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David Baxter PhD

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Social anxiety disorder: Medication vs. therapy for social phobics
January 14, 2005
By Elizabeth Querna

A woman darts her eyes nervously at strangers she passes on the street, convinced they are staring at her. A man clams up when he meets the company VP, and his voice grows so weak he can barely talk. Millions of people suffer these symptoms of social anxiety disorder and others, keeping them from meeting other people, performing well at work, or even leaving their homes. Psychotherapy and mental health medications are often used as treatments for social anxiety disorder, also called social phobia. Studies have shown both methods to be effective, though it is not clear if one works better than the other. Researchers from Duke University and the University of Pennsylvania decided to figure that out.

What the researchers wanted to know: Does medication or behavioral therapy work better to treat social anxiety disorder?

What they did: The researchers recruited people from near their universities who had social anxiety disorder. They took 295 people and split them into five groups: medication (Prozac) only, behavior therapy only, Prozac and behavior therapy, placebo pill and behavior therapy, and placebo pill only. All of the patients were given treatment for 14 weeks. The people in therapy went to weekly group sessions, and the people taking Prozac took a pill daily, increasing their dose from 10 milligrams to 40mg per day within a month.

What they found: All of the groups showed some improvement after 14 weeks except the group just taking placebo pills. However, none of the groups receiving treatment were much better off than any of the others, suggesting that both pills and psychotherapy could work but that both together do not work better than either of the two on its own. More than 40 percent of patients taking either placebo or Prozac reported insomnia, and nearly a third in all these groups reported headaches.

What it means to you: This study confirms the results of other studies that have shown that therapy and the class of drugs that Prozac belongs to, selective serotonin reuptake inhibitors, can be effective in treating social anxiety disorder. However, they do not seem to have a greater effect when combined. In this study, medication worked faster to ease patients' anxieties, while therapy had more of an effect in the second half of the treatment period. The researchers suggest that more studies be done that might stagger the beginnings of medication and therapy, which could make the combined treatments more effective.

Caveats: Some of the patients assigned to group therapy dropped out because they were nervous about being with a group of people—one of the symptoms of social anxiety disorder. Similarly, some people assigned to just medication dropped out because they did not want medication without psychotherapy. There's also a question of whether Prozac is the most appropriate drug to use; others in the same class may work better on social anxiety patients. Finally, many potential participants were excluded from the survey because they also had depression, a common condition in social anxiety patients. The authors cite a need for studies that look specifically at these people, who may react differently to therapy and medications.

Find out more: The Anxiety Disorders Association of America has a Web page that describes the symptoms of social anxiety as well as a test that can help you figure out if you have social phobia.

A more scientific, but very thorough, explanation of social anxiety disorder and its treatments can be found through the American Academy of Family Physicians website.

Read the article: Davidson, J. R. T. et al. "Fluoxetine, Comprehensive Cognitive Behavioral Therapy, and Placebo in Generalized Social Phobia." Archives of General Psychiatry. Oct. 2004, Vol. 61, No. 10, pp. 1005–1013.

Abstract online: Home of JAMA and the Specialty Journals of the American Medical Association
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