A 2010 Evidence-Based Algorithm for the Pharmacotherapy of Social Anxiety Disorder

Stein, Dan J.; Baldwin, David S.; Bandelow, Borwin; Blanco, Carlos; Fontenelle, Leonardo F.; Lee, Paul; Matsunaga, Hisato; Osser, David N.; Stein, Murray B.; Ameringen, Michael Van

doi:10.1007/s11920-010-0140-8

Cited by 24 publications

(16 citation statements)

References 47 publications

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“…With regard to pharmacotherapy, antidepressants have been recommended as the first-line treatment for SAD [3,4,5]. However, a significant proportion of patients with SAD fail to respond to antidepressants (40-60% are nonresponders over 12-20 weeks of treatment) [6,7].…”

Section: Introductionmentioning

confidence: 99%

Cognitive Behavioral Therapy for Patients with Social Anxiety Disorder Who Remain Symptomatic following Antidepressant Treatment: A Randomized, Assessor-Blinded, Controlled Trial

Yoshinaga

Matsuki²,

Niitsu

et al. 2016

Psychother Psychosom

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Background: Although antidepressants are still a commonly used treatment for social anxiety disorder (SAD), a significant proportion of patients fail to remit following antidepressants. However, no standard approach has been established for managing such patients. This study aimed to examine the effectiveness of cognitive behavioral therapy (CBT) as an adjunct to usual care (UC) compared with UC alone in SAD patients who remain symptomatic following antidepressant treatment. Methods: This was a prospective randomized open-blinded end-point study with two parallel groups (CBT + UC, and UC alone, both for 16 weeks) conducted from June 2012 to March 2014. SAD patients who remain symptomatic following antidepressant treatment were recruited, and a total sample size of 42 was set based on pilot results. Results: Patients were randomly allocated to CBT + UC (n = 21) or UC alone (n = 21). After 16 weeks, adjusted mean reduction in the Liebowitz Social Anxiety Scale from baseline for CBT + UC and UC alone was −40.87 and 0.68, respectively; the between-group difference was −41.55 (−53.68 to −29.42, p < 0.0001). Response rates were 85.7 and 10.0% for CBT + UC and UC alone, respectively (p < 0.0001). The corresponding remission rates were 47.6 and 0.0%, respectively (p = 0.0005). Significant differences were also found in favor of CBT + UC for social anxiety symptoms, depressive symptoms, and functional impairment. Conclusions: Our results suggest that in SAD patients who have been ineffectively treated with antidepressants, CBT is an effective treatment adjunct to UC over 16 weeks in reducing social anxiety and related symptoms.

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Section: Introductionmentioning

confidence: 99%

Cognitive Behavioral Therapy for Patients with Social Anxiety Disorder Who Remain Symptomatic following Antidepressant Treatment: A Randomized, Assessor-Blinded, Controlled Trial

Yoshinaga

Matsuki²,

Niitsu

et al. 2016

Psychother Psychosom

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“…If there is no response after 4 to 6 weeks of treatment and after the dosage optimization, it is possible to: 1) change medications within the same class (e.g., fluoxetine for sertraline) or 2) change the previous medication for another one from a different class (e.g., fluoxetine for venlafaxine). 187 In public health systems, specialized treatment is recommended in cases in which: 1) patients have shown refractoriness to two previous therapeutic alternatives; 2) patients have severe chronic disorders, including high level of impairment, unusually frequent avoidance behaviors and agoraphobia that do not respond to psychotropic and clearly require behavioral therapy or CBT; and 3) patients present persistent suicidal ideation.…”

Section: Monitoring Refractoriness Referringmentioning

confidence: 99%

Pediatric anxiety disorders: from neuroscience to evidence-based clinical practice

Salum

DeSousa

Rosário

et al. 2013

Rev. Bras. Psiquiatr.

