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

Published online by Cambridge University Press:  10 February 2020

Taryn Williams Open the ORCID record for Taryn Williams [Opens in a new window] ,
Michael McCaul ,
Guido Schwarzer ,
Andrea Cipriani ,
Dan J Stein  and
Jonathan Ipser
Taryn Williams*
Affiliation:
Department of Psychiatry and Neuroscience Institute, University of Cape Town, South Africa
Michael McCaul
Affiliation:
Biostatistics Unit, Division of Epidemiology and Biostatistics, Department of Global Health, Universiteit Stellenbosch University, Cape Town, South Africa
Guido Schwarzer
Affiliation:
Institute of Medical Biometry and Statistics Faculty of Medicine and Medical Center, University of Freiburg, Germany
Andrea Cipriani
Affiliation:
Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
Dan J Stein
Affiliation:
Department of Psychiatry and Neuroscience Institute, University of Cape Town, South Africa SA MRC Unit on Risk & Resilience in Mental Disorders
Jonathan Ipser
Affiliation:
Department of Psychiatry and Neuroscience Institute, University of Cape Town, South Africa
*
Author for correspondence: Taryn Williams, Email: [email protected]
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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.

Keywords

network meta-analysissocial anxiety disordersystematic review
Type
Review Article
Information
Acta Neuropsychiatrica , Volume 32 , Issue 4 , August 2020 , pp. 169 - 176
Copyright
© Scandinavian College of Neuropsychopharmacology 2020

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