در مواجهه با چالش اختلال اضطراب اجتماعی

Abstract Social anxiety disorder is a serious and prevalent disorder that leads to significant disability in the social and professional lives of patients. It is a chronic condition that frequently coexists with other psychiatric conditions such as depression or alcoholism. Pharmacotherapy with benzodiazepines, monoamine oxidase inhibitors and selective serotonin reuptake inhibitors (SSRIs) has been assessed. Alprazolam has modest efficacy, while a more robust response to clonazepam has been reported. Benzodiazepines, however, are not suitable for long-term treatment of a chronic condition such as social anxiety disorder and are ineffective against comorbid depression. Phenelzine has demonstrated efficacy but the need for dietary restrictions has limited its use. Conflicting results have been reported in placebo-controlled trials for moclobemide, with two studies showing moclobemide to be more effective than placebo while recent trials have reported less robust results. Based on clinical evidence, SSRIs are the first-line treatment in social anxiety disorder. The most extensive database for the treatment of social anxiety disorder exists for the SSRI, paroxetine. Three large multicentre, placebo-controlled, trials have been completed. In all three studies, a significantly greater proportion of patients responded to paroxetine treatment compared with placebo. Paroxetine is currently the only SSRI licensed for use in this condition.

4. Conclusions On the basis of the clinical evidence, an SSRI is recommended as first-line treatment for social anxiety disorder. Treatment should be initiated at a low dose (for example, paroxetine 20 mg) and then increased gradually if necessary to obtain a clinical response. Improvement can be evident after 4 weeks, but if the patient does not benefit from some improvement after 8 weeks one should consider switching to an alternative SSRI or the addition of behavioural therapy. It is important to emphasise that social anxiety disorder is a chronic condition that requires long-term maintenance treatment to achieve full remission and to consolidate the response. Pharmacotherapy should be continued for at least 1 year, to prevent relapse and allow patients to benefit from their improvements in social, educational, and work functioning.