Benzodiazepines social anxiety disorder

An Australian study compared medical utilization and costs in patients with panic disorder, those with social anxiety disorder, and a control group (Rees et al, 1998). Almost half of the panic disorder patients had seen a primary-care physician more than seven times over a 6-month period, compared with 7% of the social phobic patients and none of the control group. The mean costs were A 150, A 60 and A 20 respectively. The patients with panic disorder were treated with antidepressants (39%), benzodiazepines (15%), relaxants (12%), beta-blockers (7%) and other medication (7%). Twenty per cent received no medication. Patients with panic... 

Benzodiazepines. The best studied of the benzodiazepines for social anxiety disorder, clonazepam has been demonstrated in controlled trials to be effective during both acute treatment (at an average dose of 2.4mg/day) and long-term maintenance therapy lasting up to 2 years. A controlled study of another high potency benzodiazepine, alprazolam, also proved effective, though it was outperformed by the MAOI antidepressant phenelzine and exhibited response rates lower than those reported with clonazepam. 

Early controlled studies demonstrated the effectiveness of irreversible MAOIs, particularly phenelzine and tranylcypromine, for generalized social anxiety disorder. Prior to the advent of the SSRIs, MAOis were considered the gold standard treatment for social anxiety disorder. The best studied of the MAOis, phenelzine, has proved snperior to both beta blockers and the benzodiazepine alprazolam in treating generalized social anxiety disorder. 

Benzodiazepines. Longer-acting clonazepam and shorter-acting alprazolam have also been used in the treatment of social anxiety disorder, and controlled trials have shown them to be quite effective. In our experience, alprazolam is best suited for discrete periods of intermittent anxiety, though both clonazepam and the new long-acting alprazolam (Xanax XR) are likely effective for long-term treatment. 

Davidson JR. Use of benzodiazepines in social anxiety disorder, generalized anxiety disorder, and posttrau-matic stress disorder. J Clin Psychiatry. 2004 65(suppl 5) 29-33. 

FIGURE 69-3. Algorithm for the pharmacotherapy of social anxiety disorder. SSRI = selective serotonin reuptake inhibitor, BZ = benzodiazepine. (Compiled from Ballenger et al, Van Amerigen and Mancini, and Blanco... 

Jefferson JW. Benzodiazepines and anticonvulsants for social phobia (social anxiety disorder). J CUn Psychiatry 2001 62 50-53. 

The distinction among the anxiety disorders brought social phobia to the limelight. It has been documented [see Miner et ah. Chapter 25, in this volume] that benzodiazepines are also highly effective as treatment for this disorder. However, because of dependency and other undesirable side effects of the benzodiazepines, MAOls [especially selective reversible MAOls], P-blockers, and especially SRIs have been introduced as treatment modalities with quite promising efficacy. 

Benzodiazepines, the most commonly used anxiolytic drugs in the treatment of chronic anxiety states, have also been investigated in the treatment of social phobia. These agents have been shown to be effective in the treatment of other anxiety disorders, including panic disorder and generalized anxiety disorder. Three benzodiazepines, all in the high-potency class of benzodiazepines have been investigated in the treatment of social phobia. 

Antidepressant drugs, however, might have direct anxiolytic effects. That is, certain antidepressants such as paroxetine (Paxil) or venlafaxine (Effexor) can help reduce anxiety independent of their effects on depression.1,47 These antidepressants have therefore been advocated as an alternative treatment for anxiety, especially for people who cannot tolerate the side effects of traditional anxiolytics, or who might be especially susceptible to the addictive properties of drugs like the benzodiazepines.1,9,46 Moreover, antidepressants such as paroxetine or venlafaxine are now considered effective as the primary treatment for several forms of anxiety, including generalized anxiety disorder, social phobia, and panic disorder.4,29,53 Antidepressants, either used alone or in combination with antianxiety drugs, have become an important component in the treatment of anxiety. 

In another study, Malsch and Kieser (2001) investigated the anxiolytic effects of WS 1490 compared to placebo in patients previously treated with a benzodiazepine. They evaluated the potential of the kava preparation as a replacement for the benzodiazepine, as well as the ability of the kava preparation to reduce benzodiazepine withdrawal symptoms. This was a five-week randomized, double blind placebo-controlled study in outpatients with non-psychotic anxiety (e.g., generalized anxiety disorder, social phobia, and simple phobia). Forty patients were included, and all had been on benzodiazepines (i.e., lorazepam, bromazepam, oxazepam, or alprazolam) for a mean duration of 20 months prior to entering the study. Of the 40 patients, 25 were males, and the mean age of the total sample was 40 years (range 21—75 years). 

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