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 24-week randomized, double-blind, placebo-controlled study of escitalopram for the prevention of generalized social anxiety disorder.
OBJECTIVE Escitalopram has proven efficacy in the short-term treatment of generalized social anxiety disorder ( SAD ) . The present relapse prevention study investigated relapse rates during a 24-week , r and omized , double-blind , placebo-controlled period in patients with generalized SAD who had responded to 12-week open-label treatment with escitalopram .  METHOD A total of 517 patients with a primary diagnosis of generalized SAD ( per DSM-IV criteria ) and a Liebowitz Social Anxiety Scale ( LSAS ) total score of > or = 70 received 12 weeks of open-label treatment with flexible doses ( 10 - 20 mg/day ) of escitalopram . Of these patients , 371 responded ( Clinical Global Impressions-Improvement scale [ CGI-I ] score of 1 or 2 ) and were r and omly assigned to 24 weeks of double-blind treatment with escitalo-pram ( 10 or 20 mg/day ) ( N = 190 ) or placebo ( N = 181 ) , continuing with the dose level administered at the end of the open-label period . Relapse was defined as either an increase in LSAS total score of > or = 10 or withdrawal due to lack of efficacy , as judged by the investigator . The study was conducted from January 2001 to June 2002 . RESULTS Survival analysis of relapse and time to relapse showed a significant advantage for escitalopram compared to placebo ( log-rank test : p < .001 ) . The risk of relapse was 2.8 times higher for placebo-treated patients than for escitalopram-treated patients ( p < .001 ) , result ing in significantly fewer escitalopram-treated patients relapsing ( 22 % vs. 50 % ) , at both doses . Escitalopram was well tolerated during double-blind treatment of generalized SAD , and only 2.6 % of the escitalopram-treated patients withdrew because of adverse events . The overall discontinuation rate , excluding relapses , was 13.2 % for patients treated with escitalopram and 8.3 % for patients treated with placebo . CONCLUSION Escitalopram was effective and well tolerated in the long-term treatment of generalized SAD
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 .