized social anxiety disorder. A Double-Blind, Placebo-Controlled Study of a Flexible Dose of Venlafaxine ER in Adult Outpatients With Generalized Social Anxiety Disorder Efficacy of Venlafaxine ER in patients with social anxiety disorder: a double‐blind, placebo‐controlled, parallel‐group comparison with paroxetine Phenelzine vs atenolol in social phobia. A placebo-controlled comparison. A randomized, double-blind, fixed-dose comparison of paroxetine and placebo in the treatment of generalized social anxiety disorder. Pharmacotherapy of social phobia. A controlled study with moclobemide and phenelzine. Efficacy of olanzapine in social anxiety disorder: a pilot study Use of benzodiazepines and selective serotonin reuptake inhibitors in middle-aged and older adults with anxiety disorders: a longitudinal and prospective study.
abstract: Sixty patients meeting Diagnostic and Statistical Manual of Mental Disorders ( 4th ed . : American Psychiatric Association , 1994 ) criteria for generalized social phobia were assigned to cognitive therapy ( CT ) , fluoxetine plus self-exposure ( FLU + SE ) , or placebo plus self-exposure ( PLA + SE ) . At posttreatment ( 16 weeks ) , the medication blind was broken . CT and FLU + SE patients then entered a 3-month booster phase . Assessment s were at pretreatment , midtreatment , posttreatment , end of booster phase , and 12-month follow-up . Significant improvements were observed on most measures in all 3 treatments . On measures of social phobia , CT was superior to FLU + SE and PLA + SE at midtreatment and at posttreatment . FLU + SE and PLA + SE  did not differ . CT remained superior to FLU + SE at the end of the booster period and at 12-month follow-up . On general mood measures , there were few differences between the BACKGROUND This double-blind , placebo-controlled , flexible-dose study was conducted to investigate the efficacy and tolerability of the controlled-release ( CR ) formulation of paroxetine in adults with social anxiety disorder . METHOD Out patients with a primary diagnosis of social anxiety disorder according to DSM-IV criteria entered a 1-week , single-blind , placebo run-in period . Eligible patients were r and omly assigned to receive paroxetine CR ( flexible dose of 12.5 - 37.5 mg/day ) or placebo for 12 weeks of treatment . The primary efficacy measures were the change from baseline in Liebowitz Social Anxiety Scale ( LSAS ) score and the proportion of responders based on Clinical Global Impressions (CGI)-Global Improvement scale score . Data were gathered from September 2001 to July 2002 . RESULTS The intent-to-treat population consisted of 186 patients r and omly assigned to paroxetine CR and 184 patients r and omly assigned to placebo .  Statistically significant differences in favor of paroxetine CR compared with placebo were observed in the change from baseline to week 12 last-observation-carried-forward ( LOCF ) data set in LSAS total score ( difference = -13.33 , 95 % confidence interval [ CI ] = -18.25 to -8.41 , p < .001 ) . In the CGI-Global Improvement responder analysis , 57.0 % of patients treated with paroxetine CR achieved response ( very much improved or much improved ) , compared with 30.4 % of patients treated with placebo at week 12 LOCF ( odds ratio = 3.12 , 95 % CI = 2.01 to 4.83 , p < .001 ) . Dropout rates due to adverse events were low and comparable in both treatment groups . CONCLUSION Paroxetine CR effectively treated the symptoms associated with social anxiety disorder and was well tolerated , with few patients stopping treatment due to adverse events . This favorable tolerability profile may enable more patients to experience the benefits of effective therapy Allgul and er C. Paroxetine in  social anxiety disorder :  a r and omized placebo‐controlled study . Acta Psychiatr Sc and 1999 : 100 : 193–198 . © Munksgaard 1999 CONTEXT The generalized type of social phobia ( social anxiety disorder ) is a severe and often disabling form of social anxiety that affects approximately 5 % of the general population . Earlier research has shown monoamine oxidase inhibitors or benzodiazepines to be effective in treating this condition , but neither has achieved widespread use . OBJECTIVE To compare the efficacy of paroxetine , a selective serotonin reuptake inhibitor , with placebo in adults with generalized social phobia . DESIGN Twelve-week , multicenter , r and omized , double-blind trial . SETTING Thirteen centers across the United States and 1 in Canada . PARTICIPANTS Between April 13 , 1995 , and February 28 , 1996 , 187 persons meeting Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition criteria for generalized social phobia were r and omized ( and 183 returned for at least 1 efficacy assessment ) to treatment . INTERVENTION After a 1-week , single-blind , placebo , run-in period , patients received a double-blind , 11-week course of either paroxetine or matching-image placebo . The initial daily dosage of paroxetine ( or placebo ) was 20 mg with increases of 10 mg/d weekly ( flexible dosing to a maximum of 50 mg/d ) permitted after the second week of treatment . MAIN OUTCOME MEASURES Number of responders based on the Clinical Global Impression Global Improvement Item ( " much improved " or " very much improved " ) ; mean change from baseline on the Liebowitz Social Anxiety Scale total score . RESULTS Fifty ( 55.0 % ) of 91 persons taking paroxetine and 22 ( 23.9 % ) of 92 persons taking placebo were much improved or very much improved at the end of treatment ( odds ratio [ OR ] , 3.88 ; 95 % confidence interval [ CI ] , 2.81 - 5.36 ) . Mean Liebowitz Social Anxiety Scale total scores were reduced by 39.1 % ( the mean baseline score of 78.0 declined by a mean of 30.5 points at follow-up ) in the paroxetine group compared with 17.4 % ( the mean baseline score of 83.5 declined 14.5 points at follow-up ) in the placebo group , a difference of 21.7 % ( 95 % CI , 8.7%-34.7 % ) favoring paroxetine . CONCLUSIONS Paroxetine is an effective treatment for patients with generalized social phobia . Short-term ( ie , 11-week ) treatment results in substantial and clinical ly meaningful reductions in symptoms and disability . Future research should test whether these may be further reduced by extended treatment or supplementation with specific educational-cognitive-behavioral techniques BACKGROUND Evidence indicates that venlafaxine hydrochloride extended release ( ER ) effectively ameliorates anxiety symptoms . OBJECTIVES To evaluate the efficacy , safety , and tolerability of flexible-dose venlafaxine ER compared with placebo in the short-term treatment of generalized social anxiety disorder and , secondarily , to compare paroxetine with venlafaxine ER and paroxetine with placebo . DESIGN Adult out patients with DSM-IV generalized social anxiety disorder for 6 months or longer were r and omly assigned to receive venlafaxine hydrochloride ER ( 75 - 225 mg/d ) , paroxetine ( 20 - 50 mg/d ) , or placebo for 12 weeks or less at 26 centers in the United States . The primary outcome measure was the total Liebowitz Social Anxiety Scale score . Secondary measures included response ( Clinical Global Impression-Improvement score , 1 or 2 ) rates and Clinical Global Impression-Severity of Illness and Social Phobia Inventory scores . RESULTS Of 440 patients treated , 413 ( 93.9 % ) were included in the last-observation-carried-forward efficacy analysis ; of the 429 patients in the safety population , 318 ( 74.1 % ) completed the study . Mean daily doses were 201.7 mg ( SD , 38.1 mg ) of venlafaxine hydrochloride ER and 46.0 mg ( SD , 7.9 mg ) of paroxetine . Venlafaxine ER treatment was significantly superior to placebo at weeks 1 through 12 on the Liebowitz Social Anxiety Scale and Social Phobia Inventory and at week 2 and weeks 6 through 12 for Clinical Global Impression-Severity of Illness and responder status , and was significantly superior to paroxetine treatment at weeks 1 and 2 for the Social Phobia Inventory ( P < .05 for all ) . Paroxetine treatment was significantly superior to placebo at weeks 3 through 12 on the Liebowitz Social Anxiety Scale , the Clinical Global Impression-Severity of Illness scale , and the Social Phobia Inventory , and at weeks 4 through 12 for response ( P < .05 for all ) . Week 12 response rates were significantly greater for the venlafaxine ER and paroxetine groups ( 58.6 % and 62.5 % , respectively ) vs the placebo group ( 36.1 % ) ( P < .001 for both ) . CONCLUSION Venlafaxine ER is effective in the short-term treatment of generalized social anxiety disorder , with efficacy and tolerability comparable to paroxetine Background and Aims Cognitive behavioral group therapy ( CBGT ) is an effective , well-established , but not widely available treatment for  social anxiety disorder ( SAD ) .  Internet-based cognitive behavior therapy ( ICBT ) has the potential to increase availability and facilitate dissemination of therapeutic services for SAD . However , ICBT for SAD has not been directly compared with in-person treatments such as CBGT and few studies investigating ICBT have been conducted in clinical setting s. Our aim was to investigate if ICBT is at least as effective as CBGT for SAD when treatments are delivered in a psychiatric setting . Methods We conducted a r and omized controlled non-inferiority trial with allocation to ICBT ( n = 64 ) or CBGT ( n = 62 ) with blinded assessment immediately following treatment and six months post-treatment . Participants were 126 individuals with SAD who received CBGT or ICBT for a duration of 15 weeks . The Liebowitz Social Anxiety Scale ( LSAS ) was the main outcome measure . The following non-inferiority margin was set : following treatment , the lower bound of the 95 % confidence interval ( CI ) of the mean difference between groups should be less than 10 LSAS-points . Results Both groups made large improvements . At follow-up , 41 ( 64 % ) participants in the ICBT group were classified as responders ( 95 % CI , 52%–76 % ) . In the CBGT group , 28 participants ( 45 % ) responded to the treatment ( 95 % CI , 33%–58 % ) . At post-treatment and follow-up respectively , the 95 % CI of the LSAS mean difference was 0.68–17.66 ( Cohen ’s d between group = 0.41 ) and −2.51–15.69 ( Cohen ’s d between group = 0.36 ) favoring ICBT , which was well within the non-inferiority margin . Mixed effects models analyses showed no significant interaction effect for LSAS , indicating similar improvement across treatments ( F = 1.58 ; df = 2 , 219 ; p = .21 ) . Conclusions ICBT delivered in a psychiatric setting can be as effective as CBGT in the treatment of SAD and could be used to increase availability to CBT . Trial Registration Clinical Trials.gov Selective serotonin reuptake inhibitors are the pharmacological treatment of choice for the treatment of  social anxiety disorder ( SAD ) . The efficacy and tolerability of fixed doses of escitalopram were compared to those of placebo in the long‐term treatment of generalised SAD , using paroxetine as an active reference . Patients with a DSM‐IV diagnosis of SAD between 18–65 years of age were r and omised to 24 weeks of double‐blind treatment with placebo ( n = 166 ) , 5 mg escitalopram ( n = 167 ) , 10 mg escitalopram ( n = 167 ) , 20 mg escitalopram ( n = 170 ) , or 20 mg paroxetine ( n = 169 ) . Based on the primary efficacy parameter , Liebowitz Social Anxiety Scale ( LSAS ) total score at Week 12 ( LOCF ) , a significantly superior therapeutic effect compared to placebo was seen for 5 and 20 mg escitalopram and for all doses for the OC analyses . Further improvement in LSAS scores was seen at Week 24 ( OC and LOCF ) , with significant superiority over placebo for all doses of escitalopram , and 20 mg escitalopram was significantly superior to 20 mg paroxetine . Response to treatment ( assessed by a Clinical Global Impression‐Improvement score ≤2 ) was significantly higher for all active treatments than for placebo at Week 12 . Clinical relevance was supported by a significant decrease in all the Sheehan disability scores , and the good tolerability  of escitalopram treatment . It is concluded that doses of 5–20 mg escitalopram are effective and well tolerated in the short‐ and long‐term treatment of generalised SAD . Depression and Anxiety 00:000–000 , 2004 . © 2004 Wiley‐Liss , Background : Generalized social anxiety disorder is a highly prevalent anxiety disorder with deleterious effects on social and family relationships , as well as work performance . We report the results of a multicenter , r and omized , placebo-controlled