Paroxetine Is an Effective Long-term Treatment for Social Anxiety Disorder

Laurie Barclay, MD

January 06, 2003

Jan. 6, 2003 — Paroxetine is an effective long-term treatment for social anxiety disorder, according to the results of a placebo-controlled, multicenter study reported in the December issue of the Archives of General Psychiatry.

"The efficacy of selective serotonin reuptake inhibitors (SSRIs) in the acute treatment of social anxiety disorder (social phobia) is well established," write Dan J. Stein, MD, PhD, and colleagues from the University of Stellenbosch in Cape Town, South Africa. "As social anxiety disorder is a chronic, disabling condition, the International Consensus Group on Depression and Anxiety has recommended that medication should be continued for a minimum of 12 months for treatment to have maximum benefit. Despite such expert recommendations, little work on the efficacy and tolerability of maintenance pharmacotherapy in social anxiety disorder has been conducted to date."

In this study, 437 adult patients meeting DSM-IV criteria for social anxiety disorder entered a 12-week, single-blind acute treatment phase. Of 323 patients who responded to paroxetine during the acute phase and who entered a 24-week, randomized, double-blind maintenance treatment phase, 257 patients completed the study, including 136 of 162 in the paroxetine group and 121 of 161 in the placebo group.

Relapse during the maintenance phase occurred in 14% of patients in the paroxetine group and in 39% of those in the placebo group (odds ratio [OR], 0.24; 95% confidence interval [CI], 0.14 - 0.43; P < .001). The proportion of patients showing improvement on the Clinical Global Impression global improvement rating was 78% in the paroxetine group and 51% in the placebo group (OR, 3.66; 95% CI, 2.22 - 6.04; P < .001).

Compared with placebo, paroxetine treatment significantly improved the symptoms of social anxiety ( P < .001) as measured by the Liebowitz Social Anxiety Scale, Social Phobia Inventory, Sheehan Disability Scale, Symptom Checklist-90 score, and EuroQol visual analogue scale, indicating decreased disability and increased well-being.

"Maintenance treatment with paroxetine is an effective and well-tolerated treatment for the prevention of relapse in social anxiety disorder," the authors write. "This study also supports earlier expert clinical recommendations to continue pharmacotherapy for an extended period beyond the early improvement achieved in the first four months of treatment."

The investigators recommend further long-term studies lasting at least 52 weeks to confirm that paroxetine is effective in the long-term treatment of social anxiety disorder. Study limitations include exclusion of subjects with any Axis I disorders other than generalized anxiety disorder.

"This represents an exclusive population that is unlikely to be similar to that encountered by the physician during the course of his or her consultations," the authors write. "Subdivision of the study population into those with generalized vs. nongeneralized social anxiety might have been more informative."

SmithKline Beecham Pharmaceuticals supported this study and has financial arrangements with some of its authors.

Arch Gen Psychiatry. 2002;59:1111-1118

Reviewed by Gary D. Vogin, MD


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