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 .
Paroxetine in the treatment of generalized social phobia: open-label treatment and double-blind placebo-controlled discontinuation.
We conducted an 11-week forced-escalation open-label study of paroxetine in the treatment of 36 patients with generalized social phobia .  At the mean dosage of 47.9 + /- 6.2 mg/day , 23 of 30 completers ( 77 % ) were deemed responders on the basis of a clinician rating of either " very much improved " or " much improved " on the Clinical Global Impressions scale . Duke Social Phobia Scale ratings declined from 35.5 + /- 13.1 at baseline to 19.7 + /- 17.4 at week 11 ( p < 0.0005 ) , and Liebowitz Social Anxiety Scale ratings declined from 75.1 + /- 25.4 at baseline to 37.2 + /- 32.5 at week 11 ( p < 0.0005 ) . Sixteen responders were r and omized to an additional 12 weeks of either paroxetine ( with no dosage change ) or placebo ( after a taper period ) on a double-blind basis . To the best of our knowledge , this is the first controlled medication-discontinuation study in social phobia . One of eight patients r and omized to continue paroxetine  relapsed versus five of eight patients r and omized to placebo . These findings call for a double-blind , placebo-controlled treatment study of paroxetine in generalized social phobia . They also suggest that relapse rates are high if medication is discontinued early and that further study is needed to determine ( 1 ) the optimal duration of maintenance pharmacotherapy for social phobia and ( 2 ) if specific psychotherapeutic interventions before medication discontinuation may prevent relapse
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 .