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 .
Efficacy of olanzapine in social anxiety disorder: a pilot study
Based on evidence suggesting anxiolytic properties of the atypical antipsychotic olanzapine , this study was conducted to evaluate whether olanzapine may be efficacious in treating  social anxiety disorder ( SAD ) . This study was an 8-week , double-blind , placebo-controlled evaluation of olanzapine as monotherapy in which 12 patients with the DSM-IV diagnosis of SAD were r and omized to either olanzapine ( n= 7 ) or placebo ( n= 5 ) . An initial dose of 5 mg/day was titrated to a maximum of 20 mg/day . Baseline to endpoint scores from the Brief Social Phobia Scale ( BSPS ) , Social Phobia Inventory ( SPIN ) , Liebowitz Social Anxiety Scale and Sheehan Disability Scale , as well as Clinical Global Impression-Improvement ratings , were compared for olanzapine versus placebo .  Seven subjects completed all 8 weeks of the study , four in the olanzapine group and three in the placebo group . In the intent-to-treat analysis , olanzapine yielded greater improvement than placebo on the primary measures : BSPS ( p= 0.02 ) and SPIN ( p= 0.01 ) . Both treatments were well tolerated , although the olanzapine group had more drowsiness and dry mouth .  Olanzapine and placebo were both associated with negligible weight gain .  Olanzapine was superior to placebo on the primary outcome measures in this preliminary study of SAD . Additional studies of olanzapine as a treatment for SAD are warranted
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 .