Selective serotonin reuptake inhibitors

The selective serotonin reuptake inhibitors fluvoxamine,(52) paroxetine/53,5^ and sertraline(55) have demonstrated efficacy in placebo-controlled trials. A controlled trial still underway suggests that fluoxetine has a similar efficacy.(56)

A total of 30 patients were randomly assigned to 12 weeks of either fluvoxamine or placebo treatment.(52) Independent assessors classified 46 per cent (7/15) of fluvoxamine completers as significantly improved compared with 7 per cent (1/13) of placebo completers.

In an industry-supported trial,(53) 183 patients with generalized social phobia received either paroxetine or placebo. In an intent-to-treat analysis, 55 per cent (50/91) of patients receiving paroxetine, compared with only 23.9 per cent (22/92) of patients given placebo, were much or very much improved after 11 weeks. Patients tolerated paroxetine well, as indicated by relatively modest levels of attrition (15 per cent; 14/91). In an earlier study, (54) patients with generalized social phobia were treated for 11 weeks with paroxetine. Of these, 16 responders were then randomly assigned to 12 additional weeks of paroxetine or pill placebo following a step-down discontinuation: five patients given placebo, but only one paroxetine patient, relapsed following discontinuation.

Favourable results were reported for a small cross-over trial of sertraline and placebo ( n = 12).(55) Patients receiving sertraline first endorsed reductions in both clinician- and self-rated measures of social anxiety that were maintained after being switched to placebo. Patients receiving placebo first showed no changes on these measures until they received sertraline.

Finally, preliminary findings from an ongoing trial comparing fluoxetine, placebo, cognitive-behavioural therapy, cognitive-behavioural therapy plus fluoxetine, and cognitive-behavioural therapy plus placebo in the treatment of generalized social phobia indicate that all treatments exceed the efficacy of placebo. (56)

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