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 .
Mirtazapine in generalized social anxiety disorder: a randomized, double-blind, placebo-controlled study
This study is aim ed at investigating the efficacy and tolerability of mirtazapine in a generalized social anxiety disorder . Sixty patients with generalized social anxiety disorder were r and omly allocated to receive mirtazapine ( 30–45 mg/day ) ( n=30 ) or placebo ( n=30 ) for 12 weeks in a double-blind study design . Primary efficacy was assessed by the Liebowitz Social Anxiety Scale ( LSAS ) and response to treatment was defined as a reduction of 40 % on the LSAS and an improvement on the Clinical Global Impression scale of ‘ much or very much improved ’ . An intent-to-treat analysis showed no difference between mirtazapine and placebo on the absolute LSAS scores with a mean decrease of 13.5±16.9 and 11.2±17.8 respectively , and on the number of responders , 13 and 13 % , respectively . In conclusion , mirtazapine ( 30–45 mg/day ) failed to be effective in the generalized social anxiety disorder
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 .