trial comparing the efficacy , safety , and tolerability of fluvoxamine controlled release ( CR ) to placebo in patients with generalized social anxiety disorder . Methods : A total of 279 adult patients meeting all inclusion /exclusion criteria was recruited at 23 United States sites and r and omly assigned to receive either fluvoxamine CR ( 100 - 200 mg/d ) or placebo for 12 weeks . The dose could be increased , based on efficacy and tolerability , in increments of 50 mg/d at weekly intervals . The dosage remained constant during weeks 6 to 12 . Results : Treatment with fluvoxamine CR result ed in statistically and clinical ly significant improvements in symptoms associated with generalized social anxiety disorder as early as week 4 on the Liebowitz Social Anxiety Scale and the Clinical Global Impression Scale Global Improvement , and at week 6 on the Sheehan Disability Scale , Clinical Global Impression Scale Severity of Illness and the Patient Global Impression of Improvement Scale . The most frequent adverse events reported by patients on fluvoxamine CR were headache , nausea , somnolence , and insomnia . No weight gain was observed for either treatment group , and at end point , there were no differences between treatments on overall sexual function , as measured by the Arizona Sexual Experience Scale . Conclusions : Both physician and patient-rated scales indicate that fluvoxamine CR is effective and safe for the treatment of generalized social anxiety disorder Although the monoamine oxidase inhibitor phenelzine has proven efficacious in social phobia , the risk of hypertensive crises has reduced its acceptability . The reversible monoamine oxidase inhibitor moclobemide has less potential for such reactions , but its efficacy in this disorder remains unproven . A double-blind , placebo-controlled study was undertaken to assess the efficacy and safety of fixed doses of moclobemide . After a 1-week placebo run-in , subjects with social phobia were r and omly assigned to placebo or one of five doses ( 75 mg , 150 mg , 300 mg , 600 mg , or 900 mg daily ) of moclobemide for 12 weeks . Although a trend toward greater efficacy of higher doses of moclobemide was observed at 8 weeks , no differences in response to various doses of the drug and placebo were observed at 12 weeks . At 12 weeks , 35 % of subjects on 900 mg of moclobemide and 33 % of those on placebo were at least much improved . Moclobemide was well tolerated , insomnia being the only dose-related adverse event observed with the drug . In this dose-response trial , moclobemide did not demonstrate efficacy at 12 weeks . Some other controlled studies have found moclobemide and  brofaromine  , another reversible monoamine oxidase inhibitor , efficacious in social phobia . Possible reasons for inconsistent findings are discussed BACKGROUND  Generalized social phobia is common , persistent , and disabling and is often treated with selective serotonin reuptake inhibitor drugs or cognitive behavioral therapy . OBJECTIVE We compared fluoxetine ( FLU ) , comprehensive cognitive behavioral group therapy ( CCBT ) , placebo ( PBO ) , and the combinations of CCBT/FLU and CCBT/PBO . DESIGN R and omized , double-blind , placebo-controlled trial . SETTING Two academic outpatient psychiatric centers . PATIENTS Subjects meeting a primary diagnosis of generalized social phobia were recruited via advertisement . Seven hundred twenty-two were screened , and 295 were r and omized and available for inclusion in an intention-to-treat efficacy analysis ; 156 ( 52.9 % ) were male , 226 ( 76.3 % ) were white , and mean age was 37.1 years . INTERVENTIONS Treatment lasted for 14 weeks . Fluoxetine and PBO were administered at doses from 10 mg/d to 60 mg/d ( or equivalent ) . Group comprehensive cognitive behavioral therapy was administered weekly for 14 sessions . MAIN OUTCOME MEASURES An independent blinded evaluator assessed response with the Brief Social Phobia Scale and Clinical Global Impressions scales as primary outcomes . A videotaped behavioral assessment served as a secondary outcome , using the Subjective Units of Distress Scale . Adverse effects were measured by self-rating . Each treatment was compared by means of chi2 tests and piecewise linear mixed-effects models . RESULTS Clinical Global Impressions scales response rates in the intention-to-treat sample were 29 ( 50.9 % ) ( FLU ) , 31 ( 51.7 % ) ( CCBT ) , 32 ( 54.2 % ) ( CCBT/FLU ) , 30 ( 50.8 % ) ( CCBT/PBO ) , and 19 ( 31.7 % ) ( PBO ) , with all treatments being significantly better than PBO . On the Brief Social Phobia Scale , all active treatments were superior to PBO . In the linear mixed-effects models analysis , FLU was more effective than CCBT/FLU , CCBT/PBO , and PBO at week 4 ; CCBT was also more effective than CCBT/FLU and CCBT/PBO . By the final visit , all active treatments were superior to PBO but did not differ from each other . Site effects were found for the Subjective Units of Distress Scale assessment , with FLU and CCBT/FLU superior to PBO at Duke University Medical Center , Durham , NC . Treatments were well tolerated . CONCLUSIONS All active treatments were superior to PBO on primary outcomes . Combined treatment did not yield any further advantage . Notwithst and ing the benefits of treatment , many patients remained symptomatic after 14 weeks BACKGROUND Maintenance of treatment effect is important for the choice of treatment for social phobia . AIMS To examine the effect of exposure therapy and sertraline 28 weeks after cessation of medical treatment . METHOD In this study 375 patients with social phobia were r and omised to treatment with sertraline or placebo for 24 weeks , with or without the addition of exposure therapy . Fifty-two weeks after inclusion , 328 patients were evaluated by the same psychometric tests as at baseline and the end of treatment ( 24 weeks ) . RESULTS The exposure therapy group and the placebo group had a further improvement in scores on social phobia during follow-up : mean change in the Clinical Global Impression - Social Phobia overall severity score was 0.45 ( 95 % CI 0.16 - 0.65 , P < 0.01 ) for the exposure group , and 0.25 ( 95 % CI 0.00 - 0.48 , P < 0.05 ) for the placebo group . At week 52 the sertraline plus exposure group and the sertraline-alone group had a significant deterioration on the 36-item Short Form Health Survey compared with exposure alone . CONCLUSIONS Exposure therapy alone yielded a further improvement during follow-up , whereas exposure therapy combined with sertraline and sertraline alone showed a tendency towards deterioration after the completion of treatment Sixty-five patients with social phobia were treated in a study that compared a cognitive-behavioral group treatment program with pharmacotherapy with alprazolam , phenelzine sulfate , or pill-placebo plus instructions for self-directed exposure to phobic stimuli . Statistically significant repeated- measures effects were shown on all measures , indicating that the treatments studied were associated with substantial improvements in patients with severe and chronic social phobia . Patients who were treated with phenelzine were rated by clinicians as more improved on a measure of work and social disability than patients who were treated with alprazolam or placebo ( patients in the cognitive-behavior therapy group were not rated on this measure ) . Subjects showed positive cognitive changes from before to after treatment , and there were no differences between treatment groups on the cognitive measure . We discuss the implication s of these findings within the context of demographic and clinical predictors of response BACKGROUND Moclobemide , a reversible inhibitor of monoamine oxidase A , previously has been reported to have efficacy in the treatment of social phobia . METHOD Seventy-seven non-responders to one week of single-blind placebo  were r and omly assigned to moclobemide or placebo for eight weeks of double-blind treatment . Outcome was assessed by independent evaluator , treating psychiatrist and self-ratings . After eight weeks , patients who were at least minimally improved continued treatment for a further eight weeks . RESULTS Intention-to-treat sample response rates at week 8 were 7/40 ( 17.5 % ) for the moclobemide group and 5/37 ( 13.5 % ) for placebo ( NS ) . Moclobemide was significantly superior to placebo on 2 of 10 primary outcome measures .  Moclobemide was well tolerated . CONCLUSIONS Moclobemide may have efficacy in the treatment of social phobia , but absence of significant differences on most primary outcome measures and small effect sizes for all outcome measures suggest that the magnitude of its clinical effect is small The past decade has brought major new developments in the psychopharmacologic management of generalized anxiety disorder and social phobia . We examined medication-prescribing patterns for the treatment of these anxiety disorders for 12 years to assess changes in patients ' anti-anxiety psychotropic medication usage during that period of evolving practice guidelines . We examined psychotropic medication use in 305 patients with generalized anxiety disorder and 232 with social phobia enrolled in the Harvard/Brown Anxiety Disorders Research Project ( HARP ) , a prospect i ve , longitudinal study of anxiety disorders .  Psychotropic treatment patterns seem to have remained relatively stable over 12 years with benzodiazepines the medications most commonly used for both generalized anxiety disorder and social phobia . Comparatively , selective serotonin reuptake inhibitor ( SSRI ) and venlafaxine usage as st and -alone medications for these disorders remained low throughout the follow-up period . At the 12-year follow-up , 24 % of patients with generalized anxiety disorder and 30 % of patients with social phobia were utilizing neither an  SSRI/selective norepinephrine reuptake inhibitor ( SNRI ) nor a benzodiazepine . Treatment recommendations for use of SSRIs and venlafaxine in the management of generalized anxiety disorder and social phobia initially promulgated in 1998 had a modest impact on changes in psychopharmacologic practice 4 - 5 years later . Difficulties in the implementation of treatment guidelines are discussed Clonazepam and placebo were administered in a double-blind pilot study to 75 out patients with social phobia . The mean maximum dose of clonazepam was 2.4 mg/day at endpoint ( range , 0.5 to 3 mg ) . Treatment was continued for up to 10 weeks . The results of an intent-to-treat analysis indicated superior effects of clonazepam on most measures . Response rates for clonazepam and placebo were 78.3 and 20.0 % . Drug effects were apparent on performance and generalized social anxiety , on fear and phobic avoidance , on interpersonal sensitivity , on fears of negative evaluation , and on disability measures . Significant differences were evident by week 1 , 2 , or 6 , depending upon the rating scale used . Clonazepam was well tolerated in general , although unsteadiness and dizziness were more severe and persistent than was the case for placebo subjects Eighty patients meeting DSM-IV criteria for social phobia were r and omly assigned to 10 weeks of residential cognitive therapy ( RCT ) or residential interpersonal therapy ( RIPT ) . Subjects were assessed at pretreatment , midtreatment , posttreatment , and 1 year after end of treatment . The patients reported chronic , highly comorbid social phobia . Most had tried other treatments without success . Existing individual treatment protocol s for cognitive therapy and interpersonal therapy were extensively modified for an integrated group , individual , and residential format . The RCT and RIPT patients improved significantly on the primary outcome measures from pre- to posttreatment . No significant differences were observed between treatments . Patients also completed three weekly secondary outcome measures ; on one , social role security , RCT was superior to RIPT . The entire sample reported continued improvement from posttreatment to 1-year follow-up , indicating that improvements were robust . RCT in the present trial was associated with less improvement compared to individual CT in other recent trials BACKGROUND Generalized social anxiety disorder is an early onset , highly chronic , frequently disabling disorder with a lifetime prevalence of approximately 13 % . The goal of the current study was to evaluate the efficacy and tolerability of sertraline for the treatment of severe generalized social anxiety disorder in adults . METHOD After a 