Social phobia: treatment

As with panic disorder, a thorough examination with evaluation of both mental and physical status is necessary before starting treatment of social phobia. It is important to distinguish between generalized and specific forms of social phobia, since their treatment varies considerably. Most patients suffer from a generalized form. In mild cases, nonspecific therapy is quite successful.

With a specific form of social phobia, not accompanied by other mental or physical disorders, clonazepam or beta-blocker is recommended. Both drugs should be taken about an hour before getting into a situation that causes fear. 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 one hour before a public event. It is recommended that you take a trial dose of clonazepam or propranolol beforehand to make sure that the side effects do not cause more discomfort than the phobia itself.

In the generalized form of social phobia, as in panic disorder, SSRIs are the drugs of choice. The scheme of their application is the same as in panic disorder. Treatment should begin with low doses, especially if the social phobia is accompanied by panic attacks or panic disorder. When SSRIs are ineffective, high-potential benzodiazepine is prescribed (in combination with SSRIs or as monotherapy). The dosage regimen of benzodiazepines is the same as for panic disorder. Benzodiazepines are especially useful in severe, paralyzing patient anxiety, which should be stopped as soon as possible, or with anamnestic indication of bipolar disorder. As with panic disorder, benzodiazepines are not recommended to be used without SSRIs in case of symptoms of depression, often found in social phobia.

After receiving the effect, treatment should last at least 6 months. As with panic disorder, there may be difficulties in trying to cancel benzodiazepines. In this situation, a very slow dose reduction, psychotherapy or an additional SSRI is recommended.

To enhance the effect of SSRIs, azapiron can be added to it. Although this combination is completely safe and convenient, the data that would confirm its effectiveness is significantly less than evidence of the effectiveness of MAO inhibitors. Azapiron can be prescribed as a monotherapy, although there is practically no data that would confirm the effectiveness of such an approach. Tricyclic antidepressants in social phobia, apparently, are ineffective. Therefore, if the use of SSRI, benzodiazepine or a combination of these has not been successful, MAO inhibitors are recommended.

Evidence of the effectiveness of MAOI in social phobia is very convincing. MAOI is a highly effective remedy, but it can be used only in the absence of contraindications with the possibility of active collaboration with the patient. Reversible MAO inhibitors have not yet been registered in the United States, but experience in use in Europe confirms their effectiveness in social phobia. The dosing schedule is the same as for a panic disorder.

Like panic disorder, social phobia tends to be chronic, so patients should take an effective drug for at least 6 months before an attempt is made to gradually abolish it. To facilitate the procedure for discontinuing the drug, you can use the same measures as with panic disorder.

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