Therapeutic advances: paroxetine for the treatment of social anxiety disorder.

Department of Psychiatry, Medical University of South Carolina, Charleston 294245, USA.
Depression and Anxiety (Impact Factor: 4.29). 02/2000; 11(3):99-104. DOI: 10.1002/(SICI)1520-6394(2000)11:33.3.CO;2-Q
Source: PubMed

ABSTRACT Data from early studies of selective serotonin reuptake inhibitors have shown that these agents are effective in the treatment of social anxiety disorder (social phobia). This review highlights the outcomes of three large clinical trials of paroxetine in patients with social anxiety disorder. In two of the studies, patients received a flexible dose of paroxetine (20-50 mg/day) or placebo; the third trial was a fixed-dose study, in which patients received paroxetine 20, 40, or 60 mg/day, or placebo. A total of 861 subjects were randomized to treatment for 12 weeks, in centers across the U.S.A., Canada, Europe, and South Africa. The primary outcome measures were the Clinical Global Impressions (CGI) Global Improvement item and Liebowitz Social Anxiety Scale (LSAS) Total Score. In each of the studies, 45-66% of patients receiving paroxetine were rated as responders (very much or much improved on the CGI scale). Paroxetine treatment improved symptoms of social anxiety, as measured by the LSAS, compared with placebo. Differences between paroxetine and placebo groups were statistically significant and were clinically relevant within each study. In general, paroxetine was well tolerated. Paroxetine is effective for the treatment of social anxiety disorder. Based on the findings from these studies, a starting dose of 20 mg/day is recommended. The range of efficacy appears to be 20-50 mg/day for most patients.

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    ABSTRACT: Social anxiety disorder shows a high rate of comorbidity with major depression (MDD), panic disorder and most other anxiety disorders, so it is preferable to use antidepressant medications with a broad range of efficacy. Indeed, selective serotonin reuptake inhibitors (SSRIs) are now considered as the first-line treatment. The current chapter reviews three large-scale, placebo-controlled studies of the SSRI, paroxetine in social anxiety disorder. Two studies employed flexible dosing, while in the third patients received one of three fixed doses or placebo. Paroxetine-treated patients exhibited clinically and statistically significantly improved Clinical Global Impression (CGI) and Liebowitz Social Anxiety Scale (LSAS) scores, compared with placebo-treated patients. Secondary improvements in anxiety symptoms were also greater with paroxetine than placebo. Most adverse experiences were mild or moderate and patient withdrawal from the trials was low. The results of further trials to establish the efficacy of other SSRIs in the treatment of social anxiety disorder are awaited.
    SSRIs in Depression and Anxiety, Volume 8, Second Edition, 12/2001: pages 129 - 150; , ISBN: 9780470846513
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    ABSTRACT: Social anxiety disorder, generalized anxiety disorder, and panic disor-der are common and sometimes disabling conditions. While benzodi-azepines, antidepressants, buspirone, and several anticonvulsants are frequently used to treat these conditions, an individual medica-tion is often used as a member of "class" without specific attention to the data behind its use in a particular condition. This article reviews the state of the literature regarding the most common medications used to treat these anxiety disorders with specific attention to opti-mal dosing. For most of these medications there is sufficient data to suggest a minimum and average effective dose. More problematic, however—and with instructive data for only a few medications—is the question as to whether dosages higher than these levels can provide increased likelihood or degree of response.
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    ABSTRACT: Generalized anxiety disorder (GAD) is a prevalent and disabling disorder characterized by persistent worrying, anxiety symptoms, and tension. It is the most frequent anxiety disorder in primary care, being present in 22% of primary care patients who complain of anxiety problems. The high prevalence rate of GAD in primary care (8%) compared to that reported in the general population (12-month prevalence 1.9–5.1%) suggests that GAD patients are high users of primary care resources. GAD affects women more frequently than men and prevalence rates are high in midlife (prevalence in females over age 35: 10%) and older subjects but relatively low in adolescents. The natural course of GAD can be characterized as chronic with few complete remissions, a waxing and waning course of GAD symptoms, and the occurrence of substantial comorbidity particularly with depression. Patients with GAD demonstrate a considerable degree of impairment and disability, even in its pure form, uncomplicated by depression or other mental disorders. The degree of impairment is similar to that of cases with major depression. GAD comorbid with depression usually reveals considerably higher numbers of disability days in the past month than either condition in its pure form. As a result, GAD is associated with a significant economic burden owing to decreased work productivity and increased use of health care services, particularly primary health care. The appropriate use of psychological treatments and antidepressants may improve both anxiety and depression symptoms and may also play a role in preventing comorbid major depression in GAD thus reducing the burden on both the individual and society. Depression and Anxiety 16:162–171, 2002. © 2002 Wiley-Liss, Inc.
    Depression and Anxiety 01/2002; 16(4):162 - 171. DOI:10.1002/da.10065 · 4.29 Impact Factor

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