SOCIAL PHOBIA - A REVIEW OF PHARMACOLOGICAL TREATMENT

Social phobia is a common anxiety disorder characterised by marked fea r and discomfort in situations involving possible scrutiny or evaluati on by others. Over the last 10 years, several research groups have eva luated treatments for patients with social phobia. Well designed clini cal trials support the efficacy of both pharmacotherapy and cognitive- behavioural therapy in the treatment of patients with social phobia. A mong the pharmacological agents, 4 classes of drugs have been shown to be superior to placebo in double-blind, placebo-controlled trials (al though no drug has US Food and Drug Administration approval for use in social phobia). Effective agents include: (i) the monoamine oxidase i nhibitors phenelzine, moclobemide and brofaromine; (ii) the high poten cy benzodiazepines alprazolam and clonazepam; (iii) the selective sero tonin (5-hydroxytryptamine; 5-HT) reuptake inhibitor fluvoxamine; and (iv) the 5-HT3-receptor antagonist ondansetron. A number of questions concerning the treatment of social phobia remain to be answered, such as: For how long should patients with social phobia, who by definition have a chronic illness, be treated? What is the rate of symptom recur rence after treatment discontinuation? How do combined pharmacotherapy and cognitive-behavioural therapies compare with either modality alon e? Future studies are needed to address these unresolved issues.