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 .
Social phobia: the clinical efficacy and tolerability of the monoamine oxidase ‐A and serotonin uptake inhibitor brofaromine. A double‐blind placebo‐controlled study
Seventy‐seven patients with a primary diagnosis of social phobia ( DSM‐III‐R ) were r and omized to treatment with the reversible and selective monoamine oxidase type A inhibitor brofaromine ( n= 37 ) or placebo ( n= 40 ) for 12 weeks in a double‐blind trial . A fixed dose of 150 mg/day or a matching placebo was given after a 2‐week dose titration phase . Patients with additional diagnoses of simple phobia , generalized anxiety disorder , dysthymia or major depressive disorder currently in remission were accepted . Patients with other Axis I mental disorders were excluded . In the brofaromine group , 78 % of the patients scored much or very much improved on the Clinical Global Impression scale compared with 23 % in the placebo group . The anxiety and avoidance scores on the Liebowitz Social Anxiety Scale ( LSAS ) were significantly reduced in favor of brofaromine . The clinical effects were not significantly correlated with the plasma concentration of brofaromine . After 12 weeks the brofaromine group scored significantly Jower than the placebo group on a core depression part of the Montgomery‐Åsberg Depressid Rating Scale . After 12 weeks of treatment the brofaromine group had significantly higher total scores on the LSAS than an age‐ and gender‐matched group of healthy controls . The brofaromine group improved further during 9‐month follow‐up treatment period , whereas 60 % of the placebo responders who continued long‐term treatment relapsed . The most common side effects in the brofaromine group were sleep disturbances , dry mouth and nausea
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 .