Social phobia: diagnosis and epidemiology, neurobiology and pharmacology, comorbidity and treatment

Social phobia is a common disorder associated with significant psychosocial impairment, representing a substantial public health problem largely deter mined by the high prevalence, and the lifelong chronicity. Social phobia st arts in early childhood or adolescence and is often comorbid with depressio n, other anxiety disorders, alcohol and substance abuse or eating disorders . This: cascade of comorbidity, usually secondary to social phobia, increas es the disability associated with the condition. The possibility that socia l phobia may be a trigger for later developing comorbid disorders directs a ttention to the need for early effective treatment as a preventive measure. The most recent drug class to he investigated for the psychopharmacological treatment of social phobia is the SSRI group for which there is growing su pport. The other drugs classes that have been evaluated are monoamine oxida se inhibitors (MAOIs), benzodiazepines, and beta-blockers, The SSRIs repres ent a new and attractive therapeutic choice for patients with generalized s ocial phobia. Recently the fil st, large scale, placebo-controlled study to assess the efficacy of drug treatment in generalized social phobia has bee n completed with paroxetine, Paroxetine was more effective in reducing the symptoms than placebo and was well tolerated. Many now regard SSRIs as the drugs of choice in social phobia because of their effectiveness and because they avoid the problems of treatment with benzodiazepines or classical MAO Is. (C) 2000 Elsevier Science B.V. All rights reserved.