A review of 19 double-blind placebo-controlled studies in social anxiety disorder (social phobia).

Nineteen double-blind placebo-controlled studies on the treatment of Social Anxiety Disorder (Social Phobia) are reviewed. Initial trials yielded a high degree of efficacy for phenelzine, a large difference between drug and placebo and a low rate of placebo response. Controlled studies with RIMAs (moclobemide and brofaromine) yielded more moderate levels of efficacy and more pronounced placebo effects. Results of the Liebowitz Social Anxiety Scale (LSAS) permit a comparison of the outcomes of the different controlled trials. Overall, the reduction in the mean total score with various drugs is inferior to 50%, probably because the chronic nature of the disorder is not amenable to drastic changes in short-term trials. Results with the LSAS and other scales justify a ranking of the efficacy of the drugs: Classical MAOIs > SRIs > RIMAs. Two controlled studies with benzodiazepines (clonazepam and bromazepam) would position them together with the SRIs relative to efficacy but with problems associated with unwanted effects and dependence. Controlled studies with SRIs (paroxetine and fluvoxamine) demonstrated very significant differences from placebo. Paroxetine is the SRI most extensively studied in Social Anxiety Disorder with positive therapeutic results.