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 .
Quetiapine as monotherapy for social anxiety disorder: A placebo-controlled study
Social anxiety disorder ( SAD ) is one of the most common anxiety disorders . Reports have suggested an effect of the atypical antipsychotic quetiapine in anxiety disorders . Given these considerations , we conducted a controlled trial of quetiapine monotherapy in SAD . Fifteen patients were r and omized to quetiapine ( up to 400 mg/day ) or placebo for 8 weeks . The Brief Social Phobia Scale ( BSPS ) and the Clinical Global Impression of Improvement Scale ( CGI-I ) were the primary outcome measures , while the Social Phobia Inventory ( SPIN ) and the Sheehan Disability Inventory ( SDI ) were secondary measures . There was no significant difference on the BSPS score at endpoint between the quetiapine and placebo groups . There was a significant time effect but not a significant time x treatment group interaction , indicating that both the quetiapine and placebo patients did better over the course of the trial . 20 % of the quetiapine patients had a 50 % or greater drop in BSPS score at the end of the trial compared to baseline , while 0 % had such a drop in the placebo group . There was no significant difference in responders ( CGI-I score of 1 or 2 ) versus non-responder ( CGI-I score of 3 or more ) across the groups . However , 40 % of quetiapine patients and 0 % of the placebo patients showed much or very much improvement on the CGI-I. The Number Needed to Treat ( NNT ) to be a responder on the CGI-I was 3 . Significant time effects were noted for the SPIN and SDI , as well as a significant time x treatment effect in favor of quetiapine on the SPIN . Additionally , quetiapine showed a large effect size on the SPIN
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 .