Next Steps for Patients with Social Anxiety Disorders Who Don't Respond to Pharmacotherapy

Selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacotherapy for social anxiety disorder (SAD), but up to three quarters of patients fail to achieve remission after initial therapy. To determine the most effective next-step pharmacotherapy for these patients, investigators conducted a multisite, randomized, controlled, double-blind, two-phase study funded by the National Institute of Mental Health.

The initial 397 patients with SAD were not receiving psychotherapy and were given the SSRI sertraline (≤200 mg/day). After 10 weeks, 181 nonresponders were randomized to one of three 12-week treatments: augmentation of sertraline with the benzodiazepine clonazepam (≤3 mg/day; mean dose, 1.5 mg/day), a switch to the serotonin–…