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 .
Levetiracetam in social phobia: a placebo controlled pilot study
While serotonergic antidepressants are now established as first-line pharamcotherapy for generalized social anxiety disorder ( SAD ) , other agents with different mechanisms have shown promise in treating SAD . The aim of this pilot study is to examine the efficacy and safety of levetiracetam ( LEV ) , an anticonvulsant with calcium channel modulating properties , in treating SAD . Adult out patients meeting DSM-IV criteria for SAD were r and omly assigned ( 2:1 ) to double-blind treatment with either LEV ( 500 - 3000mg/day ) or placebo ( PBO ) for 7 weeks . The primary outcome measures were the change from baseline in the Brief Social Phobia Scale ( BSPS ) and response using the Clinical Global Impression of Improvement scale ( CGI-I ) . The mean ( SD ) BSPS scores at baseline and endpoint were 45.4 ( 9.7 ) and 31.2 ( 19.7 ) for LEV ( n 9 ) , compared to 43.5 ( 8.4 ) and 37.8 ( 19.9 ) for PBO ( n 7 ) ( ITT ; ns ) . Rates of response were 22 % for LEV and 14 % for PBO using the CGI-I. Using a BSPS response criterion ( > 30 % reduction ) , response rates were 44 % for LEV and 14 % for PBO . The effect sizes of LEV relative to PBO were 0.33 for the BSPS and 0.50 for the LSAS . In summary , the results of this study , while negative on the pre-defined measures , suggest promise for LEV as a new treatment of SAD . Further work should be carried out with larger sample sizes and optimal dosing strategies of the drug
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 .