SSRIs or Therapy for Social Anxiety Disorder: Which is the Better First Option?

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SSRIs or Therapy for Social Anxiety Disorder: Which is the Better First Option?
SSRIs or Therapy for Social Anxiety Disorder: Which is the Better First Option?

(HealthDay News) — Antidepressants are commonly used to treat social anxiety disorder, but a new report argues that psychotherapy is a better first option. The report was published online September 26 in The Lancet Psychiatry.

In a review of 101 clinical trials, researchers found that cognitive behavioral therapy often helped people with social anxiety disorder. The more common approach to tackling social anxiety – selective serotonin reuptake inhibitors (SSRIs) – also helped. But cognitive behavioral therapy showed even bigger "effect sizes" across studies that tested it.

While SSRIs can ease symptoms of social anxiety, they can also have side effects, including sleep problems and sexual dysfunction, study leader Evan Mayo-Wilson, a researcher at Johns Hopkins University in Baltimore, told HealthDay. "The other issue is that drugs often stop working. With [cognitive behavioral therapy], you're teaching people skills that they take with them after the therapy ends." However, Mayo-Wilson cautioned that depending on where you live, finding a therapist can be difficult. "Getting insurance coverage can be a problem, too," he said.

Mayo-Wilson noted that in Great Britain, the national health system already recommends cognitive behavioral therapy as the "treatment of choice" for social anxiety. If people prefer medication, the advice is to use an SSRI. Mayo-Wilson said he'd like to see U.S. treatment guidelines go in the same direction. He noted that cognitive behavioral therapy is given over a defined period of time – typically a few months – so the immediate costs can seem large, but would probably be lower than the cost of drugs over time.

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