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The objective of this narrative review of the literature is to describe the epidemiology, etiology, pathophysiology, diagnosis, and treatment of pediatric anxiety disorders. We aim to guide clinicians in understanding the biology of anxiety disorders and to provide general guidelines for the proper diagnoses and treatment of these conditions early in life. Anxiety disorders are prevalent, associated with a number of negative life outcomes, and currently under-recognized and under-treated. The etiology involves both genes and environmental influences modifying the neural substrate in a complex interplay. Research on pathophysiology is still in its infancy, but some brain regions, such as the amygdala and the prefrontal cortex, have been implicated in fear and anxiety. Current practice is to establish diagnosis based purely on clinical features, derived from clinical interviews with the child, parents, and teachers. Treatment is effective using medication, cognitive behavioral therapy, or a combination of both. An introduction to the neuroscience behind anxiety disorders combined with an evidence-based approach may help clinicians to understand these disorders and treat them properly in childhood.

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“…7 The following summary is based on the primary literature, meta-analyses, systematic reviews, ongoing clinical experience, published guidelines and the current status of treatment in clinical practice 8 – 11…”

Section: Introductionmentioning

confidence: 99%

“…6 7 The following summary is based on the primary literature, meta-analyses, systematic reviews, ongoing clinical experience, published guidelines and the current status of treatment in clinical practice. [8][9][10][11] First-line CBT CBT has consistently been shown to be effective as firstline treatments in randomised controlled trials. 6 There are basically three types of CBT: individual CBT, group CBT and internet CBT.…”

Section: Introductionmentioning

confidence: 99%

Strategy for treating selective serotonin reuptake inhibitor-resistant social anxiety disorder in the clinical setting: a randomised controlled trial protocol of cognitive behavioural therapy in combination with conventional treatment

et al. 2013

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IntroductionPharmacotherapy and cognitive behavioural therapy (CBT) are consistently effective as first-line treatments for social anxiety disorders (SADs). Nevertheless, pharmacotherapy is often the first choice in clinical practice. In many countries, the first line of pharmacotherapy involves the administration of a selective serotonin reuptake inhibitor (SSRI). Although a significant proportion of patients with SAD fail to respond to the initial SSRI administration, there is no standard approach to the management of SSRI-resistant SAD. This paper describes the study protocol for a randomised controlled trial to evaluate the clinical effectiveness of CBT as a next-step strategy, concomitant with conventional treatment, for patients with SSRI-resistant SAD.Methods and analysisThis Prospective Randomized Open Blinded End-point study is designed with two parallel groups, with dynamic allocation at the individual level. The interventions for the two groups are conventional treatment, alone, and CBT combined with conventional treatment, for 16 weeks. The primary end-point of SAD severity will be assessed by an independent assessor using the Liebowitz Social Anxiety Scale, and secondary end-points include severity of other social anxieties, depressive severity and functional impairment. All measures will be assessed at weeks 0 (baseline), 8 (halfway point) and 16 (postintervention) and the outcomes will be analysed based on the intent-to-treat. Statistical analyses are planned for the study design stage so that field materials can be appropriately designed.Ethics and disseminationThis study will be conducted at the academic outpatient clinic of Chiba University Hospital. Ethics approval was granted by the Institutional Review Board of Chiba University Hospital. All participants will be required to provide written informed consent. The trial will be implemented and reported in accordance with the recommendations of CONSORT.Clinical Trial Registration NumberUMIN000007552.

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A 2010 Evidence-Based Algorithm for the Pharmacotherapy of Social Anxiety Disorder

Cited by 24 publications

References 47 publications

Cognitive Behavioral Therapy for Patients with Social Anxiety Disorder Who Remain Symptomatic following Antidepressant Treatment: A Randomized, Assessor-Blinded, Controlled Trial

Cognitive Behavioral Therapy for Patients with Social Anxiety Disorder Who Remain Symptomatic following Antidepressant Treatment: A Randomized, Assessor-Blinded, Controlled Trial

Pediatric anxiety disorders: from neuroscience to evidence-based clinical practice

Strategy for treating selective serotonin reuptake inhibitor-resistant social anxiety disorder in the clinical setting: a randomised controlled trial protocol of cognitive behavioural therapy in combination with conventional treatment

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