SOCIAL PHOBIA

SSRIs
The SSRIs have been found effective in both open and double-blind trials. Interestingly, hyperstimulation, a problem when SSRIs are used in panic disorder, has not been reported in the setting of social phobia.

In Canada, currently recommended SSRIs for the treatment for panic disorder include: Prozac (fluoxetine), Luvox (fluvoxamine, Paxil paroxetine, and Zoloft (sertraline). Effexor (venlafaxine) and Serzone (nefazodone) may also be used.

MAOIs
Considered effective in up to 80% of patients with social phobia, their use has been limited by side effects. Moclobemide may be better tolerated and obviates the need for dietary precautions

Tricyclic Antidepressants
Generally not used in the treatment of social phobia.

Buspirone
Preliminary trials suggest that buspirone may be helpful in the treatment of social phobia, either alone in doses of 15 to 60 mg/day or as augmentation therapy in combination with an SSRI. May also be preferable to a benzodiazepine, as buspirone is not addicting.

Clonazepam
May improve function in doses of up to 3 mg/day; however, side effects include forgetfulness and impaired concentration and relapse rates are high once treatment is discontinued.

Beta-Blockers
Some double-blind studies have shown beta-blockers can reduce performance anxiety, while others found no additional benefit over placebo. Taken a few hours before a performance, users report less tachycardia, blushing, sweating, nausea and urinary urgency.

Psychotherapy
Used to treat social phobia for many years, with varying degrees of success. Many practitioners report success rates with psychotherapy comparable to those achieved with drug therapy.

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