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 low and higher dose extended-release venlafaxine in generalized social anxiety disorder: a 6-month randomized controlled trial
Rationale There is a need for new pharmacological treatments for  generalized social anxiety disorder ( GSAD ) , which is a common , often disabling condition . Objective To compare the efficacy and safety over 6 months duration of two dose ranges of venlafaxine extended-release ( ER ) with placebo in patients with GSAD . Method Twenty-eight-week , double-blind , multi-center study in 386 adult out patients with DSM-IV GSAD . Patients were r and omized to placebo , venlafaxine ER fixed low dose ( 75 mg/day ) , or venlafaxine ER flexible higher dose ( 150–225 mg/day ) . Primary efficacy variable was change on the Liebowitz Social Anxiety Scale ( LSAS ) . Secondary efficacy variables included , among others , the proportion of responders on the CGI Global Improvement Item ( score 1 or 2 ) , and the proportion of remitters ( defined as an LSAS score of ≤30 ) . Results Improvement on the LSAS was greater with venlafaxine ER ( at 75 mg/day or 150–225 mg/day ) than placebo , and was sustained throughout the 6-month trial . Of patients  receiving venlafaxine ER ( at any dose ) , 58 % responded to treatment compared to 33 % of those receiving placebo ( P<0.001 ) ; corresponding remission rates were 31 % and 16 % ( P<0.01 ) . There were no differences in outcome according to venlafaxine ER dosage . Conclusions Venlafaxine ER was effective in the treatment of GSAD . The comparable efficacy at low and higher doses may indicate that norepinephrine reuptake blockade does not contribute to therapeutic effect in GSAD . This hypothesis should be tested using agents with specific actions on norepinephrine reuptake blockade
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 .