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Efficacy of escitalopram in the treatment of social anxiety disorder: A meta-analysis versus placebo
Open accessAbstract
Escitalopram is the most selective of the serotonin reuptake inhibitor (SSRI) antidepressants. We conducted a meta-analysis of placebo-controlled studies where escitalopram was used to treat patients with social anxiety disorder (SAD). Data from all randomised, double-blind placebo-controlled studies in SAD with escitalopram from both specialist settings and general practice were used. Patients met the DSM-IV criteria for SAD, were ≥18 years old, and had a Liebowitz Social Anxiety Scale (LSAS) ≥60. The primary outcome measure was the estimated treatment difference in LSAS total score at Week 12. Secondary outcome measures included the estimated treatment difference in the Clinical Global Impression-Severity (CGI-S) score at Week 12. A total of 1598 patients from 3 randomised controlled trials were included in the analyses. Escitalopram (n=1061) was superior to placebo (n=537), with an estimated treatment difference on the LSAS of -9.2 points (95%CI: [-14.4; -4.0], p<0.01) (escitalopram 5mg/day), -4.6 points (95%CI: [-8.1; -1.0], p<0.01) (escitalopram 10mg/day), -10.1 points (95%CI: [-13.7; -6.5], p<0.01) (escitalopram 20mg/day) and -7.3 points (95%CI: [-12.3; -2.2], p<0.01) (escitalopram 10-20mg/day). For the CGI-S, the corresponding values were -0.55 points (95%CI: [-0.79; -0.31], p<0.01) (escitalopram 5mg/day), -0.26 points (95%CI: [-0.42; -0.10], p<0.01) (escitalopram 10mg/day), -0.48 points (95%CI: [-0.64; -0.31], p<0.01) (escitalopram 20mg/day) and -0.29 points (95%CI: [-0.51; -0.07], p<0.05) (escitalopram 10-20mg/day). The withdrawal rate due to adverse events was 7.2% for escitalopram, compared with 4.3% for placebo (p<0.05). In this meta-analysis, all doses of escitalopram showed significant superiority in efficacy versus placebo in the treatment of patients with SAD.
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SSRIs are effective for treating SAD, but the placebo response can be substantial.
“While SSRIs are effective for treating SAD, the placebo response can be substantial (Baldwin et al., 2016).”
From Revisiting the SSRI vs. placebo debate in the treatment of social anxiety disorder: the role of expectancy effects, neural responsivity, and monoamine transporters (2025) · cites this paper as Baldwin et al., 2016
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Efficacy of treatments for anxiety disorders: a meta-analysis
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“Early treatment is recommended, given the prolonged course of the disease and the low rate of spontaneous remission (Baldwin et al., 2014; Nagata et al., 2015).”
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Serotonin and brain function: a tale of two receptors
Carhart-Harris, R., & Nutt, D. (2017) · Journal of Psychopharmacology · doi:10.1177/0269881117725915 · Cited by 739
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“…disorders (Taylor et al., 2021), based on the evidence of escitalopram’s efficacy superior to placebo in the treatment of generalised anxiety disorder, panic disorder and social anxiety disorder in the 5–20 mg range (Baldwin et al., 2016; Blanco et al., 2013; Kong et al., 2020; Stahl and Li, 2003).”
BackgroundFurmark, T., Wahlstedt, K., & Faria, V. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1531725 · Cited by 1
Metadata
- Authors
- Baldwin, D. S., Asakura, S., Koyama, T., Hayano, T., Hagino, A., Reines, E., & Larsen, K.
- Affiliations
- University of Cape Town (ZA)
- Hokkaido University (JP)
- Mochida Pharmaceutical (Japan) (JP)
- Lundbeck (Denmark) (DK)
- Corresponding author
- Baldwin, David S.
- Venue
- European Neuropsychopharmacology
- Publisher
- Elsevier BV
- Published
- 2016-06
- Volume
- 26
- Issue
- 6
- Pages
- 1062-1069
- ISSN
- 0924-977X (ISSN-L)
- OpenAlex
- W2285790633
- Cited by
- 36
- References
- 5
- Citations by year
- 2025: 2 · 2024: 8 · 2023: 5 · 2022: 2 · 2021: 6 · 2020: 3 · 2019: 5 · 2018: 1 · 2017: 4
- FWCI
- 0.44
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Neuropsychopharmacology (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Funders
- H. Lundbeck A/S
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- escitalopram, social anxiety disorder, selective serotonin reuptake inhibitors, antidepressant efficacy, placebo comparison, Liebowitz Social Anxiety Scale, Clinical Global Impression Scale, dose-response relationship, adverse effects, treatment discontinuation, comorbid depression, cost-effectiveness, quality of life
- MeSH terms
- Phobia, Social, Double-Blind Method, Humans, Citalopram, Randomized Controlled Trials as Topic, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Antidepressive Agents, Second-Generation, Diagnostic and Statistical Manual of Mental Disorders
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