Abstract
Previous studies have shown selective and non-selective monoamine oxidase inhibitors (MAOIs) to be effective in the treatment of social phobia. In this study we investigated the efficacy of selective serotonin reuptake inhibitors (SSRIs) in social phobia. Thirty patients with social phobia (DSM-IIIR) were treated with the SSRI fluvoxamine (150 mg daily) using a 12-week double-blind placebo controlled design. A substantial improvement was observed in seven (46%) patients on fluvoxamine and in one (7%) on placebo. Statistically significant effects were seen on measures of social anxiety and general (or anticipatory) anxiety in patients treated with fluvoxamine compared with placebo. The level of phobic avoidance decreased also but the difference at endpoint between fluvoxamine and placebo failed to reach statistical significance. It is concluded that treatment with the SSRI fluvoxamine has beneficial effects in patients suffering from social phobia, suggesting that serotonergic mechanisms might be implicated in social anxiety.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders (DSM-III-R)
Amies PL, Gelder MG, Shaw PM (1983) Social phobia: a comparative clinical study. Br J Psychiatry 142:174–179
Beaumont G (1977) A large open multicentre trial of clomipramine in the management of phobic disorders. J Int Med Res 5:116–123
Benca R, Matuzas W, Al-Sadir J (1986) Social phobia, MVP and response to imipramine — letters to the editors. J Clin Psychopharmacol 6:50–51
Black B, Uhde TW, Tancer ME (1992) Fluoxetine for the treatment of social phobia. J Clin Psychopharmacol 12 [4]:293–295
Brady JP (1984a) Social skills training for psychiatric patients: international concepts, methods and clinical results. Am J Psychiatry 141:333–340
Brady JP (1984b) Social skills training for psychiatric patients: II. clinical outcome studies. Am J Psychiatry 141:491–498
Davidson JRT, Hughes DL, George LK, Blazer DG (1993) The epidemiology of social phobia: findings from the Duke Epidemiological Catchment Area Study. Psychol Med 23:709–718
Deltito JA, Stam M (1989) Psychopharmacological treatment of avoidant personality disorder. Comp Psychiatry 30 [6]:498–504
Den Boer JA, Westenberg HGM (1988) Effects of a serotonin and noradrenaline uptake inhibitor in panic disorder; a double blind comparative study with fluvoxamine and maprotiline. Int Clin Psychopharmacol 3:59–74
Den Boer JA, Westenberg HGM (1990) Serotonin function in panic disorder: a double blind placebo controlled study with fluvoxamine and ritanserin. Psychopharmacology 102:85–94
Den Boer JA, Westenberg HGM, Kamerbeek WDJ, Verhoeven WMA, Kahn RS (1987) Effect of serotonin uptake inhibitors in anxiety disorders; a double-blind comparison of clomipramine and fluvoxamine. Int Clin Psychopharmacol 2:21–32
Den Boer JA, IM van Vliet, Westenberg HGM (1994) Recent advances in the psychopharmacology of social phobia. Prog Neuropsychopharmacol Biol Psychiatry (in press)
Derogatis LR, Lipman RS, Covi L (1973) SCL-90: an outpatient psychiatric rating scalepreliminary report. Psychopharmacol Bull 9:13–28
Emmelkamp PMG (1982) Phobic and obsessive compulsive disorder theory research and practice. Plenum, New York
Falloon IR, Lloyd GG, Harpin R (1981) The treatment of social phobia. J Nerv Ment Dis 169:180–184
Fyer AJ, Mannuzza S, Chapman TF, Liebowitz MR, Klein DF (1993) A direct interview family study of social phobia. Arch Gen Psychiatry 50:286–293
Gelernter CS, Uhde TW, Cimbolic P, Arnkoff DB, Vittone BJ, Tancer, ME, Bartko JJ (1991) Cognitive-behavioral and pharmacological treatments of social phobia. Arch Gen Psychiatry 48:938–945
Goldstein S (1987) Treatment of social phobia with clonidine. Biol Psychiatry 22:369–372
Gorman JM, Liebowitz MR, Fyer A, Campeas R, Klein DF (1985) Treatment of social phobia with atenolol. J Clin Psychopharmacol 5:298–301
Gungras M (1977) An uncontrolled trial of clomipramine in the treatment of phobic and obsessional states in general practice. J Int Med Res 5 [suppl] 5:111–115
Hamilton M (1959) The assessment of anxiety states by rating. Br J Med Psychol 32:50–55
Hamilton M (1967) Development of a rating scale for primary depressive illness. Br J Clin Psychol 6:50–55
Kelly D, Guirguis W, Frommer E, Mitchell-Heggs N, Sargant W (1970) Treatment of phobic states with antidepressants; a retrospective study of 246 patients. Br J Psychiatry 116:387–398
Liebowitz MR (1987) Social phobia. Mod Probl Pharmacopsychiatry 22:141–173
Liebowitz MR, Schneier F, Campeas R, Goeman J, Fyer A, Hollander E, Hatterer J, Papp L (1990) Phenelzine and atenolol in social phobia. Psychopharmacol Bull 26[1]:123–125
