Summary points

Please note that parts of this guideline may be out of date, an update will be published as soon as it is available.

• SAD is highly responsive to evidence-based acute treatments:
  • Pharmacological: most SSRIs (escitalopram, fluoxetine, fluvox-amine, paroxetine, sertraline), venlafaxine, phenelzine, moclo-bemide, some benzodiazepines (clonazepam), anticonvulsants (gabapentin, pregabalin) and olanzapine.
  • Psychological: cognitive-behavioural therapy (CBT).
• There is no conclusive evidence that pharmacotherapy is more effective than CBT for the treatment of social phobia.
• Treatment duration of up to 12 weeks is needed to assess efficacy.
• Drug treatment should be continued for at least a further 6 months in patients who have responded at 12 weeks.
• Cost should be factored into the choice of medication; the most affordable medication should preferably be selected to allow for funding of the minimum period of suggested pharmacotherapy.
• In the longer term, consider CBT as this may reduce relapse rates better than drug treatment.
• Monitor efficacy and tolerability regularly during long-term treatment.
• Combining a drug and psychological approach is recommended during the initial phase of treatment.
• Consider switching to venlafaxine after non-response to acute treatment with an SSRI.
• Consider combining evidence-based pharmacological treatments if there is non-response but only where there are no contraindications to do so.