PAROXETINE IN THE TREATMENT OF GENERALIZED SOCIAL PHOBIA - OPEN-LABELTREATMENT AND DOUBLE-BLIND PLACEBO-CONTROLLED DISCONTINUATION

We conducted an 11-week forced-escalation open-label study of paroxeti ne 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 Impressio ns 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 S ocial 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 random ized to an additional 12 weeks of either paroxetine (with no dosage ch ange) or placebo (after a taper period) on a double-blind basis. To th e best of our knowledge, this is the first controlled medication-disco ntinuation study in social phobia. One of eight patients randomized to continue paroxetine relapsed versus five of eight patients randomized to placebo. These findings call for a double-blind, placebo-controlle d treatment study of paroxetine in generalized social phobia. They als o suggest that relapse rates are high if medication is discontinued ea rly and that further study is needed to determine (1) the optimal dura tion of maintenance pharmacotherapy for social phobia and (2) if speci fic psychotherapeutic interventions before medication discontinuation may prevent relapse.