1-week single-blind placebo lead-in period , patients with DSM-IV generalized social phobia were r and omly assigned to 12 weeks of double-blind treatment with flexible doses of sertraline ( 50 - 200 mg/day ) or placebo . Primary efficacy outcomes were the mean change in the Liebowitz Social Anxiety Scale ( LSAS ) total score and the responder rate for the Clinical Global Impressions-Improvement scale ( CGI-I ) , defined as a CGI-I score < /= 2 . Data were collected in 2000 and 2001 . RESULTS 211 patients were r and omly assigned to sertraline  ( intent-to-treat [ ITT ] sample , 205 ) , and 204 patients , to placebo  ( ITT sample , 196 ) . At week 12 , sertraline produced a significantly greater reduction in LSAS total score compared with placebo ( mean last-observation-carried-forward [ LOCF ] change from baseline : -31.0 vs. -21.7 ; p = .001 ) and a greater proportion of responders ( CGI-I score < /= 2 : 55.6 % vs. 29 % among week 12 completers and 46.8 % vs. 25.5 % in the ITT-LOCF sample ; p < .001 for both comparisons ) . Sertraline was well tolerated , with 7.6 % of patients discontinuing due to adverse events versus 2.9 % of placebo-treated patients . CONCLUSION The results of the current study confirm the efficacy of sertraline in the treatment of severe social anxiety disorder This study is aim ed at investigating the efficacy and tolerability of mirtazapine in a generalized social anxiety disorder . Sixty patients with generalized social anxiety disorder were r and omly allocated to receive mirtazapine ( 30–45 mg/day ) ( n=30 ) or placebo ( n=30 ) for 12 weeks in a double-blind study design . Primary efficacy was assessed by the Liebowitz Social Anxiety Scale ( LSAS ) and response to treatment was defined as a reduction of 40 % on the LSAS and an improvement on the Clinical Global Impression scale of ‘ much or very much improved ’ . An intent-to-treat analysis showed no difference between mirtazapine and placebo on the absolute LSAS scores with a mean decrease of 13.5±16.9 and 11.2±17.8 respectively , and on the number of responders , 13 and 13 % , respectively . In conclusion , mirtazapine ( 30–45 mg/day ) failed to be effective in the generalized social anxiety disorder The aim of the study was to assess the 6-months treatment efficacy and 24-month follow up of three different therapeutic programs ( A. moclobemide and supportive guidance , B. group cognitive-behavioral therapy and pill placebo , and C. combination of moclobemide and group cognitive-behavioral therapy ) in patients with a generalized form of social phobia . Eighty one patients ( 38 males and 43 females ) were r and omly assigned to three different therapeutic programs . Patients were regularly assessed on a monthly basis by an independent rater on the LSAS ( Liebowitz Social Anxiety scale ) , CGI ( Clinical Global Impression ) for severity and change and BAI ( Beck Anxiety Inventory ) . Altogether , sixty-six patients completed the six month treatment period and 15 patients dropped out . All therapeutic groups showed significant improvement . A combination of CBT and pharmacotherapy yielded the most rapid effect . Moclobemide was superior for the reduction of the subjective general anxiety ( BAI ) during the first 3 months of treatment , but its influence on avoidant behavior ( LSAS avoidance subscale ) was less pronounced . Conversely , CBT was the best choice for reduction of avoidant behavior while a reduction of subjective general anxiety appeared later than in moclobemide . After 6 months of treatment there were best results reached in groups treated with CBT and there was no advantage of the combined treatment . The relapse rate during the 24-month follow up was significantly lower in the group treated with CBT in comparison with the group A. formerly treated with moclobemide alone OBJECTIVE The purpose of this study was to determine the efficacy of fluvoxamine for the treatment of social phobia ( social anxiety disorder ) . METHOD In a 12-week multicenter , double-blind , r and omized , placebo-controlled trial , 92 patients with social phobia were treated with the selective serotonin reuptake inhibitor fluvoxamine ;  91.3 % of the patients had the generalized subtype of the disorder . The primary criterion for response was a rating of " much improved " or " very much improved " on the Clinical Global Impression of Improvement scale . Secondary response criteria were changes on three specialized rating scales for social phobia symptoms : the Brief Social Phobia Scale , the Social Phobia Inventory , and the Liebowitz Social Anxiety Scale . Psychosocial impairment was assessed in three domains ( disruption of work , social life , and home/family life ) by using the Sheehan Disability Scale . RESULTS The mean daily dose of fluvoxamine was 202 mg ( SD = 86 ) . At study end or with the last observation carried forward , within the evaluable subjects ( N = 86 ) there was a significantly higher proportion of responders in the fluvoxamine group ( 42.9 % , N = 18 ) than in the placebo group ( 22.7 % , N = 10 ) . Similarly , fluvoxamine was superior to placebo on all social phobia rating scales at week 8 and beyond . Fluvoxamine also result ed in significantly greater decreases in measures of psychosocial disability than did placebo . Overall , fluvoxamine was well tolerated and safe . CONCLUSIONS These findings indicate that fluvoxamine is efficacious in the pharmacologic management of serious forms of social phobia CONTEXT Cognitive therapy ( CT ) focuses on the modification of biased information processing and dysfunctional beliefs of social anxiety disorder ( SAD ) . Interpersonal psychotherapy ( IPT ) aims to change problematic interpersonal behavior patterns that may have an important role in the maintenance of SAD . No direct comparisons of the treatments for SAD in an outpatient setting exist . OBJECTIVE To compare the efficacy of CT , IPT , and a waiting-list control ( WLC ) condition . DESIGN R and omized controlled trial . SETTING Two academic outpatient treatment sites . Patients Of 254 potential participants screened , 117 had a primary diagnosis of SAD and were eligible for r and omization ; 106 participants completed the treatment or waiting phase . INTERVENTIONS Treatment comprised 16 individual sessions of either CT or IPT and 1 booster session . Twenty weeks after r and omization , posttreatment assessment was conducted and participants in the WLC received 1 of the treatments . MAIN OUTCOME MEASURES The primary outcome was treatment response on the Clinical Global Impression Improvement Scale as assessed by independent masked evaluators . The secondary outcome measures were independent assessor ratings using the Liebowitz Social Anxiety Scale , the Hamilton Rating Scale for Depression , and patient self-ratings of SAD symptoms . RESULTS At the posttreatment assessment , response rates were 65.8 % for CT , 42.1 % for IPT , and 7.3 % for WLC . Regarding response rates and Liebowitz Social Anxiety Scale scores , CT performed significantly better than did IPT , and both treatments were superior to WLC . At 1-year follow-up , the differences between CT and IPT were largely maintained , with significantly higher response rates in the CT vs the IPT group ( 68.4 % vs 31.6 % ) and better outcomes on the Liebowitz Social Anxiety Scale . No significant treatment × site interactions were noted . CONCLUSIONS Cognitive therapy and IPT led to considerable improvements that were maintained 1 year after treatment ; CT was more efficacious than was IPT in reducing social phobia symptoms While serotonergic antidepressants are now established as first-line pharamcotherapy for generalized social anxiety disorder ( SAD ) , other agents with different mechanisms have shown promise in treating SAD . The aim of this pilot study is to examine the efficacy and safety of levetiracetam ( LEV ) , an anticonvulsant with calcium channel modulating properties , in treating SAD . Adult out patients meeting DSM-IV criteria for SAD were r and omly assigned ( 2:1 ) to double-blind treatment with either LEV ( 500 - 3000mg/day ) or placebo ( PBO ) for 7 weeks . The primary outcome measures were the change from baseline in the Brief Social Phobia Scale ( BSPS ) and response using the Clinical Global Impression of Improvement scale ( CGI-I ) . The mean ( SD ) BSPS scores at baseline and endpoint were 45.4 ( 9.7 ) and 31.2 ( 19.7 ) for LEV ( n 9 ) , compared to 43.5 ( 8.4 ) and 37.8 ( 19.9 ) for PBO ( n 7 ) ( ITT ; ns ) . Rates of response were 22 % for LEV and 14 % for PBO using the CGI-I. Using a BSPS response criterion ( > 30 % reduction ) , response rates were 44 % for LEV and 14 % for PBO . The effect sizes of LEV relative to PBO were 0.33 for the BSPS and 0.50 for the LSAS . In summary , the results of this study , while negative on the pre-defined measures , suggest promise for LEV as a new treatment of SAD . Further work should be carried out with larger sample sizes and optimal dosing strategies of the drug Previous studies have shown selective and non-selective monoamine oxidase inhibitors ( MAOIs ) to be effective in the treatment of social phobia . In this study we investigated the efficacy of selective serotonin reuptake inhibitors ( SSRIs ) in social phobia . Thirty patients with social phobia ( DSM-IIIR ) were treated with the SSRI fluvoxamine ( 150 mg daily ) using a 12-week double-blind placebo controlled design . A substantial improvement was observed in seven ( 46 % ) patients on fluvoxamine and in one ( 7 % ) on placebo . Statistically significant effects were seen on measures of social anxiety and general ( or anticipatory ) anxiety in patients treated with fluvoxamine compared with placebo . The level of phobic avoidance decreased also but the difference at endpoint between fluvoxamine and placebo failed to reach statistical significance . It is concluded that treatment with the SSRI fluvoxamine has beneficial effects in patients suffering from social phobia , suggesting that serotonergic mechanisms might be implicated in social anxiety OBJECTIVE The authors evaluated the efficacy , safety , and tolerability of sertraline , a selective serotonin reuptake inhibitor , in the treatment of generalized social phobia . METHOD Adult out patients with generalized social phobia ( N=204 ) from 10 Canadian centers were r and omly assigned to receive sertraline or placebo in a 2:1 ratio for a 20-week double-blind study following a 1-week , single-blind , placebo run-in . The initial dose of sertraline was 50 mg/day with increases of 50 mg/day every 3 weeks permitted after the fourth week of treatment ( dosing was flexible up to a maximum of 200 mg/day ) . Primary efficacy assessment s were the percentage of patients rated much or very much improved on the Clinical Global Impression ( CGI ) improvement item and the mean changes from baseline to study endpoint in total score on the social phobia subscale of the Marks Fear Question naire and total score on the Brief Social Phobia Scale . RESULTS In intent-to-treat endpoint analyses of 203 of the patients , significantly more of the 134 patients given sertraline  ( N=71 [ 53 % ] ) than of the 69 patients receiving placebo  ( N=20 [ 29 % ] ) were considered responders according to their CGI improvement scores at the end of treatment . The mean reductions in the social phobia subscale of the Marks Fear Question naire and in the total score on the Brief Social Phobia Scale were 32.6 % and 34.3 % in the sertraline group and 10.8 % and 18.6 % in the placebo group , respectively . Analysis of covariance showed superiority of sertraline over placebo on all primary and secondary efficacy measures . Sertraline was well tolerated : 103 ( 76 % ) of the 135 sertraline-treated patients and 54 ( 78 % ) of the 69 placebo-treated patients completed the study . CONCLUSIONS Sertraline is an effective treatment for patients with generalized social phobia Seventy‐seven patients with a primary diagnosis of social phobia ( DSM‐III‐R ) were r and omized to treatment with the reversible and selective monoamine oxidase type A inhibitor brofaromine ( n= 37 ) or placebo ( n= 40 ) for 12 weeks in a double‐blind trial . A fixed dose of 150 mg/day or a matching placebo was given after a 2‐week dose titration phase . Patients with additional diagnoses of simple phobia , generalized anxiety disorder , dysthymia or major depressive disorder currently in remission were accepted . Patients with other Axis I mental disorders were excluded . In the brofaromine group , 78 % of the patients scored much or very much improved on the Clinical Global Impression scale compared with 23 % in the placebo group . The anxiety and avoidance scores on the Liebowitz Social Anxiety Scale ( LSAS ) were significantly reduced in favor of brofaromine . The clinical effects were not significantly correlated with the plasma concentration of brofaromine . After 12 weeks the brofaromine group scored significantly Jower than the placebo group on a core depression part of the Montgomery‐Åsberg Depressid Rating Scale . After 12 weeks of treatment the brofaromine group had significantly higher total scores on the LSAS than an age‐ and gender‐matched group of healthy controls . The brofaromine group improved further during 9‐month follow‐up treatment period , whereas 60 % of the placebo responders who continued long‐term treatment relapsed . The most common side effects in the brofaromine group were sleep disturbances , dry mouth and nausea A r and omized , double-blind , placebo-controlled , parallel-group study was conducted to evaluate the efficacy and safety of gabapentin in relieving the symptoms of social phobia . Sixty-nine patients were r and omly assigned to receive double-blind treatment with either gabapentin ( dosed flexibly between 900 and 3,600 mg daily in three divided doses ) or placebo for 14 weeks . A significant reduction ( p < 0.05 ) in the symptoms of social phobia was observed among patients on gabapentin compared with those on placebo as evaluated by clinician- and patient-rated scales . Results were similar for the intent-to-treat and week-2 completer population s. Adverse events were consistent with the known side effect profile of gabapentin .  