Paroxetine - A review of its use in social anxiety disorder

Paroxetine potentiates serotonergic neurotransmission by potently and selec tively inhibiting neuronal serotonin (5-hydroxytryptamine; 5-HT) reuptake. Paroxetine has been established as treatment for depression, obsessive-comp ulsive disorder, panic disorder and social anxiety disorder (social phobia) , This review focuses on the use of the drug in the latter indication. Once daily paroxetine 20 to 60 mg/day was effective in the management of pa tients with social anxiety disorder in 3 large randomized, double-blind, pl acebo-controlled multicentre trials of 12 weeks' duration. Reduction in the clinical severity of disease from baseline values was significantly greate r with paroxetine than with placebo from 2 to 4 weeks until end-point. Redu ction in the 3 measures of functional disability (work, social life and fam ily life) fram baseline Values was greater with paroxetine than with placeb o at 12 weeks, although improvement in the family life subscore did not gen erally attain a statistically significant difference between the two treatm ent groups. Preliminary data indicate that the efficacy of paroxetine may b e sustained for periods of at least 24 weeks. The efficacy of paroxetine ha s not been directly compared with that of other agents in patients with soc ial anxiety disorder. Available data indicate that short term administration of paroxetine is gen erally well tolerated in patients with social anxiety disorder. Most advers e events with paroxetine were related Co the pharmacological activity of th e drug on neurotransmitter systems and were of mild to moderate intensity. At 12 weeks, adverse events experienced in;greater than or equal to 5% of p aroxetine recipients (with 2-fold greater incidence than placebo recipients ) in placebo-controlled trials included sweating, nausea, dry mouth, consti pation, decreased appetite, somnolence, tremor, decreased libido, yawning, abnormal ejaculation, female genitial disorders and impotence. Caution is r equired in patients receiving paroxetine with other drugs chat are metaboli sed by or inhibit cytochrome P450 2D6 or have serotonergic activity. There are no direct comparative data on the tolerability of paroxetine versus tha t of other agents in patients with social anxiety disorder. Conclusions: Paroxetine is effective in patients with social anxiety disord er and available data indicate that short term treatment with the drug is w ell tollerated in most patients. Although longer term data and trials compa ring the efficacy of paroxetine with that of other agents are needed in pat ients with social anxiety disorder, the drug has potential to become a firs t-line treatment fur this indication.