Antidepressants for social anxiety disorder: A systematic review and meta‐analysis

• Published in: Neuropsychopharmacology reports Vol. 42; no. 4; pp. 398 - 409
• Main Authors: Mitsui, Nobuyuki, Fujii, Yutaka, Asakura, Satoshi, Imai, Hissei, Yamada, Hisashi, Yoshinaga, Naoki, Kanai, Yoshihiro, Inoue, Takeshi, Shimizu, Eiji
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.12.2022; Wiley
• Subjects: Anticonvulsants; Antidepressants; Antidepressive Agents - therapeutic use; Antipsychotics; Anxiety disorders; Benzodiazepines; Bias; Drug therapy; Fear & phobias; Humans; Japan; Meta-analysis; Phobia, Social - drug therapy; Psychotropic drugs; Response rates; School dropouts; Selective Serotonin Reuptake Inhibitors - therapeutic use; Serotonin; Serotonin and Noradrenaline Reuptake Inhibitors; Social anxiety; social anxiety disorder; Systematic review; Japan; United States > US; meta-analysis; antidepressants; systematic review; Japan; social anxiety disorder
• ISSN: 2574-173X; 2574-173X
• DOI: 10.1002/npr2.12275

Aim This systematic review is aimed to update and reintegrate the pharmacotherapy of social anxiety disorder (SAD), including the Japanese medical database. Methods We conducted a systematic review and meta‐analysis of pharmacotherapy of SAD according to the Medical Information Distribution Service. We used data from a most recent systematic review, and updated search were conducted using MEDLINE, PubMed, CENTRAL, ICTRP, and ICHUSHI from August 1st, 2017 to January 31st, 2022. The outcome were response rates assessed by Clinical Global Impressions Improvement, efficacy assessed by the Liebowitz Social Anxiety Scale (LSAS), and dropout rates. We performed a random effect of meta‐analysis to obtain the differences in each outcome between active medication and placebo. We used RevMan version 5.3 for analyses. Results We identified 5 studies through update search and performed meta‐analysis for 33 studies on selective serotonin reuptake inhibitor (SSRI) and 6 studies on serotonin noradrenalin reuptake inhibitor (SNRI). The response rate (RR = 1.62) and the LSAS score reduction (mean difference = −9.65) of SSRI, and the response rate (RR = 1.57) and the LSAS score reduction (mean difference = −11.72) of SNRI were significantly different from placebo. The dropout rates of SSRI or SNRI were not significant. The response rates of SSRIs in both Japanese studies (RR = 1.44) and countries other than Japan (RR = 1.67) were significant. Most findings were based on low quality of evidence. Conclusion SSRIs are valid option for pharmacotherapy of SAD including Japanese patients. SNRIs are another effective option. However, the results should be interpreted cautiously due to several risk of bias.