Liebowitz MR, Schneier F, Campeas R, Hollander E, Hatterer J, Fyer A, Gorman J, Papp L, Davies S, Gully R, Klein D (1992) Phenelzine versus atenolol in social phobia; a placebo-controlled comparison. Arch Gen Psychiatry 49:290–300
Lydiard RB, Laraia MT, Howell ED (1988) Alprazolam in the treatment of social phobia. J Clin Psychiatry 49:17–19
Marks IM (1985) Behavioral treatment of social phobia. Psychopharmacol Bull 21:615–618
Marks IM (1970) The classification of phobic disorders. Br J Psychiatry 116:377–386
Mountjoy CQ, Roth M, Garside RF, Leitch IM (1977) A clinical trial of phenelzine in anxiety depressive and phobic neurosis. Br J Psychiatry 131:486–492
Munjack DJ, Baltazar PL, Bohn PB (1990) Clonazepam in the treatment of social phobia: a pilot study. J Clin Psychiatry 51 [suppl]:35–40
Munjack DJ, Bruns J, Baltazar PL, Brown R, Leonard M, Nagy R, Koek R, Crocker B, Schafer S (1991) A pilot study of buspirone in the treatment of social phobia. J Anxiety Disord 5:87–98
Nichols KA (1974) Severe social anxiety. Br J Med Psychol 47:301–306
Ost LG, Jerremalm A, Johanson J (1980) Individual response patterns and the effects of differeent behavioural methods in the treatment of social phobia. Behav Res Ther 19:1–16
Pecknold JC, McClure DJ, Appeltauer L, Allan T, Wrzesinski L (1982) Does tryptophan potentiate clomipramine in the treatment of agoraphobic and social phobia patients? Br J Psychiatry 140:484–490
Perugi G, Simonini E, Savoni M (1990) Primary and secondary social phobia: psychopathology and familial differences. Comp Psychiatry 31:245–252
Reich J, Yates W (1988) Family history of psychiatric disorders in social phobia. Comp Psychiatry 29[1]:72–75
Schneier FR, Chin SJ, Hollander E, Liebowitz MR (1992a) Fluoxetine in social phobia (Letter to the editor). J Clin Psychopharmacol 12:62–63
Schneier FR, Campeas R, Fallon B (1990) Buspirone in social phobia. Presentation at the 17th Congress of Collegium Internationale Neuro-Psychopharmacologicum, Kyoto Japan
Schneier FR, Chin SJ, Hollander E, Liebowitz MR (1992b) Fluoxetine in social phobia (Letter to the editor). J Clin Psychopharmacol 12:62–63
Schneier F, Saoud JB, Campeas R, Fallon BA, Hollander E, Coplan J, Liebowitz MR (1993) Buspirone in social phobia. J Clin Psychopharmacol 13:251–256
Solyom L, Heseltine GFD, McClure DJ (1973) Behaviour therapy vs drug therapy in the treatment of phobic neurosis. Can Psychiatr Assoc J 18:25–31
Solyom C, Solyom L, la Pierre Y, Pecknold J, Morton L (1981) Phenelzine and exposure in the treatment of phobias. Biol Psychiatry 16:239–247
Solyom L, Ledwidge B, Solyom C (1986) Delineating social phobia. Br J Psychiatry 149:464–470
Sternbach H (1990) Fluoxetine treatment of social phobia. J Clin Psychopharmacol 10[3]:230
Turner SM, Beidel DC, Townsley RM (1992) Social Phobia: a comparison of specific and generalised subtypes and avoidant personality disorder. J Abn Psychol 101:326–331
Tyrer P, Steinberg D (1975) Symptomatic treatment of agoraphobia and social phobias: a follow-up study. Br J Psychiatry 127:163–165
Tyrer P, Candy J, Kelly D (1973) A study of the clinical effects of phenelzine and placebo in the treatment of phobic anxiety. Psychopharmacology 32:237–254
Van Ameringen M, Mancini C, Streiner DL (1993) Fluoxetine efficacy in social phobia. J Clin Psychiatry 54[1]:27–32
Van Praag HM (1992) About the centrality of mood lowering in mood disorders. Eur Neuropsychopharmacol 2:393–404
Van Vliet IM, Den Boer JA, Westenberg HGM (1992) Psychopharmacological treatment of social phobia: clinical and biochemical effects of brofaromine, a selective MAO-A inhibitor. Eur Neuropsychopharmacol 2:21–29
Versiani M, Mundinn FD, Wardi AE, Liebowitz MR (1988) Tranylcypromine in social phobia. J Clin Psychopharmacol 8:279–283
Versiani M (1990) Social phobia and pharmacotherapy. Hum Psychopharmacol 5:103–104
Versiani M, Nardi AE, Mundim FD (1989) Fobia social. J Brasil Psychiatrica 38:251–263
Versiani M, Nardi AE, Mundim FD, Alves AB, Liebowitz MR, Amrein R (1992) Pharmacotherapy of social phobia. A controlled study with moclobemide and phenelzine. Br J Psychiatry 161:353–360
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
van Vliet, I.M., den Boer, J.A. & Westenberg, H.G.M. Psychopharmacological treatment of social phobia; a double blind placebo controlled study with fluvoxamine. Psychopharmacology 115, 128–134 (1994). https://doi.org/10.1007/BF02244762
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF02244762