The selective serotonin reuptake in more generalized and in less inhibitorparoxetine is effective generalized social anxiety disorder

Rationale: The DSM-IV includes the specifier "generalized" to refer to soci al anxiety disorder (social phobia) patients if the fears include "most soc ial situations". The focus on interventions such as the selective serotonin reuptake inhibitors (SSRIs) for generalized social anxiety disorder arguab ly runs the risk that inadequate treatment will be provided to patients wit h the non-generalized or discrete subtypes. There are, however, few data to address whether more generalized and less generalized subgroups of social anxiety disorder differ in response to medication. Objective: To compare re sponse of more generalized and less generalized social anxiety disorder to pharmacotherapy. Methods: Data from three randomized placebo-controlled dou ble-blind multicenter trials of the SSRI paroxetine in social anxiety disor der were pooled. Response on the Clinical Global Impression Global Improvem ent item was analyzed using logistic regression, and change in total Liebow itz Social Anxiety Score was analyzed using analysis of variance, with both models incorporating treatment (paroxetine vs placebo), subgroup (more gen eralized vs less generalized), demographic, and clinical variables. Results : The prevalence of more generalized social anxiety disorder was higher in females than in males. However, there was no significant difference in term s of age or clinical characteristics (duration of condition, baseline pulse , mean arterial blood pressure). At treatment endpoint there were significa nt treatment effects (for paroxetine vs placebo), but no significant subgro up effects (for more generalized vs less generalized). Conclusions: Althoug h the current database is limited insofar as few patients with discrete soc ial anxiety disorder would have been included, it is helpful in addressing the value of medication for patients lying on the spectrum from generalized to non-generalized and discrete social anxiety disorder. Paroxetine was ef fective in both more generalized and in less generalized social anxiety dis order.