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 .
An open trial of topiramate in the treatment of generalized social phobia.
BACKGROUND Selective serotonin reuptake inhibitors ( SSRIs ) are the current gold st and ard in the pharmacologic treatment of generalized social phobia . SSRIs are only effective in approximately 50 % of individuals with generalized social phobia and can be associated with significant side effects . Based on the successful use of the anticonvulsants gabapentin and pregabalin in treating generalized social phobia , we conducted an open trial examining the efficacy of the glutamatergic and GABAergic anticonvulsant topiramate in the treatment of generalized social phobia . METHOD Twenty-three adult out patients with DSM-IV social phobia , generalized type , were entered into a 16-week open trial of topiramate , starting at 25 mg/day , and gradually titrated up to a maximum dose of 400 mg/day . RESULTS Twelve of 23 patients completed the trial . In the intent-to-treat ( ITT ) analysis , 11 ( 47.8 % ) of 23 were responders by a Clinical Global Impressions Improvement ( CGI-I ) scale rating of " much " or " very much " improved . The mean drop in the Liebowitz Social Anxiety Scale ( LSAS ) score for the ITT group was 29.4 % . The change in LSAS score from baseline to endpoint was significant for the ITT group ( F = 3.44 , df = 4,110 ; p = .01 ) . In the completers group , 9 ( 75.0 % ) of 12 were responders by CGI-I at 16 weeks , with a mean drop in LSAS score of 45.1 % . The rate of remission in the ITT sample , using a definition of an LSAS score of < /= 30 , gave a remission rate of 26.1 % ( 6/23 ) . CONCLUSION This study suggests that topiramate may be effective in the treatment of generalized social phobia . These results also suggest the possibility that the neurotransmitters glutamate and GABA may be involved in the neurobiology of generalized social phobia
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 .