Cognitive behavior therapy  appears to be more effective than other evidence -based psychological techniques , and its effects appear to be more enduring than those of pharmacotherapy .
There is some evidence , albeit limited to certain drug classes , that the combination of  medication and cognitive behavior therapy may be more effective than either strategy used alone .
This article proposes a number of recommendations for the treatment of  generalized social phobia  , based on a systematic literature review and meta- analysis .
For medications , selective serotonin reuptake inhibitors and dual serotonin-norepinephrine reuptake inhibitors are first-line choices based on their efficacy and tolerability profiles .
There are other medication classes with demonstrated efficacy in social phobia ( benzodiazepines , antipsychotics , alpha-2-delta lig and s ) , but due to limited published clinical trial data and the potential for dependence and withdrawal issues with benzodiazepines , it is unclear how best to incorporate these drugs into treatment regimens .
Levetiracetam in generalized social anxiety disorder: a double-blind, randomized controlled trial.
OBJECTIVE This multicenter , double-blind , placebo-controlled , 2-arm , parallel-group study was carried out to determine the effectiveness and safety of the novel anticonvulsant levetiracetam for the treatment of generalized social anxiety disorder ( GSAD ) . METHOD After a 1-week , single-blind , placebo run-in period , 217 adult out patients meeting DSM-IV criteria for social anxiety disorder , generalized type , were r and omly assigned ( 1:1 ) to 12 weeks of double-blind treatment with either levetiracetam ( n = 111 ) or placebo ( n = 106 ) . Participants were required to have scores of > or= 60 on the Liebowitz Social Anxiety Scale ( LSAS ) and a total score of < or= 17 on the 17-item Hamilton Depression Rating Scale ( HDRS ) .  The primary outcome measure was mean change from baseline on LSAS total score .  Levetiracetam was initiated at 250 mg/d and flexibly titrated up to a maximum dose of 3,000 mg/d ( 1,500 mg bid ) . Dosage was held stable for the last 6 weeks of treatment . The study was conducted from September 2003 to June 2004 . RESULTS No statistically significant difference was found between the adjusted mean changes in LSAS score for levetiracetam ( -24.4 ) and placebo ( -28.7 ) using an efficacy intent-to-treat , last- observation-carried-forward analysis . Rates of response ( > or= 30 % reduction in LSAS score ) were similar with 41.3 % ( levetiracetam ) and 46.6 % ( placebo ) . No significant between-group differences were found on secondary outcome measures , which included changes in Sheehan Disability Scale , Clinical Global Impression of Change , and HDRS scores . CONCLUSIONS Although well-tolerated , levetiracetam failed to separate from placebo in this trial for the treatment of moderate to severe GSAD
Cognitive behavior therapy  appears to be more effective than other evidence -based psychological techniques , and its effects appear to be more enduring than those of pharmacotherapy .
There is some evidence , albeit limited to certain drug classes , that the combination of  medication and cognitive behavior therapy may be more effective than either strategy used alone .
This article proposes a number of recommendations for the treatment of  generalized social phobia  , based on a systematic literature review and meta- analysis .
For medications , selective serotonin reuptake inhibitors and dual serotonin-norepinephrine reuptake inhibitors are first-line choices based on their efficacy and tolerability profiles .
There are other medication classes with demonstrated efficacy in social phobia ( benzodiazepines , antipsychotics , alpha-2-delta lig and s ) , but due to limited published clinical trial data and the potential for dependence and withdrawal issues with benzodiazepines , it is unclear how best to incorporate these drugs into treatment regimens .