Dizziness ( p = 0.05 ) , dry mouth ( p = 0.05 ) , somnolence , nausea , flatulence , and decreased libido occurred at a higher frequency among patients receiving gabapentin than among those receiving placebo .  No serious adverse events or deaths were reported . On the basis of these limited data , it seems that gabapentin offers a favorable risk-benefit ratio for the treatment of patients with social phobia .  Further studies are required to confirm this effect and to determine whether a dose-response relationship exists BACKGROUND The efficacy of selective serotonin reuptake inhibitors in the acute treatment of social anxiety disorder ( social phobia ) is well established . OBJECTIVE To evaluate whether the efficacy of paroxetine hydrochloride in this disorder is maintained in the long term . METHODS This was a placebo-controlled multicenter study comprising a single-blind acute treatment phase ( 12 weeks ) and a r and omized , double-blind maintenance treatment phase ( 24 weeks ) for patients who had responded to paroxetine during the acute phase . Four hundred thirty-seven adult patients with social anxiety disorder ( according to Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , criteria , code 300.23 ) entered the acute phase , and 323 continued into the maintenance phase ( 162 paroxetine and 161 placebo ) . The principal outcome measure was the proportion of patients relapsing during the maintenance phase . RESULTS Two hundred fifty-seven patients completed the study ( 136 paroxetine-treated and 121 placebo-treated patients ) . Significantly fewer patients relapsed in the paroxetine group than in the placebo group ( 14 % vs 39 % ; odds ratio , 0.24 ; 95 % confidence interval , 0.14 - 0.43 ; P<.001 ) . At the end of the study , a significantly greater proportion of patients in the paroxetine group showed improvement as shown on the Clinical Global Impression global improvement rating compared with the placebo group ( 78 % vs 51 % ; odds ratio , 3.66 ; 95 % confidence interval , 2.22 - 6.04 ; P<.001 ) . Compared with placebo , paroxetine treatment significantly ( P<.001 ) improved the symptoms of social anxiety as shown on the Liebowitz Social Anxiety Scale , Social Phobia Inventory , Sheehan Disability Scale , Symptom Checklist-90 score , and EuroQol visual analogue scale , indicating decreased disability and increased well-being .  Paroxetine was well tolerated . CONCLUSION Paroxetine is an effective long-term treatment for social anxiety disorder We conducted an 11-week forced-escalation open-label study of paroxetine in the treatment of 36 patients with generalized social phobia .  At the mean dosage of 47.9 + /- 6.2 mg/day , 23 of 30 completers ( 77 % ) were deemed responders on the basis of a clinician rating of either " very much improved " or " much improved " on the Clinical Global Impressions scale . Duke Social Phobia Scale ratings declined from 35.5 + /- 13.1 at baseline to 19.7 + /- 17.4 at week 11 ( p < 0.0005 ) , and Liebowitz Social Anxiety Scale ratings declined from 75.1 + /- 25.4 at baseline to 37.2 + /- 32.5 at week 11 ( p < 0.0005 ) . Sixteen responders were r and omized to an additional 12 weeks of either paroxetine ( with no dosage change ) or placebo ( after a taper period ) on a double-blind basis . To the best of our knowledge , this is the first controlled medication-discontinuation study in social phobia . One of eight patients r and omized to continue paroxetine  relapsed versus five of eight patients r and omized to placebo . These findings call for a double-blind , placebo-controlled treatment study of paroxetine in generalized social phobia . They also suggest that relapse rates are high if medication is discontinued early and that further study is needed to determine ( 1 ) the optimal duration of maintenance pharmacotherapy for social phobia and ( 2 ) if specific psychotherapeutic interventions before medication discontinuation may prevent relapse Social anxiety disorder ( SAD ) is one of the most common anxiety disorders . Reports have suggested an effect of the atypical antipsychotic quetiapine in anxiety disorders . Given these considerations , we conducted a controlled trial of quetiapine monotherapy in SAD . Fifteen patients were r and omized to quetiapine ( up to 400 mg/day ) or placebo for 8 weeks . The Brief Social Phobia Scale ( BSPS ) and the Clinical Global Impression of Improvement Scale ( CGI-I ) were the primary outcome measures , while the Social Phobia Inventory ( SPIN ) and the Sheehan Disability Inventory ( SDI ) were secondary measures . There was no significant difference on the BSPS score at endpoint between the quetiapine and placebo groups . There was a significant time effect but not a significant time x treatment group interaction , indicating that both the quetiapine and placebo patients did better over the course of the trial . 20 % of the quetiapine patients had a 50 % or greater drop in BSPS score at the end of the trial compared to baseline , while 0 % had such a drop in the placebo group . There was no significant difference in responders ( CGI-I score of 1 or 2 ) versus non-responder ( CGI-I score of 3 or more ) across the groups . However , 40 % of quetiapine patients and 0 % of the placebo patients showed much or very much improvement on the CGI-I. The Number Needed to Treat ( NNT ) to be a responder on the CGI-I was 3 . Significant time effects were noted for the SPIN and SDI , as well as a significant time x treatment effect in favor of quetiapine on the SPIN . Additionally , quetiapine showed a large effect size on the SPIN BACKGROUND Selective serotonin reuptake inhibitors ( SSRIs ) are the current gold st and ard in the pharmacologic treatment of generalized social phobia . SSRIs are only effective in approximately 50 % of individuals with generalized social phobia and can be associated with significant side effects . Based on the successful use of the anticonvulsants gabapentin and pregabalin in treating generalized social phobia , we conducted an open trial examining the efficacy of the glutamatergic and GABAergic anticonvulsant topiramate in the treatment of generalized social phobia . METHOD Twenty-three adult out patients with DSM-IV social phobia , generalized type , were entered into a 16-week open trial of topiramate , starting at 25 mg/day , and gradually titrated up to a maximum dose of 400 mg/day . RESULTS Twelve of 23 patients completed the trial . In the intent-to-treat ( ITT ) analysis , 11 ( 47.8 % ) of 23 were responders by a Clinical Global Impressions Improvement ( CGI-I ) scale rating of " much " or " very much " improved . The mean drop in the Liebowitz Social Anxiety Scale ( LSAS ) score for the ITT group was 29.4 % . The change in LSAS score from baseline to endpoint was significant for the ITT group ( F = 3.44 , df = 4,110 ; p = .01 ) . In the completers group , 9 ( 75.0 % ) of 12 were responders by CGI-I at 16 weeks , with a mean drop in LSAS score of 45.1 % . The rate of remission in the ITT sample , using a definition of an LSAS score of < /= 30 , gave a remission rate of 26.1 % ( 6/23 ) . CONCLUSION This study suggests that topiramate may be effective in the treatment of generalized social phobia . These results also suggest the possibility that the neurotransmitters glutamate and GABA may be involved in the neurobiology of generalized social phobia The current mainstays of social anxiety disorder pharmacotherapy are serotonergic agents , with less known about the efficacy of more noradrenergic drugs . Atomoxetine ( ATM ) , a highly selective norepinephrine reuptake inhibitor , is currently approved for the treatment of attention-deficit/hyperactivity disorder ( ADHD ) . We describe the first controlled trial of ATM with respect to efficacy and tolerability in adults with the generalized subtype of social anxiety disorder ( GSAD ) without comorbid ADHD . Twenty-seven out patients with clinical ly prevailing diagnoses of GSAD by the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition were r and omized in a 1:1 ratio to 10 weeks of double-blind flexible-dose treatment with either ATM 40 - 100 mg per day ( n = 14 ) or placebo ( n = 13 ) . Primary efficacy outcome was score at end point on the Liebowitz Social Anxiety Scale in the intention-to-treat sample . There were no significant group differences in patients completing the study ( ATM  , 79 % ; placebo  , 77 % ) . Whereas ATM was well tolerated , there were no significant differences in clinical efficacy between ATM and placebo for GSAD . There were few responders overall ( ATM , 21 % ; placebo , 33 % ) , but proportions were similar in each group ( & khgr;2 [ 1 , 26 ] = 0.47 ; P = 0.67 ) . Analysis of variance with repeated measures on the Liebowitz Social Anxiety Scale was performed to detect any differential change in social anxiety symptoms between groups . A significant time effect was found ( F = 8.71 ; P = 0.007 ) , but the time-by-treatment interaction was nonsignificant ( F = 0.013 ; P = 0.91 ) . Although the small sample size limits confidence in the reported results , the comparable , and low , response rates for ATM and placebo suggest that in the absence of comorbid ADHD , ATM is unlikely to be an effective agent for the treatment of GSAD Mindfulness-based stress reduction ( MBSR ) has been reported to reduce anxiety in a broad range of clinical population s. However , its efficacy in alleviating core symptoms of specific anxiety disorders is not well established . We conducted a r and omized trial to evaluate how well MBSR compared to a first-line psychological intervention for social anxiety disorder ( SAD ) . Fifty-three patients with DSM-IV generalized SAD were r and omized to an 8-week course of MBSR or 12 weekly sessions of cognitive-behavioral group therapy ( CBGT ) . Although patients in both treatment groups improved , patients receiving CBGT had significantly lower scores on clinician- and patient-rated measures of social anxiety . Response and remission rates were also significantly greater with CBGT . Both interventions were comparable in improving mood , functionality and quality of life . The results confirm that CBGT is the treatment of choice of generalized SAD and suggest that MBSR may have some benefit in the treatment of generalized SAD Rationale There is a need for new pharmacological treatments for  generalized social anxiety disorder ( GSAD ) , which is a common , often disabling condition . Objective To compare the efficacy and safety over 6 months duration of two dose ranges of venlafaxine extended-release ( ER ) with placebo in patients with GSAD . Method Twenty-eight-week , double-blind , multi-center study in 386 adult out patients with DSM-IV GSAD . Patients were r and omized to placebo , venlafaxine ER fixed low dose ( 75 mg/day ) , or venlafaxine ER flexible higher dose ( 150–225 mg/day ) . Primary efficacy variable was change on the Liebowitz Social Anxiety Scale ( LSAS ) . Secondary efficacy variables included , among others , the proportion of responders on the CGI Global Improvement Item ( score 1 or 2 ) , and the proportion of remitters ( defined as an LSAS score of ≤30 ) . Results Improvement on the LSAS was greater with venlafaxine ER ( at 75 mg/day or 150–225 mg/day ) than placebo , and was sustained throughout the 6-month trial . Of patients  receiving venlafaxine ER ( at any dose ) , 58 % responded to treatment compared to 33 % of those receiving placebo ( P<0.001 ) ; corresponding remission rates were 31 % and 16 % ( P<0.01 ) . There were no differences in outcome according to venlafaxine ER dosage . Conclusions Venlafaxine ER was effective in the treatment of GSAD . The comparable efficacy at low and higher doses may indicate that norepinephrine reuptake blockade does not contribute to therapeutic effect in GSAD . This hypothesis should be tested using agents with specific actions on norepinephrine reuptake blockade Abstract : Social phobia is an anxiety disorder characterized by extreme fear and phobic avoidance of social and performance situations and by a relatively poor health-related quality of life . The goal of this study was to compare the efficacy of mirtazapine versus placebo in the treatment of patients with social phobia . In 2004 , we conducted a r and omized , double-blind , placebo-controlled study of mirtazapine in 66 female subjects from the general population meeting the criteria for social phobia . The subjects were r and omly assigned in a 1:1 manner to mirtazapine ( n = 33 ) or placebo ( n = 33 ) . The treatment lasted 10 weeks . Seven patients dropped out . Primary outcome measures were self-reported changes on the Social Phobia Inventory , Liebowitz Social Anxiety Scale , and Health Survey ( SF-36 ) . In comparison with the placebo group and according to the intent-to-treat principle , significant differences on the Social Phobia Inventory and Liebowitz Social Anxiety Scale scales ( all P < 0.001 ) , as well as on most ( 5 from 8) scales of SF-36 ( all P < 0.001 ) , were observed in the mirtazapine-treated subjects . All patients tolerated mirtazapine relatively well . Mirtazapine appears to be an effective agent in the treatment of  social phobia in women and in the improvement of their health-related quality of life BACKGROUND Both psychodynamic group therapy ( PGT ) and clonazepam are used as treatment strategies in reducing symptoms of generalized social anxiety disorder ( GSAD ) . However , many individuals remain symptomatic after treatment with PGT or clonazepam . METHOD Fifty-eight adult out patients with a diagnosis of GSAD according to DSM-IV were r and omized to 12 weeks PGT plus clonazepam or clonazepam . The Clinical Global Impression-Improvement ( CGI-I ) Scale was the primary efficacy measure . Secondary efficacy measures included the Liebowitz Social Anxiety Scale ( LSAS ) total score , the World Health Organization Instrument to Assess Quality of Life-Brief ( WHOQOL-Bref ) Scale and the Beck Depression Inventory ( BDI ) . RESULTS CGI-I data from 57 patients ( intent-to-treat population ) showed that patients who received PGT plus clonazepam presented significantly greater improvement than those who received clonazepam ( P=0.033 ) . There were no significant differences between the two groups in the secondary efficacy measures . CONCLUSIONS Our study suggests that the combination of PGT with clonazepam may be a promising strategy for the treatment of GSAD , regarding gains in the global functioning . However the present study failed to detect more specific changes in social anxiety symptomatology between the two groups The aim of this study was to evaluate the efficacy , tolerability , and effects on quality of life of sertraline , a selective serotonin reuptake inhibitor , in the prevention of relapse of generalized social phobia .  Fifty adult out patients with generalized social phobia who were rated much or very much improved on the Clinical Global Impression Scale of Improvement ( CGI-I ) after 20 weeks of sertraline treatment ( 50 - 200 mg/day ) were r and omly assigned in a one-to-one ratio to either continue double-blind treatment with sertraline or immediately switch to placebo for another 24 weeks . The initial 20-week study was placebo-controlled , and 15 responders to placebo also continued to receive double-blind placebo treatment in the continuation study . Eighty-eight percent of patients in the sertraline-continuation group and only 40 % of patients in the placebo-switch and placebo-responder groups completed the study . In intent-to-treat endpoint analyses , 1 ( 4 % ) of 25 patients in the sertraline-continuation group and 9 ( 36 % ) of 25 patients in the placebo-switch group had relapsed at study endpoint ( chi2 = 8.0 , Fisher exact test , p = 0.01 ) . The relative risk ( hazards ratio ) for relapse associated with placebo-switch relative to sertraline-continuation treatment was 10.2 ( 95 % confidence interval , 1.3 - 80.7 ) . Mean CGI-Severity , Marks Fear Question naire ( MFQ ) Social Phobia subscale , and Duke Brief Social Phobia Scale ( BSPS ) total scores were reduced by 0.07 , 0.34 , and 1.86 in the Sertraline-Continuation group and increased by 0.88 , 4.09 , and 5.99 in the Placebo-Switch group ( all F > 5.3 , p < 0.03 ) , respectively . CGI-Severity , MFQ Social Phobia subscale , and BSPS scores also increased in the Placebo-Responder group . Discontinuations because of lack of efficacy were 4 % in the sertraline-continuation group , 28 % in the placebo-switch group ( chi2 = 5.36 , Fisher exact test , p = 0.049 ) , relative to sertraline , and 27 % in the placebo-responder group . Sertraline was effective in preventing relapse of generalized social phobia . Future research should assess whether improvements may be maintained or further increased by longer periods of treatment or through the addition of cognitive-behavioral techniques BACKGROUND This article presents results of the acute treatment phase of a 2-site study comparing cognitive behavioral group therapy ( CBGT ) and treatment with the monoamine oxidase inhibitor phenelzine sulfate for social phobia . METHODS One hundred thirty-three patients from 2 sites received 12 weeks of CBGT , phenelzine therapy , pill placebo administration , or educational-supportive group therapy ( an attention-placebo treatment of equal credibility to CBGT ) . The " allegiance effect , " ie , the tendency for treatments to seem most efficacious in setting s of similar theoretical orientation and less efficacious in theoretically divergent setting s , was also examined by comparing responses to the treatment conditions at both sites : 1 known for pharmacological treatment of anxiety disorders and the other for cognitive behavioral treatment . RESULTS After 12 weeks , phenelzine therapy and CBGT led to superior response rates and greater change on dimensional measures than did either control condition . However , response to phenelzine therapy was more evident after 6 weeks , and phenelzine therapy was also superior to CBGT after 12 weeks on some measures . There were few differences between sites , suggesting that these treatments can be efficacious at facilities with differing theoretical allegiances . CONCLUSIONS After 12 weeks , both phenelzine therapy and CBGT were associated with marked positive response . Although phenelzine therapy was superior to CBGT on some measures , both were more efficacious than the control conditions . More extended cognitive behavioral treatment and the combination of modalities may enhance treatment effect The objective of this study was to evaluate the efficacy and tolerability of pregabalin for the treatment of generalized social anxiety disorder ( SAD ) . Patients with generalized SAD , who met the Diagnostic and Statistical Manual of Mental Disorders ( fourth edition ) criteria ( total N=329 ) , were r and omly assigned to 11 weeks of double-blind treatment with fixed daily doses of either pregabalin ( 300 , 450 , and 600(mg ) or placebo . The treatment with pregabalin ( 600(mg ) was associated with a significantly greater mean reduction in the Liebowitz Social Anxiety Scale total score , from baseline to endpoint , compared with placebo ( -29.8 vs. -19.7 ; P= 0.0099 ) , whereas reduction on pregabalin ( 300(mg , -20.2 ) and pregabalin ( 450(mg , -25.5 ) was not significant Treatment with pregabalin ( 600(mg ) was also associated with a significantly greater improvement than placebo on the fear and avoidance subscales of the Liebowitz Social Anxiety Scale , as well as the majority of other secondary measures . Onset of improvement occurred by week 1 in the pregabalin 600-mg dose group . The most common adverse events on all three doses of pregabalin were somnolence and dizziness . Consistent with a previous study , the results of this study suggest that the 600-mg dose of pregabalin per day may be efficacious in the treatment of SAD OBJECTIVE This is the first trial examining duloxetine for  generalized social anxiety disorder ( GSAD ) and the effect of increased dose for those without early remission . METHODS Individuals ( n=39 ) with GSAD received 6 weeks of open-label duloxetine 60 mg/day ; those with a Liebowitz Social Anxiety Disorder Scale ( LSAS ) score > 30 at week 6 were r and omized in double-blind fashion to an additional 18 weeks of continued duloxetine 60 mg/day or to duloxetine 120 mg/day . RESULTS Duloxetine was associated with a significant LSAS reduction at week 6 ( 91.3 [ 17.7 ] to 69.8 [ 28.5 ] , paired t [df]=5.2 [ 38 ] , P<.0001 ) , and r and omized participants overall continued to improve at week 24 ( 74.6 [ 23.9 ] to 60.3 [ 29.7 ] ; paired t [df]=3.3 [ 27 ] , P=.0026 ) . Though the increased dose strategy was associated with a moderate effect size ( Cohen 's d=.57 ) , there was no significant difference at week 24 endpoint in LSAS reduction ( 20.5 [ 26.0 ] versus 7.3 [ 17.2 ] , t [df]=1.6 [ 26 ] , P=.13 ) nor remission ( 33 % versus 8 % ) for duloxetine with dose increased to 120 mg/day compared to duloxetine continued at 60 mg/day . Overall , 44 % ( 17/39 ) discontinued prior to week 24 . CONCLUSIONS Though with limited power , these data provide preliminary support for the efficacy of duloxetine for GSAD , and suggest continued improvement but limited remission overall at 24 weeks for individuals remaining symptomatic at week 6 . These observations warrant further controlled study BACKGROUND No controlled trial of treatment of generalised social phobia has been conducted in general practice . AIMS To examine the efficacy of sertraline or exposure therapy , administered alone or in combination in this setting . METHOD Study was of a r and omised , double-blind design . Patients ( n = 387 ) received sertraline 50 - 150 mg or placebo for 24 weeks . Patients were additionally r and omised to exposure therapy or general medical care . RESULTS  Sertraline-treated  patients were significantly more improved than non-sertraline-treated patients ( chi(2)=12.53 , P<0.001 ; odds ratio=0.534 ; 95 % Cl 0.347 - 0.835 ) . No significant difference was observed between exposure- and non-exposure-treated patients ( chi(2)=2.18 , P=0.140 ; odds ratio=0.732 ; 95 % Cl 0.475 - 1.134 ) . In the pairwise comparisons , combined sertraline and exposure ( chi(2)=12.32 ; P<0.001 ) and sertraline ( chi(2)=10.13 ; P=0.002 ) were significantly superior to placebo . CONCLUSIONS Sertraline is an effective treatment for generalised social phobia . Combined treatment with sertraline and exposure therapy , conducted by the general practitioner , may enhance the treatment efficacy in primary care The objective of the study was to examine the efficacy of fluoxetine in  social phobia . Sixty subjects were r and omly assigned to 14 weeks of double-blind therapy with either fluoxetine or placebo . Dose was fixed at 20 mg for fluoxetine during the first 8 weeks of double-blind treatment ; during the final 6 weeks , the dose could be increased every two weeks by 20 mg to a maximum of 60 mg/day . An intentto-treat analysis was used . A significant change from baseline to endpoint was found for both fluoxetine and placebo on the Liebowitz Social Anxiety Scale . However , no significant difference was found between fluoxetine and placebo . The change for fluoxetine was somewhat lower than that found with other selective serotonin reuptake inhibitors , whereas the placebo response was greater .  