Pharmacological treatments for social anxiety disorder in adults: a systematic review and network meta-analysis

Williams, Taryn; McCaul, Michael; Schwarzer, Guido; Cipriani, Andrea; Stein, Dan J.; Ipser, Jonathan

doi:10.1017/neu.2020.6

Cited by 20 publications

(12 citation statements)

References 38 publications

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“…Regarding the treatment of SAD, currently existing systematic reviews include a network meta-analysis on psychotherapy and pharmacotherapy, 7 systematic review on pharmacotherapy, 8 and the latest network meta-analysis on pharmacotherapy. 9 Focusing on the pharmacotherapy, the efficacy, and high acceptability of selective serotonin reuptake inhibitor (SSRI) for SAD have been reported in these previous reviews. In addition to SSRIs, RCTs with the serotonin noradrenalin reuptake inhibitor (SNRI), monoamine oxidase inhibitors (MAOIs), reversible inhibitors of monoamine oxidase A (RIMAs), anticonvulsants with gamma-amino butyric acid (GABA) analogues, benzodiazepines, the antipsychotics, and the noradrenergic and specific serotonergic antidepressant (NaSSA) have been reported, which could be effective treatment options, but the number of trials is small and the quality of evidence was reported to be low.…”

Section: Introductionmentioning

confidence: 99%

Antidepressants for social anxiety disorder: A systematic review and meta‐analysis

Mitsui

Fujii

Asakura

et al. 2022

Neuropsychopharm Rep

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Aim: This systematic review is aimed to update and reintegrate the pharmacotherapy of social anxiety disorder (SAD), including the Japanese medical database. Methods:We conducted a systematic review and meta-analysis of pharmacotherapy of SAD according to the Medical Information Distribution Service. We used data from a most recent systematic review, and updated search were conducted using MEDLINE, PubMed, CENTRAL, ICTRP, and ICHUSHI from August 1st, 2017 to January 31st, 2022. The outcome were response rates assessed by Clinical Global Impressions Improvement, 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. 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.

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Section: Introductionmentioning

confidence: 99%

Antidepressants for social anxiety disorder: A systematic review and meta‐analysis

Mitsui

Fujii

Asakura

et al. 2022

Neuropsychopharm Rep

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“…Beyond its licensed use for GAD in the UK, pregabalin has been used in the management of other anxiety disorders [ 11 ] and acute anxiety states such as preoperative anxiety [ 12 ]. The efficacy of pregabalin is well established in GAD [ 13 ] but is unclear in other anxiety diagnoses such as social anxiety disorder [ 14 ]. A review of pregabalin for preoperative anxiolysis did not attempt a quantitative synthesis [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Gabapentin and pregabalin in bipolar disorder, anxiety states, and insomnia: Systematic review, meta-analysis, and rationale

et al. 2021

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The gabapentinoids, gabapentin, and pregabalin, target the α2δ subunits of voltage-gated calcium channels. Initially licensed for pain and seizures, they have become widely prescribed drugs. Many of these uses are off-label for psychiatric indications, and there is increasing concern about their safety, so it is particularly important to have good evidence to justify this usage. We conducted a systematic review and meta-analysis of the evidence for three of their common psychiatric uses: bipolar disorder, anxiety, and insomnia. Fifty-five double-blind randomised controlled trials (RCTs) and 15 open-label studies were identified. For bipolar disorder, four double-blind RCTs investigating gabapentin, and no double-blind RCTs investigating pregabalin, were identified. A quantitative synthesis could not be performed due to heterogeneity in the study population, design and outcome measures. Across the anxiety spectrum, a consistent but not universal effect in favour of gabapentinoids compared to placebo was seen (standardised mean difference [SMD] ranging between -2.25 and -0.25). Notably, pregabalin (SMD -0.55, 95% CI -0.92 to -0.18) and gabapentin (SMD -0.92, 95% CI -1.32 to -0.52) were more effective than placebo in reducing preoperative anxiety. In insomnia, results were inconclusive. We conclude that there is moderate evidence of the efficacy of gabapentinoids in anxiety states, but minimal evidence in bipolar disorder and insomnia and they should be used for these disorders only with strong justification. This recommendation applies despite the attractive pharmacological and genetic rationale for targeting voltage-gated calcium channels.

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“…PLZ (Fig. 1 ) is a non-selective (inhibits both MAO-A and -B) irreversible MAOI marketed as an antidepressant, but it has also been reported in clinical studies to be effective in treatment of anxiety disorders such as panic disorder and social anxiety disorder (Aarre 2003 ; Buigues and Vallejo 1987 ; Davidson et al 1987 ; Liebowitz et al 1988 ; McGrath et al 1986 ; Sheehan et al 1980 ; Williams et al 2020 ; Zhang and Davidson 2007 ). As with other irreversible non-subtype-selective MAO inhibitors, some dietary restrictions are recommended for patients on PLZ to avoid a potential hypertensive crisis when certain foods are ingested, although effects on blood pressure appear to be less problematic than originally proposed in the literature (see Gillman 2018 for discussion of this aspect).…”

Section: Introductionmentioning

confidence: 99%

Overview of the Neuroprotective Effects of the MAO-Inhibiting Antidepressant Phenelzine

et al. 2021

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Phenelzine (PLZ) is a monoamine oxidase (MAO)-inhibiting antidepressant with anxiolytic properties. This multifaceted drug has a number of pharmacological and neurochemical effects in addition to inhibition of MAO, and findings on these effects have contributed to a body of evidence indicating that PLZ also has neuroprotective/neurorescue properties. These attributes are reviewed in this paper and include catabolism to the active metabolite β-phenylethylidenehydrazine (PEH) and effects of PLZ and PEH on the GABA-glutamate balance in brain, sequestration of reactive aldehydes, and inhibition of primary amine oxidase. Also discussed are the encouraging findings of the effects of PLZ in animal models of stroke, spinal cord injury, traumatic brain injury, and multiple sclerosis, as well other actions such as reduction of nitrative stress, reduction of the effects of a toxin on dopaminergic neurons, potential anticonvulsant actions, and effects on brain-derived neurotrophic factor, neural cell adhesion molecules, an anti-apoptotic factor, and brain levels of ornithine and N-acetylamino acids.

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Pharmacological treatments for social anxiety disorder in adults: a systematic review and network meta-analysis

Cited by 20 publications

References 38 publications

Antidepressants for social anxiety disorder: A systematic review and meta‐analysis

Antidepressants for social anxiety disorder: A systematic review and meta‐analysis

Gabapentin and pregabalin in bipolar disorder, anxiety states, and insomnia: Systematic review, meta-analysis, and rationale

Overview of the Neuroprotective Effects of the MAO-Inhibiting Antidepressant Phenelzine

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