Clinical Question

What are the effects of medications for social phobia?

Evidence-Based Answer

In adults, medications may improve the symptoms of social phobia in the short term, but their usefulness may be overstated because of publication bias. Selective serotonin reuptake inhibitors (SSRIs) have the strongest evidence of efficacy and the most favorable side-effect profile.

Practice Pointers

Social phobia affects about 5.3 million Americans. Persons with social phobia fear and avoid social situations or doing things in front of others. It may be limited to certain situations such as public speaking, or it can be generalized. Some persons have such severe fear that they are unable to work or leave their homes. Stein and colleagues searched for published and unpublished trials of pharmacotherapy for treatment of social phobia.

A total of 36 randomized controlled trials (RCTs) with 4,268 patients were found. Most of the RCTs followed patients for less than 14 weeks, and 17 of the studies reviewed SSRIs. A variety of other medications were studied, including monoamine oxidase inhibitors (MAOIs), reversible inhibitors of monoamine oxidase A, benzodiazepines, buspirone, beta blockers, and gabapentin. Because of the wide variation in study design, it is difficult to make specific therapeutic recommendations.

In general, treated patients were more likely to respond than patients who received placebo. The relative risk of nonresponse for treated patients was 0.63 (95 percent confidence interval, 0.55 to 0.72). Average symptom scores were better in patients who took SSRIs and MAOIs. However, funnel-plot analysis of treatment response suggests possible publication bias (i.e., small studies finding little or no benefit may not have been published).

This review supports the view that medications, especially SSRIs, are beneficial for selected patients with social phobia, at least in the short term.^1,2