Fluoxetine failed to separate from placebo in this trial . It is unknown whether a larger dose for longer duration would have yielded separation from placebo . A higher than usual  placebo response rate was found Escitalopram has demonstrated efficacy for the acute treatment of social anxiety disorder ( SAD ) in two placebo-controlled trials and for long-term treatment in a relapse-prevention study . Social anxiety disorder is a heterogeneous disorder . This study questions whether this new selective serotonin reuptake inhibitor is effective across different subgroups of patients . Data from two r and omised , placebo-controlled , 12-week escitalopram SAD trials were pooled . General linear models were used to determine the efficacy of escitalopram in different patient subgroups . Furthermore , a factor analysis of the primary efficacy scale , the Liebowitz Social Anxiety Scale ( LSAS ) , was undertaken , and a determination made of whether treatment effects were similar for the different symptom dimensions . Escitalopram was effective in both younger and older patients , in male and female patients , and in patients with more and less severe social anxiety symptoms .  The LSAS factor analysis showed six factors , which were differentially associated with different areas of disability .  Escitalopram was significantly superior to placebo for all six symptom dimensions . The treatment effects of escitalopram were independent of gender , symptom severity and chronicity , and comorbid depressive symptoms . A six-factor model of social anxiety symptoms is supported by the distinctive association between these symptom dimensions and different areas of disability , but did not predict differential response to escitalopram Social phobia ( social anxiety disorder ) is a highly prevalent and chronic disorder that is associated with significant comorbidity and disability . Despite recent advances in the pharmacotherapy of the disorder , there is a paucity of r and omized controlled trials on patients with comorbid disorders and on maintenance treatment . A r and omized placebo-controlled , double-blind multi-site trial of moclobemide , a reversible inhibitor of monoamine oxidase A , was undertaken with 390 subjects . After an initial 12 weeks , there was the option of continuing for an additional 6 months of treatment . The primary efficacy parameter chosen was responder status as defined by the Clinical Global Impression scale change item . From week 4 onwards , there was a significantly higher response rate on moclobemide than on placebo .  Superiority of medication over placebo was similar in patients with comorbid anxiety disorders ( 33 % of subjects ) and without , as well as in patients with different subtypes of social anxiety disorder ; indeed , treatment with moclobemide rather than placebo was the strongest predictor of response . Adverse events were similar across treatment groups , and were typically mild and transient . In the extension phase , response rates remained higher in the moclobemide group , and ratings of tolerability were equally high in both groups . Thus , in a large sample of social anxiety disorder patients with and without comorbid anxiety disorders , moclobemide was both effective and well-tolerated in the short as well as long-term . These data confirm and extend previous findings on the value of moclobemide in the treatment of social anxiety disorder , and strengthen the range of therapeutic options for managing this important disorder Patients with social phobia who responded well to 6 months of open-label treatment with clonazepam  were assigned to receive either continuation treatment ( CT ) with clonazepam for another 5 months , or to undergo discontinuation treatment ( DT ) using a clonazepam taper at the rate of 0.25 mg every 2 weeks , with double-blind placebo substitution . Clinical efficacy was compared between the CT and DT groups using three different social phobia scales . Benzodiazepine withdrawal symptoms were also measured . Relapse rates were 0 and 21.1 % in the CT and DT groups , respectively . Subjects in the CT group generally showed a more favorable clinical response at midpoint and /or endpoint , although even in the DT group clinical response remained good . With respect to withdrawal symptoms , the rates were low in both groups ( 12.5 % for CT and 27.7 % for DT ) with no real evidence suggesting significant withdrawal difficulties . At the end of 11 months of treatment with clonazepam , however , a more rapid withdrawal rate was associated with greater distress . This study offers preliminary evidence to suggest that continuation therapy with clonazepam in the treatment of social phobia is safe and effective , producing a somewhat greater clinical benefit than a slow-taper discontinuation regime . However , even in the DT group , withdrawal symptoms were not found to be a major problem . The study can be taken as supportive of benefit for longterm clonazepam treatment in social phobia , as well as being compatible with a reasonably good outcome after short-term treatment and slow taper We report the results of an 8-week open trial of imipramine in 15 patients with social phobia . Nine patients completed the trial ; six dropped out early because of adverse effects .  The mean reduction in the Liebowitz Social Anxiety Scale was 15 % and 18 % for the intent-to-treat and completer groups , respectively ; the overall response rate ( based on the Clinical Global Impression Scale of 1 or 2 , very much or much improved ) was 20 % ( 3/15 ) and 22 % ( 2/9 ) , respectively . The results from this open trial do not support the efficacy of imipramine as a treatment for social phobia We summarise a series of studies using a MAOI to help establish the validity of a subgroup of depressives referred to as atypical depressives . Patients with reactive mood meeting DSM-III criteria for depressive illness who had associated atypical features ( which include hyperphagia , hypersomnolence , leaden paralysis , and rejection sensitivity ) were r and omised to imipramine , phenelzine and placebo . Non-responders were crossed over , and in all there were over 400 patient trials .  Phenelzine consistently was found to be superior to imipramine . Only in trials which included patients lacking atypical ,  vegetative symptoms  was imipramine found to equal phenelzine . We conclude that the research er and the clinician should consider the relevance of the atypical depressive syndrome BACKGROUND Generalized social anxiety disorder is a debilitating psychiatric illness characterized by maladaptive thoughts about social situations . This double-blind study evaluated the anxiolytic efficacy , safety , and tolerability of venlafaxine extended release ( ER ) in adult out- patients with generalized social anxiety disorder . METHOD Patients were r and omly assigned to receive 12 weeks of treatment with a flexible dose of venlafaxine ER ( 75 to 225 mg/day ) or placebo . The Liebowitz Social Anxiety Scale ( LSAS ) total score was the primary efficacy variable . Secondary efficacy variables included scores on the Clinical Global Impressions-Severity of Illness ( CGI-S ) and -Improvement ( CGI-I ) scales , Social Phobia Inventory ( SPIN ) , and LSAS subscales . Response was defined as a CGI-I score of 1 or 2 . Two definitions of remission were used : LSAS total score < or = 30 and CGI-I score of 1 . RESULTS Data from 271 patients ( intent-to-treat population ) were analyzed for efficacy ; 279 patients were analyzed for safety . Overall , 173 patients completed the study . Improvement on the LSAS was significantly greater with venlafaxine ER treatment than with placebo at weeks 6 through 12 ( p < .05 , weeks 6 and 8 ; p < .01 , week 10 ; and p < .001 , week 12 ) and at weeks 8 through 12 based on CGI-S and SPIN scores . Week 12 response and remission ( LSAS score < or = 30 ) rates were significantly greater in the venlafaxine ER group than in the placebo group ( response : 44 % vs. 30 % , respectively , p = .018 ; remission : 20 % vs. 7 % , respectively , p < .01 ) . Patients experienced no unexpected or serious adverse events . CONCLUSION Venlafaxine ER is safe , well tolerated , and efficacious in the short-term treatment of generalized social anxiety disorder OBJECTIVE Numerous studies have demonstrated the efficacy of serotonergic antidepres-sants , particularly the selective serotonin reuptake inhibitors ( SSRIs ) , in the treatment of social phobia . We evaluated the efficacy , safety , and tolerability of nefazodone , a 5-HT(2 ) antagonist , in patients with generalized social phobia ( GSP ) . METHOD One hundred five patients with GSP ( confirmed using the Structured Clinical Interview for DSM-IV ) from 4 Canadian outpatient anxiety clinics were assigned r and omly to nefazodone ( 300 - 600 mg/day , flexible dose ) or placebo for 14 weeks of double-blind treatment . Data were collected from October 12 , 1999 , through December 8 , 2001 . Primary efficacy outcomes were the Clinical Global Impressions-Improvement scale ( CGI-I ) score and the Liebowitz Social Anxiety Scale score . RESULTS In the intent-to-treat sample , 16 ( 31.4 % ) of 51 subjects taking nefazodone and 12 ( 23.5 % ) of 51 subjects taking placebo were rated as much or very much improved on the CGI-I at endpoint ( chi(2 ) = 0.79 , p = .38 ) . With the exception of the Social Phobia Scale , no significant differences were found in measures of social phobia when comparing the nefazodone and placebo groups . CONCLUSION These findings suggest that nefazodone is not an effective agent in the treatment of GSP . These data parallel some recent findings with the use of the SSRI fluoxetine in GSP . The lack of efficacy of 2 serotonergic antidepressants in GSP suggests that serotonin reuptake inhibition may not be the only mechanism of action required for efficacy to occur in the treatment of GSP The safety and efficacy of brofaromine , a reversible and selective monoamine oxidase inhibitor , were examined in a multicenter trial of 102 out patients with social phobia . After a 1-week placebo washout , subjects were r and omly assigned to 10 weeks of treatment with either brofaromine ( N = 52 ) or placebo ( N = 50 ) . Brofaromine dosage began at 50 mg/day and was titrated to a maximum of 150 mg/day , depending on treatment response . Brofaromine produced a significantly greater change from baseline in Liebowitz Social Anxiety Scale ( LSAS ) scores compared with placebo , F(1 ) = 6.01 , p < 0.016 . Mean LSAS scores decreased from 81.8 at baseline to 62.6 at endpoint for brofaromine , t = 5.41,p < 0.001 , and from 79.8 to 70.7 for placebo , t = 3.66 , p < 0.001 . Eleven of the 14 brofaromine  early terminators discontinued because of adverse experiences , as did 4 of the 17 placebo early terminators . Side effects more common with brofaromine than placebo included insomnia , dizziness , dry mouth , anorexia , tinnitus , and tremor . No clinical ly significant variations in vital signs or laboratory values were found . The findings are consistent with the clinical efficacy for the treatment of social phobia CONTEXT Medication and cognitive behavioral treatment are the best-established treatments for social anxiety disorder , yet many individuals remain symptomatic after treatment . OBJECTIVE To determine whether combined medication and cognitive behavioral treatment is superior to either monotherapy or pill placebo . DESIGN R and omized , double-blind , placebo-controlled trial . SETTING Research clinics at Columbia University and Temple University . PARTICIPANTS One hundred twenty-eight individuals with a primary DSM-IV diagnosis of social anxiety disorder . INTERVENTIONS Cognitive behavioral group therapy ( CBGT ) , phenelzine sulfate , pill placebo , and combined CBGT plus phenelzine . MAIN OUTCOME MEASURES Liebowitz Social Anxiety Scale and Clinical Global Impression ( CGI ) scale scores at weeks 12 and 24 . RESULTS Linear mixed-effects models showed a specific order of effects , with steepest reductions in Liebowitz Social Anxiety Scale scores for the combined group , followed by the monotherapies , and the least reduction in the placebo group ( Williams test = 4.97 , P < .01 ) . The CGI response rates in the intention-to-treat sample at week 12 were 9 of 27 ( 33.3 % ) ( placebo ) , 16 of 34 ( 47.1 % ) ( CBGT ) , 19 of 35 ( 54.3 % ) ( phenelzine ) , and 23 of 32 ( 71.9 % ) ( combined treatment ) ( chi(2)(1 ) = 8.76 , P < .01 ) . Corresponding remission rates ( CGI = 1 ) were 2 of 27 ( 7.4 % ) , 3 of 34 ( 8.8 % ) , 8 of 35 ( 22.9 % ) , and 15 of 32 ( 46.9 % ) ( chi(2)(1 ) = 15.92 , P < .01 ) . At week 24 , response rates were 9 of 27 ( 33.3 % ) , 18 of 34 ( 52.9 % ) , 17 