Social Anxiety Disorder Assessment and Pharmacological Management

Social phobia is one of the most common disorders in the general population, with a lifetime prevalence of 11 % to 15%, and is highly prevalent in primary care settings. Only 5 % of social phobic patients seek treat-ment, despite numerous related complications when the disorder goes untreated. It is advisable, therefore, that clinicians be prepared to recognize and effectively manage patients with this anxiety disorder. We provide a brief review of the assessment, differential diagnosis and pharmacological treatment of social phobia. We based our suggestions for treatment on the results of randomized clinical trials found in the PUB-MED/MEDLINE database from 1966 to February of 2001 as well as on our clinical experience with social phobic patients. Of the three classes of drugs with established efficacy in the treatment of social phobia (irre-versible MAOIs, SSRIs and benzodiazepines) the SSRIs are considered the treatment of choice because of their tolerability, side effect profile and safety. Two other classes of drugs are considered of controversial efficacy (re-versible type-A MAOIs and beta-blockers), while several new drugs have shown positive initial results (gabap-entin, venlafaxine and nefazodone). When SSRI treatment is ineffective, psychiatrists should not shy away from prescribing benzodiazepines or MAOIs if the risks of abuse / dependency (with benzodiazepines) or hyper-tensive crises (with MAOIs) are outweighed by the suffering and impairment associated with severe case