As an astrophysicist, 48-year-old Lily Y delights in the
fact that the universe is constantly expanding. Her own
universe, however, seems to have shrunk in the past few
years as her social anxieties have limited her life to
her apartment, her office and the grocery store. The selective
serotonin reuptake inhibitor (SSRI) paroxetine is approved
and can be prescribed to treat social anxiety disorder
(SAD) but the possible link to suicide in depression has
most folks saying "Thanks, but no thanks." Fortunately,
help is on the way for SAD folk like Lily. A study in
the February issue of the Archives of General Psychiatry
has found that extended release venlafaxine is an effective
treatment alternative.
"The demonstrated efficacy of venlafaxine
extended release (ER) in social anxiety disorder gives
clinicians another important tool in treating this common,
chronic and often debilitating condition," claimed study
co-author Dr Michael Liebowitz, director of the Anxiety
Clinic at the New York State Psychiatric Institute.
A randomized, double blind parallel
group comparison study looked at the effectiveness and
tolerability of the serotonin-norepinepherine reuptake
inhibitor venlafaxine, as compared to paroxetine, and
placebo in 440 SAD sufferers. The study measured levels
of SAD symptoms as well as drug side effects during
the 12-week treatment period.
The venlafaxine and paroxetine
groups reported more relief from their symptoms over
the 12-week study as compared to the placebo group.
By the end of the study period, the Liebowitz Social
Anxiety Scale (LSAS) scores of the placebo group decreased
by 22 points while the scores of the venlafaxine and
paroxetine groups dropped by 35 and 39 points, respectively.
BETTER
THAN NOTHING
However, more venlafaxine and paroxetine users withdrew
from the study because of intolerable side effects as
compared to the placebo group. Nonetheless, more placebo
users withdrew from the study due to a lack of effect.
"While it does not appear that
the noradernergic reuptake blocking effects of venlafaxine
are crucial to its efficacy in social anxiety disorder,
this dual reuptake inhibitor differs sufficiently from
the SSRIs to make it a useful alternative for treating
social anxiety disorder," said Dr Liebowitz.
Considering that most of the study
participants reported suffering from SAD for over twenty
years, the improvement in their outlook during the short
study period was encouraging. The authors recommend
studying the use of venlafaxine over a longer time period
to see how much it can help SAD sufferers improve their
quality of life.
Arch Gen Psychiatry Feb 2005;62:190-8
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