A 30-year-old man with Social Anxiety Disorder (Social Phobia) has failed an adequate SSRI trial. Which is the MOST evidence-based second-line pharmacological treatment?
- A Venlafaxine (SNRI) ✓
- B Alprazolam
- C Propranolol (beta-blocker)
- D Buspirone
Explanation
First-line pharmacotherapy for Social Anxiety Disorder includes SSRIs (e.g., paroxetine, sertraline) and SNRIs (e.g., venlafaxine). If an SSRI trial fails, switching to or adding venlafaxine (an SNRI) is the most evidence-based second-line option. Venlafaxine extended-release has FDA approval for generalized social anxiety disorder. Propranolol is useful for situational performance anxiety (e.g., giving a speech) but lacks evidence for generalized social anxiety disorder. Benzodiazepines like alprazolam have abuse potential and are not recommended as long-term treatment. Buspirone has limited evidence in social anxiety.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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