A Cochrane review [Abstract] 1 included 66 RCTs with 11,597 participants with social anxiety disorder (SAnD), and 63 trials in the meta-analysis. The treatment time varied from one to 24 weeks. There was a treatment response for selective serotonin reuptake inhibitors (SSRIs) vs. placebo (RR 1.65; 95% CI 1.48 to 1.85, 24 studies, n= 4984). There was also benefit for monoamine oxidase inhibitors (MAOIs) (RR 2.36; 95% CI 1.48 to 3.75; 4 trials, n= 235), reversible inhibitors of monoamine oxidase A (RIMAs) (RR 1.83; 95% CI 1.32 to 2.55; 8 trials, n= 1270), and benzodiazepines (RR 4.03; 95% CI 2.45 to 6.65; 2 trials, n= 132). There was also a clinical response for the anticonvulsants with gamma-amino butyric acid (GABA) analogues (RR 1.60; 95% CI 1.16 to 2.20; 3 trials, n= 532). The SSRIs were the only medication proving effective in reducing relapses. The treatment withdrawal of SSRIs and the serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine was higher than for placebo (SSRIs: RR 2.59; 95% CI 1.97 to 3.39; 24 trials, n= 5131; venlafaxine: RR 3.23; 95% CI 2.15 to 4.86; 4 trials, n= 1213), but there were low absolute rates of withdrawal for both. There was no benefit for the rest of the medications vs. placebo.For the secondary outcome of SAnD symptom severity, there was benefit for the SSRIs, the SNRI venlafaxine, MAOIs, RIMAs, benzodiazepines, the antipsychotic olanzapine, and the noradrenergic and specific serotonergic antidepressant (NaSSA) atomoxetine in the reduction of SAnD symptoms. Treatment with SSRIs and RIMAs was also associated with a reduction in depression symptoms. The SSRIs were the only medication class that demonstrated evidence of reduction in disability across a number of domains.There was a response to long-term treatment with medication for the SSRIs, for the MAOIs and for the RIMAs.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and indirectness (short follow-up time).
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