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 .
Psychopharmacological treatment of social phobia: clinical and biochemical effects of brofaromine, a selective MAO-A inhibitor
There is circumstantial evidence that antidepressants , particularly monoamine oxidase inhibitors ( MAOIs ) and beta-blockers , may have some beneficial effects in social phobia . In this study 30 patients with social phobia ( DSM-IIIR ) were treated with the selective and reversible MAO-A inhibitor brofaromine , using a 12-week double-blind placebo controlled design . A clinical relevant improvement was seen in 80 % of the patients treated with brofaromine ( 150 mg daily ) . A significant improvement was found on measures of social anxiety , phobic avoidance , general ( or anticipatory ) anxiety and interpersonal sensitivity in patients on brofaromine , but not on placebo . Biochemical measurements revealed a decrease in turnover of noradrenaline , serotonin and dopamine as assessed by the plasma metabolite levels , and an increase in nocturnal release of melatonin . Most prominent side-effect was middle sleep disturbance . No changes in blood pressure were observed . During a follow-up period of 12 weeks a further improvement was found in patients treated with brofaromine
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 .