ANTIDEPRESSANTS FOR SOCIAL ANXIETY DISORDER
Authors: Mitsui *Nobuyuki Mitsui , Fujii Yutaka , Asakura Satoshi , Imai Hissei , Yamada Hisashi , Yoshinaga Naoki , Kanai Yoshihiro , Inoue Takeshi , Shimizu Eiji 
Published: February 2025

Abstract

Background
Regarding the treatment of social anxiety disorder (SAD), currently existing systematic reviews include a network meta-analysis on psychotherapy and pharmacotherapy (Mayo-Wilson et al., 2014), systematic review on pharmacotherapy (Williams et al., 2017), and the latest network meta- analysis on pharmacotherapy (Williams et al., 2020). Although there are systematic reviews on the pharmacotherapy of SAD, there are no reports on differences in drug responsiveness in populations with different cultural backgrounds. SAD is a disease with culturally bonding characteristics, and it is necessary to confirm whether there are also differences in the responsiveness to pharmacotherapy. Especially in Japan, where SAD was known as “Taijin-kyofusho (TKS)” before the diagnostic criteria for SAD were established, it is presumed that the efficacy of pharmacotherapy for SAD could be different.

Aims & Objectives
This systematic review is aimed to update and reintegrate the pharmacotherapy of social anxiety disorder (SAD), including the Japanese medical database.

Method
We conducted a systematic review and meta-analysis of pharmacotherapy ofSAD according to the Medical Information Distribution Service. We used data from amost recent systematic review, and updated search were conducted using MEDLINE, Pubmed, CENTRAL, ICTRP, and ICHUSHI from August 1st, 2017 to January 31st, The outcome were response rates assessed by Clinical Global ImpressionsImprovement, efficacy assessed by the Liebowitz Social Anxiety Scale (LSAS), and dropout rates. We performed a random effect of meta-analysis to obtain the differences in each outcome between active medication and placebo. We used RevMan version 5.3 for analyses.

Results
We identified 5 studies through update search and performed meta-analysis for 33 studies on selective serotonin reuptake inhibitor (SSRI) and 6 studies on serotonin noradrenalin reuptake inhibitor (SNRI). The response rate (RR=1.62) and the LSAS score reduction (mean difference=-9.65) of SSRI, and the response rate (RR=1.57) and the LSAS score reduction (mean difference=-11.72) of SNRI were significantly different from placebo. The dropout rates of SSRI or SNRI were not significant. The response rates of SSRIs in both Japanese studies (RR=1.44) and countries other than Japan (RR=1.67) were significant. Most findings were based on low quality of evidence.

Discussion & Conclusion
SSRIs are valid option for pharmacotherapy of SAD including Japanese patients. SNRIs are another effective option. However, the results should be interpreted cautiously due to several risk of bias. The results suggest that the efficacy of pharmacotherapy for Japanese patients with SAD could be low, however, further data accumulation is needed to draw any conclusions.

References
MAYO-WILSON, E., DIAS, S., MAVRANEZOULI, I., KEW, K., CLARK, D. M., ADES, A. E. &PILLING, S. 2014. Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry, 1, 368-76.
WILLIAMS, T., HATTINGH, C. J., KARIUKI, C. M., TROMP, S. A., VAN BALKOM, A. J., IPSER, J. C. &STEIN, D. J. 2017. Pharmacotherapy for social anxiety disorder (SAnD). Cochrane Database of Systematic Reviews.
WILLIAMS, T., MCCAUL, M., SCHWARZER, G., CIPRIANI, A., STEIN, D. J. &IPSER, J. 2020. Pharmacological treatments for social anxiety disorder in adults: a systematic review and network meta-analysis. Acta Neuropsychiatr, 32, 169-176.