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 .
A Randomized Controlled Trial of Atomoxetine in Generalized Social Anxiety Disorder
The current mainstays of social anxiety disorder pharmacotherapy are serotonergic agents , with less known about the efficacy of more noradrenergic drugs . Atomoxetine ( ATM ) , a highly selective norepinephrine reuptake inhibitor , is currently approved for the treatment of attention-deficit/hyperactivity disorder ( ADHD ) . We describe the first controlled trial of ATM with respect to efficacy and tolerability in adults with the generalized subtype of social anxiety disorder ( GSAD ) without comorbid ADHD . Twenty-seven out patients with clinical ly prevailing diagnoses of GSAD by the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition were r and omized in a 1:1 ratio to 10 weeks of double-blind flexible-dose treatment with either ATM 40 - 100 mg per day ( n = 14 ) or placebo ( n = 13 ) . Primary efficacy outcome was score at end point on the Liebowitz Social Anxiety Scale in the intention-to-treat sample . There were no significant group differences in patients completing the study ( ATM  , 79 % ; placebo  , 77 % ) . Whereas ATM was well tolerated , there were no significant differences in clinical efficacy between ATM and placebo for GSAD . There were few responders overall ( ATM , 21 % ; placebo , 33 % ) , but proportions were similar in each group ( & khgr;2 [ 1 , 26 ] = 0.47 ; P = 0.67 ) . Analysis of variance with repeated measures on the Liebowitz Social Anxiety Scale was performed to detect any differential change in social anxiety symptoms between groups . A significant time effect was found ( F = 8.71 ; P = 0.007 ) , but the time-by-treatment interaction was nonsignificant ( F = 0.013 ; P = 0.91 ) . Although the small sample size limits confidence in the reported results , the comparable , and low , response rates for ATM and placebo suggest that in the absence of comorbid ADHD , ATM is unlikely to be an effective agent for the treatment of 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 .