Davidson Jonathan R T
Department of Psychiatry and Behavioral Science and the Anxiety and Traumatic Stress Program, Duke University Medical Center, Durham, NC 27710, USA.
J Clin Psychiatry. 2006;67 Suppl 12:20-6.
The treatment goals for social anxiety disorder (SAD) are to reduce fear, avoidance, physical distress, disability, and comorbidity. This review illustrates some of the primary studies used to evaluate efficacy of treatments for SAD. The selective serotonin reuptake inhibitors (SSRIs) paroxetine, sertraline, fluoxetine, fluvoxamine, and escitalopram and the serotonin-norepinephrine reuptake inhibitor venlafaxine are effective treatments. They have the additional benefit of being able to treat comorbid conditions. For people who do not respond to serotonin reuptake inhibitors, treatment options include benzodiazepines (clonazepam, alprazolam, and bromazepam), alpha2delta calcium-channel blockers (gabapentin and pregabalin), reversible inhibitors of monoamine oxidase A (moclobemide, although agents in this class are not available in the United States), antiepileptics (levetiracetam), and atypical antipsychotics (olanzapine). The irreversible monoamine oxidase inhibitor phenelzine can be considered an effective third-line therapy. Combination treatments may be beneficial, but more research is needed. Benefits of beta-blockers (propranolol and atenolol) are limited to performance anxiety. Botulinum toxin A may be an effective augmentation treatment option for severe axillary hyperhidrosis in patients with SAD. Studies show that patients with SAD who are maintained on paroxetine, sertraline, or clonazepam have a low relapse rate.
社交焦虑障碍（SAD）的治疗目标是减轻恐惧、回避行为、身体不适、功能障碍和共病情况。本综述阐述了一些用于评估SAD治疗效果的主要研究。选择性5-羟色胺再摄取抑制剂（SSRI）帕罗西汀、舍曲林、氟西汀、氟伏沙明和艾司西酞普兰以及5-羟色胺-去甲肾上腺素再摄取抑制剂文拉法辛都是有效的治疗药物。它们还有能够治疗共病情况的额外益处。对于对5-羟色胺再摄取抑制剂无反应的患者，治疗选择包括苯二氮䓬类药物（氯硝西泮、阿普唑仑和溴西泮）、α2δ钙通道阻滞剂（加巴喷丁和普瑞巴林）、单胺氧化酶A可逆抑制剂（吗氯贝胺，尽管此类药物在美国无法获得）、抗癫痫药（左乙拉西坦）和非典型抗精神病药（奥氮平）。不可逆单胺氧化酶抑制剂苯乙肼可被视为一种有效的三线治疗方法。联合治疗可能有益，但还需要更多研究。β受体阻滞剂（普萘洛尔和阿替洛尔）的益处仅限于表演焦虑。肉毒杆菌毒素A可能是SAD患者严重腋窝多汗症的一种有效的增效治疗选择。研究表明，接受帕罗西汀、舍曲林或氯硝西泮维持治疗的SAD患者复发率较低。
