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 paroxetine for relapse prevention in social anxiety disorder: a 24-week study.
BACKGROUND The efficacy of selective serotonin reuptake inhibitors in the acute treatment of social anxiety disorder ( social phobia ) is well established . OBJECTIVE To evaluate whether the efficacy of paroxetine hydrochloride in this disorder is maintained in the long term . METHODS This was a placebo-controlled multicenter study comprising a single-blind acute treatment phase ( 12 weeks ) and a r and omized , double-blind maintenance treatment phase ( 24 weeks ) for patients who had responded to paroxetine during the acute phase . Four hundred thirty-seven adult patients with social anxiety disorder ( according to Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , criteria , code 300.23 ) entered the acute phase , and 323 continued into the maintenance phase ( 162 paroxetine and 161 placebo ) . The principal outcome measure was the proportion of patients relapsing during the maintenance phase . RESULTS Two hundred fifty-seven patients completed the study ( 136 paroxetine-treated and 121 placebo-treated patients ) . Significantly fewer patients relapsed in the paroxetine group than in the placebo group ( 14 % vs 39 % ; odds ratio , 0.24 ; 95 % confidence interval , 0.14 - 0.43 ; P<.001 ) . At the end of the study , a significantly greater proportion of patients in the paroxetine group showed improvement as shown on the Clinical Global Impression global improvement rating compared with the placebo group ( 78 % vs 51 % ; odds ratio , 3.66 ; 95 % confidence interval , 2.22 - 6.04 ; P<.001 ) . Compared with placebo , paroxetine treatment significantly ( P<.001 ) improved the symptoms of social anxiety as shown on the Liebowitz Social Anxiety Scale , Social Phobia Inventory , Sheehan Disability Scale , Symptom Checklist-90 score , and EuroQol visual analogue scale , indicating decreased disability and increased well-being .  Paroxetine was well tolerated . CONCLUSION Paroxetine is an effective long-term treatment for social anxiety disorder
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 .