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Recent Advances in Understanding and Treating Social Anxiety Disorder

Published online by Cambridge University Press:  07 November 2014

Herman G. M. Westenberg
Herman G. M. Westenberg*
Affiliation:
Dr. Westenberg is professor in the Section Psychiatric Phenotypes of Biological Psychiatry at the Rudolf Magnus Institute of Neuroscience and the Department of Psychiatry at the, University Medical Center Utrecht, in, The Netherlands.
*
Herman G. M. Westenberg, PhD, Department of Psychiatry, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands; Tel: 31-88-755-9019; Fax: 31-30-212-9205; E-mail: [email protected].
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Abstract

The common occurrence and high level of morbidity and burden associated with social anxiety disorder (SAD) are gaining widespread recognition. Interest in understanding and treating the disorder has also grown in response to large-scale investigations that have demonstrated high levels of efficacy with both pharmacologic and nonpharmacologic treatments. Such trials indicate that many patients with generalized SAD (roughly 40% to 60%) respond (eg, Clinical Global Impressions–Improvement rating 1 or 2) after an adequate treatment trial, despite having suffered with disabling symptoms for most of their adult lives. First-line therapy options include the selective serotonin reuptake inhibitors and the dual-acting serotonin-norepinephrine reuptake inhibitor venlafaxine. Second-line options consist of anticonvulsants (gabapentin, pregabalin, valproic acid) and benzodiazepines (clonazepam). Reversible and irreversible monoamine oxidase inhibitors (moclobemide and phenelzine, respectively), while effective, are not widely used. Nonpharmacologic approaches, such as cognitive-behavioral therapy (CBT), are also effective for SAD. Newer treatment strategies such as levetiracetam, atypical antipsychotics, or D-cycloserine in combination with CBT appear promising but require further investigation. Finding a well-tolerated, safe, and effective treatment for each individual patient is crucial as most will require ongoing treatment in order to maintain benefits, prevent SAD relapse, and to experience optimal outcomes in the long term.

Type
Research Article
Information
CNS Spectrums , Volume 14 , Issue S3 , 2009 , pp. 24 - 33
Copyright
Copyright © Cambridge University Press 2009

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