Bmj-ebm.highwire.org

Paroxetine was effective for reducing symptoms in
social phobia
Baldwin D, Bobes J, Stein DJ, et al, on behalf of the Paroxetine Study Group. Paroxetine in social phobia/social anxiety
disorder. Randomised, double-blind, placebo-controlled study. Br J Psychiatry 1999 Aug;175:120–6.
QUESTION: In patients with social phobia, is paroxetine effective for reducing
symptoms?
Main outcome measures
Randomised {allocation concealed*}†, blinded {clini- Mean change in scores on the Liebowitz Social Anxiety cians, patients, outcome assessors, and statisticians}*†, Scale (LSAS, maximum score 144 points) and the placebo controlled trial with 12 week follow up.
proportion of responders on the Clinical GlobalImpression (CGI) scale (maximum score 7 points). Sec- ondary outcomes included the score on the Social 39 centres in Belgium, France, Germany, Ireland, South Avoidance and Distress Scale (maximum score 28 Africa, Spain, and the United Kingdom.
Patients
290 patients who were >18 years of age (mean age 36 y,
Main results
54% women) and had a primary diagnosis of social More patients in the paroxetine group than in the phobia according to the Diagnostic and Statistical placebo group were treatment responders (p < 0.001) Manual of Mental Disorders, Fourth Edition, criteria.
(table). Paroxetine led to greater improvement from Exclusion criteria included any other recent Axis 1 baseline than did placebo in scores on the LSAS {differ- disorder, serious medical disorders, or recent use of psy- ence in mean change from baseline 13.8, 95% CI 6.1 to chotropic drugs or psychotherapy. 73% of patients com- 21.5}‡ the Social Avoidance and Distress Scale {differ- pleted the study, and 97% were analysed.
ence in mean change from baseline 3.3, 1.4 to 5.3}‡ andthe CGI {difference in mean change from baseline 0.7, Intervention
Patients were allocated to paroxetine, 20 mg/day ini-tially and increased by 10 mg/day as needed to a maxi-mum of 50 mg/day (mean dose 34.7 mg/d) (n = 139), orto placebo (n = 151) for 12 weeks.
Conclusion
In patients with social phobia, paroxetine was effective
Paroxetine v placebo for social phobia at 12 weeks§ Paroxetine
RBI (95% CI)
*See glossary.
†Information supplied by author.
‡Difference in mean change and CI calculated from §Abbreviations defined in glossary; RBI, NNT, and CI calculated from data in article.
COMMENTARY
Social phobia is a situationally linked, intense, irrational, persistent fear of being scrutinised or negatively evaluated by others1 andis associated with fear of humiliation or embarrassment.2 Thus, socially demanding situations become disabling. Patients are cog-nitively aware of the irrationality of their fear. Prevalence rates are about 13% for lifetime3 and 7% at 1 year.1–3. The presence ofsocial phobia increases the risk for mental, drug, and alcohol comorbid illnesses.1 If the condition remains untreated, it can becomechronic and unremitting, leading to education and employment difficulties.1 4 Cognitive behaviour therapy with or without antidepressants is the most effective treatment.1 However, properly administered therapy is not available, affordable, or obtainable for most people with social phobia. Current drug options are selective serotoninreuptake inhibitors (SSRIs), monoamine oxidase inhibitors, and benzodiazepines. Little evidence exists for the effectiveness of tri-cyclic antidepressants.1 The study by Baldwin and colleagues and the current deluge of consumer education and marketing illuminate this hidden, underdiagnosed anxiety disorder. A crossover design would yield even more information and would perhaps address the effectsafter 12 weeks of treatment or after discontinuation. As is often the case, the sample was selected: patients had pure social phobia,no comorbid conditions, and no history of failed SSRI therapy for any illness. Excluding previous non-responders biases theresults toward SSRI efficacy. This luxury does not exist in the office where initial treatment occurs. However, the overall results of this study support using paroxetine to treat social phobia initially; other data also support using other SSRIs and treatments.1 The main message is the importance of recognising and diagnosing this under recognised, debilitating illness because of the tremen- dous implications for quality of life.
For correspondence:Dr D Baldwin, Mental University of Pittsburgh Medical Center, St. Margaret 1 Bruce TJ, Saeed SA. Am Fam Physician 1999;60:2311–20.
2 American Psychiatric Association, Task Force on DSM-IV. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. 4th ed. Washing- ton, DC: American Psychiatric Association; 1994.
3 MCP Hahnemann University Social Anxiety Treatment Program. http://www.mcphu.edu/shp/fear/#3.
4 Davidson JR. J Clin Psychiatry 1998;59(Suppl 17):47–53.

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