Volume 5, Number 3

Pharmacological Treatment of Social Anxiety Disorder

Raquel Carmona, MD, Muhammad Saqlain Raza, MD, Carlos Blanco, MD, PhD

Dr. Carmona is Attending Psychiatrist, Department of Psychiatry, Clinica Puerta de Hierro, Madrid, Spain.

Dr. Raza is PGY-I, Department of Psychiatry, University of Alabama, Birmingham, Alabama.

Dr. Blanco is Assistant Professor, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY.

Editor's Note

In this article, Drs. Carmona, Raza, and Blanco review the fast-growing field of the pharmacological treatment of social anxiety disorder (SAD), also known as social phobia. SAD has become increasingly recognized over the past decades since its inclusion in the DSM diagnostic system. It is a common condition that carries a heavy burden of disability because the onset of disability is usually in the mid and late teens and, thus, it interferes with educational and social development. Thus, individuals with SAD do not fulfill their potential, and they may fail to develop stable relationships.

It is important that psychiatrists campaign to persuade the general public and politicians, particularly those controlling health care delivery, that SAD is not just medicalized shyness. It is a serious condition with the disabilities noted above.

The authors deal comprehensively with a range of treatments that have been proven to show some efficacy in SAD. In particular, they highlight evidence for the effectiveness of the selective serotonin reuptake inhibitors. This has been shown for various compounds, including paroxetine, sertraline, fluvoxamine, and, most recently, escitalopram. The use of drug therapy provides a window of opportunity for other measures, particularly nonpharmacological measures, to become effective. Discontinuation of a medication should be followed by successful control of the phobic symptoms. Other medications shown to be effective in SAD include the benzodiazepines, the monoamine oxidase inhibitors (MAOIs), and the reversible MAOIs. The area in most urgent need of further research is guidelines development for the combination and temporal patterns of use for the various drug and nondrug treatments.

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