of 35 ( 48.6 % ) , and 25 of 32 ( 78.1 % ) ( chi(2)(1 ) = 12.02 , P = .001 ) . Remission rates were 4 of 27 ( 14.8 % ) , 8 of 34 ( 23.5 % ) , 9 of 35 ( 25.7 % ) , and 17 of 32 ( 53.1 % ) ( chi(2)(1 ) = 10.72 , P = .001 ) . CONCLUSION Combined phenelzine and CBGT treatment is superior to either treatment alone and to placebo on dimensional measures and on rates of response and remission Objective : To compare the effectiveness of Internet cognitive behaviour therapy ( CBT ) with face-to-face CBT in social phobia . Methods : R and omized controlled trial of 75 patients with social phobia referred to an anxiety disorders clinic . A total of 37 patients participated , and post-treatment data was obtained from 25 Subjects ( Ss ) . An intention to treat analysis was used . The same therapist ( M.D. ) treated both groups . Results : Both groups made significant progress on symptoms and disability measures . There were no significant differences in outcome between the Internet and face-to-face groups . The total amount of therapist time required was 18 min per patient for the Internet group and 240 min per patient for the face-to-face group . Conclusions : Both forms of treatment were equally effective and this is consistent with previous findings in depression and panic disorder . The difference in clinician time required was substantial . If Internet CBT was offered as ‘ st and ard of care ’ the staff time saved would permit a stepped care model in which in-depth therapy for the difficult to recover patients could be provided without an increase in staff OBJECTIVE This multicenter , double-blind , placebo-controlled , 2-arm , parallel-group study was carried out to determine the effectiveness and safety of the novel anticonvulsant levetiracetam for the treatment of generalized social anxiety disorder ( GSAD ) . METHOD After a 1-week , single-blind , placebo run-in period , 217 adult out patients meeting DSM-IV criteria for social anxiety disorder , generalized type , were r and omly assigned ( 1:1 ) to 12 weeks of double-blind treatment with either levetiracetam ( n = 111 ) or placebo ( n = 106 ) . Participants were required to have scores of > or= 60 on the Liebowitz Social Anxiety Scale ( LSAS ) and a total score of < or= 17 on the 17-item Hamilton Depression Rating Scale ( HDRS ) .  The primary outcome measure was mean change from baseline on LSAS total score .  Levetiracetam was initiated at 250 mg/d and flexibly titrated up to a maximum dose of 3,000 mg/d ( 1,500 mg bid ) . Dosage was held stable for the last 6 weeks of treatment . The study was conducted from September 2003 to June 2004 . RESULTS No statistically significant difference was found between the adjusted mean changes in LSAS score for levetiracetam ( -24.4 ) and placebo ( -28.7 ) using an efficacy intent-to-treat , last- observation-carried-forward analysis . Rates of response ( > or= 30 % reduction in LSAS score ) were similar with 41.3 % ( levetiracetam ) and 46.6 % ( placebo ) . No significant between-group differences were found on secondary outcome measures , which included changes in Sheehan Disability Scale , Clinical Global Impression of Change , and HDRS scores . CONCLUSIONS Although well-tolerated , levetiracetam failed to separate from placebo in this trial for the treatment of moderate to severe GSAD BACKGROUND Preliminary studies have suggested that paroxetine may be effective in social phobia/social anxiety disorder . AIMS To assess the efficacy and tolerability of paroxetine in the acute ( 12-week ) treatment of social phobia . METHOD Two-hundred and ninety patients with social phobia were assigned r and omly to paroxetine ( 20 - 50 mg/day flexible dose ) or placebo for 12 weeks of double-blind treatment . Primary efficacy outcomes were the Liebowitz Social Anxiety Scale ( LSAS ) total score ( patient-rated ) and the Clinical Global Impression ( CGI ) scale global improvement item . The secondary efficacy variables included CGI scale severity of illness score and the patient-rated Social Avoidance and Distress Scale . RESULTS Paroxetine produced a significantly greater reduction in LSAS total score ( mean change from baseline : -29.4 v. -15.6 ; P < or = 0.001 ) and a greater proportion of responders ( score < or = 2 on CGI global improvement ) ( 65.7 % v. 32.4 % ; P < 0.001 ) compared with placebo at the end of the 12-week study period . Both primary efficacy variables were statistically significant compared with placebo from week 4 onwards . Paroxetine was generally well tolerated . CONCLUSIONS Paroxetine is an effective , well-tolerated treatment for patients with social phobia BACKGROUND Generalized social anxiety disorder ( GSAD ) is a pervasive form of social anxiety that affects approximately 5 % of persons in the community . Among evidence -based pharmacologic treatments for the disorder , selective serotonin reuptake inhibitors ( SSRIs ) have become widely used and are known to be efficacious . Monotherapy with the benzodiazepine clonazepam is also efficacious for GSAD , but the adjunctive use of clonazepam with an SSRI to potentially improve outcomes has not been studied to date . METHOD Twenty-eight patients ( 22 men and 6 women ) with DSM-IV-defined GSAD were r and omly assigned to receive double-blind clonazepam ( or placebo ) , 1.0 to 2.0 mg/day ( divided b.i.d . ) along with open-label paroxetine , 20 to 40 mg/day , for 10 weeks . A 2-week taper of double-blind medication was followed by an additional 8 weeks of open-label paroxetine treatment ( during which the dose of paroxetine could be increased to a maximum of 50 mg/day ) . Twenty-three patients ( 82 % ) met DSM-IV criteria for avoidant personality disorder . The patients ' mean + /- SD age was 31.2 + /- 7.7 years , and their mean duration of illness was 12.1 + /- 5.8 years . Data were gathered from August 2001 to April 2002 . RESULTS Nineteen ( 68 % ) of 28 patients completed treatment . At the end of the 10-week double-blind treatment , there was a trend ( p < .06 ) favoring the paroxetine/clonazepam group , who had a 79 % response rate ( Clinical Global Impressions-Global Improvement scale [ CGI-I ] score of 1 or 2 ) compared with a 43 % response rate for the paroxetine/placebo group . However , no significant differences on other outcome measures were noted between the 2 groups in an intent-to-treat analysis , in terms of either very early ( 2 - 4 weeks ) or not as early ( 5 - 10 weeks ) responses during treatment . Dropout rates due to adverse events were rare ( 1 patient in each group ) , indicating that the paroxetine/clonazepam combination was well tolerated . CONCLUSION Coadministration of clonazepam with an SSRI , in contrast to findings in panic disorder , did not lead to more rapid resolution of symptoms in GSAD . On the other h and , there is some evidence that the clonazepam-added group had superior global outcomes ( e.g. , as measured on the CGI-I ) , although power to detect such differences in this study was small . These observations suggest that a role for adjunctive benzodiazepines in patients with GSAD ( e.g. , for augmenting SSRI partial response or nonresponse ) is deserving of further controlled investigation There is circumstantial evidence that antidepressants , particularly monoamine oxidase inhibitors ( MAOIs ) and beta-blockers , may have some beneficial effects in social phobia . In this study 30 patients with social phobia ( DSM-IIIR ) were treated with the selective and reversible MAO-A inhibitor brofaromine , using a 12-week double-blind placebo controlled design . A clinical relevant improvement was seen in 80 % of the patients treated with brofaromine ( 150 mg daily ) . A significant improvement was found on measures of social anxiety , phobic avoidance , general ( or anticipatory ) anxiety and interpersonal sensitivity in patients on brofaromine , but not on placebo . Biochemical measurements revealed a decrease in turnover of noradrenaline , serotonin and dopamine as assessed by the plasma metabolite levels , and an increase in nocturnal release of melatonin . Most prominent side-effect was middle sleep disturbance . No changes in blood pressure were observed . During a follow-up period of 12 weeks a further improvement was found in patients treated with brofaromine Abstract : Pregabalin is a novel compound in the development for the treatment of  anxiety disorders .  The safety and efficacy of pregabalin for the treatment of social anxiety disorder  was evaluated in a double-blind , multicenter clinical trial in which 135 patients were r and omized to 10 weeks of double-blind treatment with either pregabalin 150 mg/d , pregabalin 600 mg/d , or placebo . The primary efficacy parameter was change from baseline to end point in the Liebowitz Social Anxiety Scale ( LSAS ) total score . Safety was assessed through clinical and laboratory monitoring , and recording spontaneously reported adverse events . Ninety-four patients ( 70 % ) completed the 11-week double-blind treatment phase . LSAS total score was significantly decreased by pregabalin 600 mg/d treatment compared with placebo ( P = 0.024 , analysis of covariance ) . Significant differences ( P ≤ 0.05 ) between pregabalin 600 mg/d and placebo were seen on several secondary measures including the LSAS subscales of total fear , total avoidance , social fear , and social avoidance , and the Brief Social Phobia Scale fear subscale . Pregabalin 150 mg/d was not significantly better than placebo on any measures . Somnolence and dizziness were the most frequently occurring adverse events among patients receiving pregabalin 600 mg/d . In conclusion , pregabalin 600 mg/d was an effective and well-tolerated treatment of social anxiety disorder & NA ; The aim of the study was to examine the efficacy of valproic acid in participants with social anxiety disorder . Following a 2‐week single‐blind , placebo run‐in period , 17 participants were enrolled in a 12‐week open flexible‐dose trial of valproic acid ( 500‐2500 mg ) . The primary outcome measures were the mean change from baseline in the Liebowitz Social Anxiety Scale ( LSAS ) total score and responder status [ defined as a Clinical Global Impression of Improvement score ( CGI‐I ) ≤ 2 ] . Social anxiety symptoms as measured by the LSAS and CGI‐I scores significantly improved with treatment . The mean reduction in the LSAS was 21.3 points in the last visit carried forward analysis and 19.1 points for the completer analysis , with 41.1 % and 46.6 % participants , respectively , achieving responder status . The results from this open‐label trial suggest the potential efficacy of valproic acid for the treatment of social anxiety disorder . Placebo‐controlled trials are indicated to confirm these findings OBJECTIVE Escitalopram has proven efficacy in the short-term treatment of generalized social anxiety disorder ( SAD ) . The present relapse prevention study investigated relapse rates during a 24-week , r and omized , double-blind , placebo-controlled period in patients with generalized SAD who had responded to 12-week open-label treatment with escitalopram .  