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 .
Venlafaxine extended release vs placebo and paroxetine in social anxiety disorder.
BACKGROUND Evidence indicates that venlafaxine hydrochloride extended release ( ER ) effectively ameliorates anxiety symptoms . OBJECTIVES To evaluate the efficacy , safety , and tolerability of flexible-dose venlafaxine ER compared with placebo in the short-term treatment of generalized social anxiety disorder and , secondarily , to compare paroxetine with venlafaxine ER and paroxetine with placebo . DESIGN Adult out patients with DSM-IV generalized social anxiety disorder for 6 months or longer were r and omly assigned to receive venlafaxine hydrochloride ER ( 75 - 225 mg/d ) , paroxetine ( 20 - 50 mg/d ) , or placebo for 12 weeks or less at 26 centers in the United States . The primary outcome measure was the total Liebowitz Social Anxiety Scale score . Secondary measures included response ( Clinical Global Impression-Improvement score , 1 or 2 ) rates and Clinical Global Impression-Severity of Illness and Social Phobia Inventory scores . RESULTS Of 440 patients treated , 413 ( 93.9 % ) were included in the last-observation-carried-forward efficacy analysis ; of the 429 patients in the safety population , 318 ( 74.1 % ) completed the study . Mean daily doses were 201.7 mg ( SD , 38.1 mg ) of venlafaxine hydrochloride ER and 46.0 mg ( SD , 7.9 mg ) of paroxetine . Venlafaxine ER treatment was significantly superior to placebo at weeks 1 through 12 on the Liebowitz Social Anxiety Scale and Social Phobia Inventory and at week 2 and weeks 6 through 12 for Clinical Global Impression-Severity of Illness and responder status , and was significantly superior to paroxetine treatment at weeks 1 and 2 for the Social Phobia Inventory ( P < .05 for all ) . Paroxetine treatment was significantly superior to placebo at weeks 3 through 12 on the Liebowitz Social Anxiety Scale , the Clinical Global Impression-Severity of Illness scale , and the Social Phobia Inventory , and at weeks 4 through 12 for response ( P < .05 for all ) . Week 12 response rates were significantly greater for the venlafaxine ER and paroxetine groups ( 58.6 % and 62.5 % , respectively ) vs the placebo group ( 36.1 % ) ( P < .001 for both ) . CONCLUSION Venlafaxine ER is effective in the short-term treatment of generalized social anxiety disorder , with efficacy and tolerability comparable to paroxetine
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 .