Controlled-Release Paroxetine in the Treatment of Patients With Social Anxiety Disorder

Lepola, Ulla; Bergtholdt, Bettina; Lambert, Jane St; Davy, Katherine; Ruggiero, L.

doi:10.4088/jcp.v65n0213

Cited by 63 publications

(38 citation statements)

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“…baseline severity of illness) Study duration 12 weeks or longer Fatal flaws in study design or data analysis that contribute to a 'poor' quality rating for internal validity Adult and pediatric outpatients Outcomes include Liebowitz Social Anxiety Scale, Clinical Global Impression of Improvement scale, or the Sheehan Disability Scale Safety/tolerability Randomized, controlled trials comparing one second-generation antidepressant to another second-generation antidepressant or placebo Statistically significant differences between treatment groups deemed to affect outcomes (e.g., baseline severity of illness) Study duration 12 weeks or longer Fatal flaws in study design or data analysis that contribute to a 'poor' quality rating for internal validity placebo-controlled trials (Stein et al, 1998Allgulander, 1999;Baldwin et al, 1999;Blomhoff et al, 2001;Kobak et al, 2002;Liebowitz et al, 2003;Davidson et al, 2004;Lepola et al, 2004;Rickels et al, 2004;Wagner et al, 2004;Kasper et al, 2005) were included (see Appendix 1). We excluded five trials: one because it assessed relapse prevention (Stein et al, 2003); the second because it did not assess the LSAS, CGI-I, or SDS (Van Vliet et al, 1994); the third because it lasted less than 12 weeks (Katzelnick et al, 1995); and the fourth and the fifth because they did not meet our predefined quality criteria (Martins et al, 1994;Allgulander and Nilsson, 2001).…”

Section: Resultsmentioning

confidence: 98%

Efficacy and tolerability of second-generation antidepressants in social anxiety disorder

Hansen

Gartlehner

Moore

et al. 2008

International Clinical Psychopharmacology

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A systematic review and meta-analysis were conducted to evaluate the comparative efficacy and tolerability of second-generation antidepressants in social anxiety disorder. Studies were identified by searching MEDLINE, Embase, The Cochrane Library, PsychLit, and the International Pharmaceutical Abstracts from January 1980 through October 2006. Comparative evidence was summarized and indirect comparisons were made using network meta-analysis. Only three head-to-head trials were identified; comparative trials found only minimal differences in efficacy between escitalopram and paroxetine, and no statistically significant differences in efficacy between extended-release venlafaxine and paroxetine. Pooled evidence from 15 placebo-controlled trials suggests that escitalopram [relative benefit (RB) 1.3; 95% confidence interval (CI) 1.2-1.5], paroxetine (RB 1.9; 95% CI 1.5-2.3), sertraline (RB 1.8; 95% CI 1.5-2.2), and venlafaxine (RB 1.7; 95% CI 1.5-1.9) all produce significantly more responders than placebo; evidence favored fluvoxamine over placebo but was not significant (RB 1.5; 95% CI 0.9-2.4). Network meta-analysis did not reveal differences in efficacy among drugs. Overall, a fair amount of evidence supports the efficacy of escitalopram, fluvoxamine, paroxetine, sertraline, and venlafaxine in social anxiety disorder. The drugs do not differ in efficacy, although their adverse event profiles do.

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Section: Resultsmentioning

confidence: 98%

Efficacy and tolerability of second-generation antidepressants in social anxiety disorder

Hansen

Gartlehner

Moore

et al. 2008

International Clinical Psychopharmacology

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“…The primary efficacy measure did not reach statistical significance, while fluvoxamine differed from placebo on secondary measures (Stein et al 2003b)(A). Á Paroxetine was effective in a number of DBPC studies (Allgulander 1999;Baldwin et al 1999;Lepola et al 2004;Liebowitz et al 2002a;Pollack et al 2001;Stein et al 1998). Also, in two placebo-controlled comparator studies, paroxetine was as effective as venlafaxine (Allgulander et al 2004b;Liebowitz et al 2005a).…”

Section: Summary Of Recommendations For the Treatment Of Gadmentioning

confidence: 99%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Bandelow

Zohar

Hollander

et al. 2008

The World Journal of Biological Psychiatry

712

410

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In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders, a consensus panel of 30 international experts, are now based on 510 published randomized, placebo-or comparator-controlled clinical studies (RCTs) and 130 open studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/ SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines.

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“…There are 11 published placebo-controlled studies of paroxetine and all have found it to be superior to placebo for the treatment of SAD (Allgulander, 1999 ;Baldwin et al 1999 ;Lader et al 2004 ;Lepola et al 2004 ;Liebowitz et al 2002Liebowitz et al , 2005aSeedat & Stein, 2004 ;Stein et al 1998Stein et al , 2002aWagner, 2003).…”

Section: Rimasmentioning

confidence: 95%

The evidence-based pharmacotherapy of social anxiety disorder

Blanco

Bragdon

Schneier

et al. 2013

International Journal of Neuropsychopharmacology

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Social anxiety disorder (SAD) is a highly prevalent and often disabling disorder. This paper reviews the pharmacological treatment of SAD based on published placebo-controlled studies and published meta-analyses. It addresses three specific questions: What is the first-line pharmacological treatment of SAD? How long should treatment last? What should be the management of treatment-resistant cases? Based on their efficacy for SAD and common co-morbid disorders, tolerability and safety, selective serotonin reuptake inhibitors (SSRIs) and venlafaxine should be considered the first-line treatment for most patients. Less information is available regarding the optimal length of treatment, although individuals who discontinue treatment after 12-20 wk appear more likely to relapse than those who continue on medication. Even less empirical evidence is available to support strategies for treatment-resistant cases. Clinical experience suggests that SSRI non-responders may benefit from augmentation with benzodiazepines or gabapentin or from switching to monoamine oxidase inhibitors, reversible inhibitors of monoamine oxidase A, benzodiazepines or gabapentin. Cognitive-behavioural is a well-established alternative first line therapy that may also be a helpful adjunct in non-responders to pharmacological treatment of SAD.

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Controlled-Release Paroxetine in the Treatment of Patients With Social Anxiety Disorder

Cited by 63 publications

References 0 publications

Efficacy and tolerability of second-generation antidepressants in social anxiety disorder

Efficacy and tolerability of second-generation antidepressants in social anxiety disorder

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

The evidence-based pharmacotherapy of social anxiety disorder

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