A double-blind placebo-controlled trial of paroxetine in the management ofsocial phobia (social anxiety disorder) in South Africa

Background. Social phobia, also known as social anxiety disorder, is a high ly prevalent disorder with significant morbidity. Patients with social phob ia frequently develop co-morbid psychiatric disorders such as depression an d substance abuse, and the disorder impacts significantly on social and occ upational functioning. It has been suggested that the selective serotonin r euptake inhibitors (SSRIs) are useful in the management of this disorder, b ut few controlled trials have been undertaken in this regard. There are als o few data on the pharmacotherapy of social phobia in South Africa. Methods. A double-blind randomised placebo-controlled multi-site flexible-d ose trial of paroxetine was undertaken over 12 weeks among patients with a primary diagnosis of social phobia. Primary response measures were the Glob al Improvement item on the Clinical Global Impression scale (CGI) and mean change from baseline in the patient-rated Liebowitz Social Anxiety Scale (L SAS) total score. Ninety-three patients participated at 9 South African sit es; their data are reported here. Results. There was a significant drug effect on both the CGI Global Improve ment score and the LSAS at 12 weeks. In addition, there was no significant difference in overall rate of adverse experiences between those on paroxeti ne and those on placebo. Conclusions: Paroxetine is both effective and safe in the acute treatment o f social phobia. The findings here are consistent with those of previous co ntrolled studies of the SSRIs as well as with previous work done in the USA on the use of paroxetine in the treatment of this disorder. Early diagnosi s,and treatment of social phobia should be encouraged. However, further res earch on long-term pharmacotherapy of social phobia is needed.