New frontiers in the pharmacological treatment of social anxiety disorder in adults: an up-to-date comprehensive overview

ABSTRACT

Introduction

Social anxiety disorder (SAD) is associated with scarce functioning and poor quality of life. Although selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are currently first-line treatments, side effects are common and affect treatment compliance in approximately 50% of patients. This review aimed to summarize data on the efficacy of unlabeled molecules for SAD treatment.

Areas covered

Research in the main psychiatric databases was conducted (PubMed, PsychINFO, and EMBASE-Ovid) to select studies investigating the efficacy of marketed molecules not labeled for SAD treatment.

Expert opinion

Pregabalin at high doses (450–600 mg/day) appears to be a reliable alternative strategy for SAD treatment. Among the SSRIs not labeled for SAD, citalopram showed the most promising results. Quetiapine, levetiracetam, and other antidepressants/serotonergic agents, such as fluoxetine, duloxetine, monoamine oxidase inhibitors, tricyclics, mirtazapine, atomoxetine, nefazodone, vilazodone, and buspirone, presented negative, limited, or contrasting results. Data on anticonvulsants, olanzapine, tiagabine, and ketamine were positive, but preliminary. The risk/benefit ratio must be considered in the prescription of unlabeled compounds; treatment with pregabalin may be associated with somnolence and dizziness. Future research may contribute to the identification of targeted molecules for the treatment of this disorder.

KEYWORDS:

• Alternative treatments
• efficacy
• pharmacotherapy
• social anxiety disorder
• social phobia
• unmet needs

Article highlights

• Social anxiety disorder (SAD) is associated with substantial impairment of daily functioning and quality of life.

• Typical antidepressant treatments account for poor compliance or scarce responses in almost 50% of patients with SAD.

• A literature search was performed on the efficacy of marketed molecules that were not approved for SAD treatment.

• Pregabalin is the compound presenting the strongest evidence of efficacy in SAD.

• Among unlabeled antidepressants, citalopram may represent a valid alternative molecule.

• The pathophysiology of SAD is not completely understood, and further research may contribute to elucidating the neurobiological underpinnings of this disorder.

Declaration of interest

M Buoli has acted as a speaker for Mylan and Lundbeck, and as a consultant for Lundbeck. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.