METHOD A total of 517 patients with a primary diagnosis of generalized SAD ( per DSM-IV criteria ) and a Liebowitz Social Anxiety Scale ( LSAS ) total score of > or = 70 received 12 weeks of open-label treatment with flexible doses ( 10 - 20 mg/day ) of escitalopram . Of these patients , 371 responded ( Clinical Global Impressions-Improvement scale [ CGI-I ] score of 1 or 2 ) and were r and omly assigned to 24 weeks of double-blind treatment with escitalo-pram ( 10 or 20 mg/day ) ( N = 190 ) or placebo ( N = 181 ) , continuing with the dose level administered at the end of the open-label period . Relapse was defined as either an increase in LSAS total score of > or = 10 or withdrawal due to lack of efficacy , as judged by the investigator . The study was conducted from January 2001 to June 2002 . RESULTS Survival analysis of relapse and time to relapse showed a significant advantage for escitalopram compared to placebo ( log-rank test : p < .001 ) . The risk of relapse was 2.8 times higher for placebo-treated patients than for escitalopram-treated patients ( p < .001 ) , result ing in significantly fewer escitalopram-treated patients relapsing ( 22 % vs. 50 % ) , at both doses . Escitalopram was well tolerated during double-blind treatment of generalized SAD , and only 2.6 % of the escitalopram-treated patients withdrew because of adverse events . The overall discontinuation rate , excluding relapses , was 13.2 % for patients treated with escitalopram and 8.3 % for patients treated with placebo . CONCLUSION Escitalopram was effective and well tolerated in the long-term treatment of generalized SAD Abstract : Venlafaxine extended release ( ER ) is a dual serotonin-norepinephrine reuptake inhibitor previously shown to be effective in the treatment of major depressive disorder and generalized anxiety disorder . This placebo-controlled , multicenter , r and omized , double-blind trial examined the efficacy and safety of venlafaxine ER in out patients with generalized social anxiety disorder . Two hundred seventy-two out patients were r and omly assigned to receive either a flexible dose of venlafaxine ER ( 75 to 225 mg/d ) or placebo for 12 weeks . Venlafaxine ER was statistically significantly more effective than placebo as demonstrated by the Liebowitz Social Anxiety Scale total scores at weeks 4 to 12 . Scores of both the Clinical Global Impression-Severity and Clinical Global Impression-Improvement scales showed that venlafaxine ER was significantly more effective than placebo at weeks 4 to 12 . In addition , more venlafaxine ER-treated patients achieved CGI-Improvement scores of 1 or 2 than placebo-treated patients at weeks 4 to 12 , demonstrating a greater percentage of responders to venlafaxine ER treatment . Assessment using the fear/anxiety and avoidance subscales of the Liebowitz Social Anxiety Scale and the Social Phobia Inventory Scale also showed venlafaxine ER to be more effective than placebo at weeks 4 to 12 and 6 to 12 , respectively . The Sheehan Disability Inventory showed that patients in the venlafaxine ER-treated group had significantly better outcomes in social life at weeks 4 and 12 , and in work at week 12 . Adverse events were similar to those reported in studies of venlafaxine ER in depression and generalized anxiety disorder .  Venlafaxine ER was safe , well tolerated , and efficacious in the short-term treatment of generalized social anxiety disorder This study evaluated the anxiolytic efficacy , safety and tolerability of a flexible dose of venlafaxine extended release ( ER ) compared with placebo and paroxetine in the short‐term treatment of generalized social anxiety disorder ( SAD ) . Adult out patients with generalized SAD ( n = 434 ) were r and omized to receive capsules of venlafaxine ER 75 mg to 225 mg/day , paroxetine 20 mg to 50 mg/day , or placebo for 12 weeks . The primary efficacy variable was the Liebowitz social anxiety scale total score . Secondary efficacy variables included the patient‐rated social phobia inventory and the proportion of responders in each group ( a responder was defined as having a clinical global impression‐improvement score of 1 or 2 ) . Treatment with venlafaxine ER was associated with significantly greater improvement than treatment with placebo for all primary and secondary efficacy variables ( p < 0.05 ) . No significant differences in primary or secondary efficacy variables were observed between the venlafaxine ER and paroxetine groups . The week 12 response rates were 69 % , 66 % and 36 % for the venlafaxine ER , paroxetine and placebo groups , respectively . Both active treatments were generally well tolerated and were associated with a similar incidence of adverse events . This study shows that venlafaxine ER is an effective , safe and well‐tolerated drug treatment for SAD . Copyright © 2004 John Wiley & Sons , Seventy-four patients who met DSM-III criteria for social phobia completed 8 weeks of double-blind , r and omly assigned treatment with the monoamine oxidase inhibitor phenelzine sulfate , the cardioselective beta-adrenergic blocker atenolol , or placebo . The overall response rates were 64 % for phenelzine , 30 % for atenolol , and 23 % for placebo . Phenelzine was widely superior to both  atenolol and placebo  on independent rater analyses and , to a lesser extent , on self-report , with no significant differences between  atenolol  and placebo .  At the end of 16 weeks , phenelzine was still significantly superior to placebo , while  atenolol  showed an intermediate response that did not differ significantly from either of the other treatments . Patients with generalized social phobia  constituted 76 % of the sample , and they were preferentially responsive to phenelzine . The small size of the discrete social phobic sample precluded separate outcome analyses for this subtype . Overall , the findings support the responsivity of social phobia to monoamine oxidase inhibitors BACKGROUND This multicenter , double-blind , placebo-controlled study was carried out to determine the effectiveness and safety of various daily dosages of paroxetine for the treatment of generalized social anxiety disorder . METHOD A 1-week , single-blind , placebo run-in was followed by 12 weeks of double-blind treatment . 384 eligible patients meeting DSM-IV criteria for social anxiety disorder were r and omly assigned to receive paroxetine , 20 ( N = 97 ) , 40 ( N = 95 ) , or 60 mg ( N = 97 ) , or placebo ( N = 95 ) once daily in a 1:1:1:1 ratio . Primary efficacy variables included mean change from baseline in the Liebowitz Social Anxiety Scale ( LSAS ) total score and proportion of patients exhibiting a therapeutic response ( defined as a Clinical Global Impressions-Global Improvement scale [ CGI-1 ] score of 1 or 2 ) . RESULTS In the last-observation-carried-forward analyses , patients treated with paroxetine , 20 mg/day , had significantly greater improvement on mean LSAS total scores compared with those receiving placebo ( p < .001 ) , while the incidence of responders , based on the CGI-I rating , was significantly greater with paroxetine , 40 mg/day , than with placebo ( p = .012 ) . Patients treated with paroxetine , 20 and 60 mg , also had significantly better responses on the social item of the Sheehan Disability Scale than did patients treated with placebo ( p < .019 ) . The completer analyses showed a significant difference between the placebo group and the 20-mg and 40-mg paroxetine groups on LSAS total score and rate of response ( p < or = .006 ) . There were no serious adverse experiences attributed to paroxetine treatment . CONCLUSION Paroxetine , 20 mg/day , is an effective and safe treatment for patients with generalized social anxiety disorder and significantly improves social anxiety , avoidance of social interactions , social disability , and overall clinical condition . Further data analyses are needed to determine whether more specific guidelines for paroxetine dosage escalation in social anxiety disorder can be drawn In a double-blind , parallel group trial , 78 subjects with social phobia received moclobemide ( a new reversible inhibitor of monoamine oxidase A ) phenelzine , or placebo . After eight weeks , both active drugs-phenelzine somewhat more than moclobemide -- were clinical ly and statistically significantly more effective than placebo , as assessed by rating scales . There was some further improvement between weeks 8 and 16 , particularly in the moclobemide group ; at week 16 , 82 % of the moclobemide and 91 % of the phenelzine-treated patients were almost asymptomatic .  Moclobemide was , however , much better tolerated than phenelzine . Patients withdrawn from active drugs had relapsed by week 24 , providing additional support for the efficacy of the active drugs Based on evidence suggesting anxiolytic properties of the atypical antipsychotic olanzapine , this study was conducted to evaluate whether olanzapine may be efficacious in treating  social anxiety disorder ( SAD ) . This study was an 8-week , double-blind , placebo-controlled evaluation of olanzapine as monotherapy in which 12 patients with the DSM-IV diagnosis of SAD were r and omized to either olanzapine ( n= 7 ) or placebo ( n= 5 ) . An initial dose of 5 mg/day was titrated to a maximum of 20 mg/day . Baseline to endpoint scores from the Brief Social Phobia Scale ( BSPS ) , Social Phobia Inventory ( SPIN ) , Liebowitz Social Anxiety Scale and Sheehan Disability Scale , as well as Clinical Global Impression-Improvement ratings , were compared for olanzapine versus placebo .  Seven subjects completed all 8 weeks of the study , four in the olanzapine group and three in the placebo group . In the intent-to-treat analysis , olanzapine yielded greater improvement than placebo on the primary measures : BSPS ( p= 0.02 ) and SPIN ( p= 0.01 ) . Both treatments were well tolerated , although the olanzapine group had more drowsiness and dry mouth .  Olanzapine and placebo were both associated with negligible weight gain .  Olanzapine was superior to placebo on the primary outcome measures in this preliminary study of SAD . Additional studies of olanzapine as a treatment for SAD are warranted OBJECTIVE The purpose of this study was to examine the use of benzodiazepines ( BZs ) and selective serotonin reuptake inhibitors/selective norepinephrine reuptake inhibitors ( SSRIs/SNRIs ) over nine years of follow-up in middle-aged and older adults with diagnoses of panic disorder with or without agoraphobia , social phobia , or generalized anxiety disorder . SETTING AND PARTICIPANTS Participants in this study were enrolled in the Harvard/Brown Anxiety Research Project ( HARP ) . HARP is a naturalistic , longitudinal , multisite study of adults with anxiety disorders who are recruited from psychiatric setting s. The analytic sample consisted of 51 participants with anxiety disorders who were 55 to 70 years old at baseline and a younger cohort of 211 participants added for comparative analysis . DESIGN The authors examined patterns of medication use ( BZs and SSRIs/SNRIs ) in participants with anxiety disorders as they aged , by assessing the proportion of participants taking these medications using generalized estimating equation modeling . MEASUREMENTS The present data were derived from the structured diagnostic interview administered at enrollment using a combination of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders , Third Edition-R Non-Affective Disorder , Patient Version , Research Diagnostic Criteria Schedule for Affective Disorders-Lifetime , and subsequent follow-up interviews over a nine-year period using the Longitudinal Interval Follow-up Evaluation-Pharmacia & Upjohn to assess the weekly course of disorders to indicate syndrome severity and document medication use by specific type and dose on a weekly basis . RESULTS Findings showed that rates of BZ use were high among both the older ( 53 % at baseline ) and the younger ( 57.4 % ) age groups and did not significantly decrease over time , after controlling for time in episode of their anxiety disorders . There was a statistically significant increase in  SSRI/SNRI use over time in both groups . At the beginning of the study , 18 % of the older group and 21 % of the younger group were using SSRIs/SNRIs ; however , at the end of the study , the rates increased to 35 % and 43 % , respectively . CONCLUSIONS Although there was an increase in  SSRI/SNRI use in older participants with anxiety disorders over the course of study , at nine years of follow-up , only 35 % of participants were utilizing SSRI/SNRI medication , while more than one-half of the same participants were continuing to use BZs . To the authors ' knowledge , there are no r and omized clinical trials that have addressed comparative efficacy and safety of BZs and SSRIs/SNRIs in this population . However , there is documented evidence of adverse effects of chronic BZ use and the risk of developing dependency in older population
target: Cognitive behavior therapy  appears to be more effective than other evidence -based psychological techniques , and its effects appear to be more enduring than those of pharmacotherapy .
  There is some evidence , albeit limited to certain drug classes , that the combination of  medication and cognitive behavior therapy may be more effective than either strategy used alone .
background: This article proposes a number of recommendations for the treatment of  generalized social phobia  , based on a systematic literature review and meta- analysis .
  For medications , selective serotonin reuptake inhibitors and dual serotonin-norepinephrine reuptake inhibitors are first-line choices based on their efficacy and tolerability profiles .
  There are other medication classes with demonstrated efficacy in social phobia ( benzodiazepines , antipsychotics , alpha-2-delta lig and s ) , but due to limited published clinical trial data and the potential for dependence and withdrawal issues with benzodiazepines , it is unclear how best to incorporate these drugs into treatment regimens .