Pharmacological treatments for social anxiety disorder in adults: a systematic review and network meta-analysis
Abstract
OBJECTIVE: The aim of this paper was to provide a systematic review and update on the pharmacotherapy of social anxiety disorder (SAD), including the efficacy and tolerability of these agents, the ranking of interventions, and the grading of results by quality of evidence. METHODS: The Common Mental Disorder Controlled Trial Register and two trial registries were searched for randomised controlled trials (RCTs) comparing any pharmacological intervention or placebo in the treatment of SAD. We performed a standard pairwise meta-analysis using a random effects model and carried out a network meta-analysis (NMA) using the statistical package, R. Quality of evidence was also assessed. RESULTS: We included 67 RCTs in the review and 21 to 45 interventions in the NMA. Paroxetine was most effective in the reduction of symptom severity as compared to placebo. Superior response to treatment was also observed for paroxetine, brofaromine, bromazepam, clonazepam, escitalopram, fluvoxamine, phenelzine, and sertraline. Higher dropout rates were found for fluvoxamine. Brofaromine, escitalopram, fluvoxamine, paroxetine, pregabalin, sertraline, and venlafaxine performed worse in comparison to placebo for the outcome of dropouts due to adverse events. Olanzapine yielded a relatively high rank for treatment efficacy and buspirone the worse rank for dropouts due to any cause. CONCLUSION: The differences between drugs and placebo were small, apart from a significant reduction in symptom severity and response for paroxetine. We suggest paroxetine as a first-line treatment of SAD, with the consideration of future research on the drug olanzapine as well as brofaromine, bromazepam, clonazepam, escitalopram, fluvoxamine, phenelzine, and sertraline because we observed a response to treatment.
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Meta-analytic data suggest that SSRIs and SNRIs are associated with favorable outcomes compared to placebo yet are also associated with higher dropout rates over the treatment course.
“Meta-analytic data on medication-based therapies suggests that SSRIs and SNRIs are associated favorable outcomes compared to placebo yet are also associated with higher dropout rates over the treatment course (14, 15).”
The efficacy of pharmacotherapies appears dependent on continued adherence to medication, with as many as 25% of people reporting relapse after discontinuation of the drug.
“The efficacy of pharmacotherapies also appears dependent on continued adherence to medication, with as many as 25% of people reporting relapse after discontinuation of the drug.”
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Strawn, J. R., Stahl, S. M., Nasser, A. F., Cutler, A. J., & Bernik, M. (2026) · CNS Spectrums · doi:10.1017/s1092852926101254
- Authors
- Williams, T., McCaul, M., Schwarzer, G., Cipriani, A., Stein, D. J., & Ipser, J.
- Affiliations
- University of Cape Town (ZA)
- Stellenbosch University (ZA)
- University of Freiburg (DE)
- Oxford Health NHS Foundation Trust (GB)
- South African Medical Research Council (ZA)
- Corresponding author
- Williams, Taryn
- Venue
- Acta Neuropsychiatrica
- Publisher
- Cambridge University Press (CUP)
- Published
- 2020-02-10
- Volume
- 32
- Issue
- 4
- Pages
- 169-176
- ISSN
- 0924-2708 (ISSN-L)
- 1601-5215
- OpenAlex
- W3006121501
- Cited by
- 59
- References
- 44
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 29 · 2023: 4 · 2022: 6 · 2021: 10
- FWCI
- 0.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta Neuropsychiatrica (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- social anxiety disorder, pharmacotherapy, paroxetine, first-line therapy, treatment efficacy, tolerability, adverse events, drug ranking, olanzapine, buspirone, benzodiazepines, selective serotonin reuptake inhibitors, pregabalin, venlafaxine, fluvoxamine, escitalopram, sertraline, phenelzine, brofaromine
- MeSH terms
- Network Meta-Analysis, Phobia, Social, Adult, Humans, Anti-Anxiety Agents, Randomized Controlled Trials as Topic, Treatment Outcome
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