A. SSRIs, such as paroxetine (Paxil) 20-40 mg/day or sertraline (Zoloft) 50100 mg/day, are the first-line medication for social phobia. Benzodiazepines, such as clonazepam (Klonopin) 0.5 - 2 mg per day, may be used if SSRIs are ineffective.
B. Social phobia with performance anxiety responds well to beta blockers, such as propranolol. The effective dosage can be very low, such as 10-20 mg qid. It may also be used on a prn basis; 20-40 mg given 30-60 minutes prior to the anxiety provoking event.
C. Cognitive/behavioral therapies are effective, and should focus on cognitive retraining, desensitization, and relaxation techniques. Combined pharmacotherapy and cognitive or behavioral therapies is the most effective treatment.
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