Social Phobia - Treatment

As with panic disorder, before starting treatment for social phobia, a thorough examination is necessary, assessing both the mental and physical status. It is important to distinguish between generalized and specific forms of social phobia, as their treatment differs significantly. Most patients suffer from the generalized form. In mild cases, nonspecific therapy can be quite successful.

For a specific form of social phobia that is not accompanied by other mental or somatic disorders, clonazepam or a beta-blocker is recommended. Both drugs should be taken about an hour before entering the feared situation. The main disadvantages of benzodiazepines are the risk of developing physical dependence and adverse effects on cognitive functions. Treatment with clonazepam usually begins with a very low dose of 0.25 mg, then it is increased to 0.5-1 mg. The main disadvantage of beta-blockers is their effect on the cardiovascular system. Treatment usually begins with 10-20 mg of propranolol, then the dose is increased to 40 mg. The drug is taken an hour before a public event. It is recommended to take a test dose of clonazepam or propranolol in advance to make sure that the side effects do not cause more significant discomfort than the phobia itself.

In generalized social phobia, as in panic disorder, the drugs of choice are SSRIs. The regimen for their use is the same as for panic disorder. Treatment should be started with low doses, especially if social phobia is accompanied by panic attacks or panic disorder. If SSRIs are ineffective, a high-potency benzodiazepine is prescribed (in combination with an SSRI or as monotherapy). The dosing regimen for benzodiazepines is the same as for panic disorder. Benzodiazepines are especially useful for severe, paralyzing anxiety that needs to be relieved as quickly as possible, or if there is a history of bipolar disorder. As with panic disorder, benzodiazepines are not recommended without SSRIs for symptoms of depression, which are often found in social phobia.

Once the effect is achieved, treatment should continue for at least 6 months. As with panic disorder, there may be difficulties when trying to stop benzodiazepines. In this situation, a very slow reduction in dosage, psychotherapy, or additional administration of SSRIs are recommended.

To enhance the effect of SSRIs, azapiron can be added to them. Although this combination is quite safe and convenient, there is significantly less data to support its effectiveness than there is evidence for the effectiveness of MAO inhibitors. Azapirone can also be prescribed as monotherapy, although there is virtually no data to support the effectiveness of this approach. Tricyclic antidepressants for social phobia are apparently ineffective. Therefore, if the use of SSRIs, benzodiazepines, or a combination of both has not led to success, then MAO inhibitors are recommended.

The evidence for the effectiveness of MAOIs in social phobia is quite convincing. MAOIs are highly effective, but they can only be used in the absence of contraindications and with the patient's active cooperation. Reversible MAO inhibitors are not yet registered in the United States, but experience in Europe confirms their effectiveness in social phobia. The dosage regimen is the same as for panic disorder.

Like panic disorder, social phobia tends to be chronic, so sufferers must take an effective medication for at least 6 months before attempting to taper off the medication. The same steps used for panic disorder can be used to ease the withdrawal process.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ]