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 .
Double-blind, placebo-controlled assessment of combined clonazepam with paroxetine compared with paroxetine monotherapy for generalized social anxiety disorder.
BACKGROUND Generalized social anxiety disorder ( GSAD ) is a pervasive form of social anxiety that affects approximately 5 % of persons in the community . Among evidence -based pharmacologic treatments for the disorder , selective serotonin reuptake inhibitors ( SSRIs ) have become widely used and are known to be efficacious . Monotherapy with the benzodiazepine clonazepam is also efficacious for GSAD , but the adjunctive use of clonazepam with an SSRI to potentially improve outcomes has not been studied to date . METHOD Twenty-eight patients ( 22 men and 6 women ) with DSM-IV-defined GSAD were r and omly assigned to receive double-blind clonazepam ( or placebo ) , 1.0 to 2.0 mg/day ( divided b.i.d . ) along with open-label paroxetine , 20 to 40 mg/day , for 10 weeks . A 2-week taper of double-blind medication was followed by an additional 8 weeks of open-label paroxetine treatment ( during which the dose of paroxetine could be increased to a maximum of 50 mg/day ) . Twenty-three patients ( 82 % ) met DSM-IV criteria for avoidant personality disorder . The patients ' mean + /- SD age was 31.2 + /- 7.7 years , and their mean duration of illness was 12.1 + /- 5.8 years . Data were gathered from August 2001 to April 2002 . RESULTS Nineteen ( 68 % ) of 28 patients completed treatment . At the end of the 10-week double-blind treatment , there was a trend ( p < .06 ) favoring the paroxetine/clonazepam group , who had a 79 % response rate ( Clinical Global Impressions-Global Improvement scale [ CGI-I ] score of 1 or 2 ) compared with a 43 % response rate for the paroxetine/placebo group . However , no significant differences on other outcome measures were noted between the 2 groups in an intent-to-treat analysis , in terms of either very early ( 2 - 4 weeks ) or not as early ( 5 - 10 weeks ) responses during treatment . Dropout rates due to adverse events were rare ( 1 patient in each group ) , indicating that the paroxetine/clonazepam combination was well tolerated . CONCLUSION Coadministration of clonazepam with an SSRI , in contrast to findings in panic disorder , did not lead to more rapid resolution of symptoms in GSAD . On the other h and , there is some evidence that the clonazepam-added group had superior global outcomes ( e.g. , as measured on the CGI-I ) , although power to detect such differences in this study was small . These observations suggest that a role for adjunctive benzodiazepines in patients with GSAD ( e.g. , for augmenting SSRI partial response or nonresponse ) is deserving of further controlled investigation
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 .