95 Moclobemide, after the promising buy MS-275 results of Versiani et al,91 produced a less robust, result, in the large multicenter controlled study that followed,96 in which 600

mg/day was superior to placebo (47% of responders compared with 34% receiving placebo). Another large multicenter trial,97 as well a single study,98 failed to confirm the efficacy of this drug in social anxiety. Certainly the greatest amount of carefully controlled data are from the recent, paroxetine studies.99-99 In multicenter, double-blind, placebo-controlled, 12-week trials in severely symptomatic patients with social phobia, 55% of patients had a marked or moderate response at a mean dosage of 36.6 mg/day. Scores on the liebowitz Social Anxiety Inhibitors,research,lifescience,medical Scale fell about 40% on paroxetine (30.5 points). Differences were observed in the second week and throughout the remainder of the trial. These Inhibitors,research,lifescience,medical positive findings were confirmed by Baldwin et al102 and Allgulander.103

Other controlled trials with SSRIs include fluvoxamine,88,104 sertraline,105,106 fluoxetine,107 venlafaxine,108 and nefazodone.109 In these trials, the clinically significant response rates of patients were in the 42% to 77% range. Finally, open trials of citalopram110-112 and buproprion113 have suggested that these drugs may be effective in the treatment, of social anxiety disorder, but controlled studies are needed to confirm preliminary results. Other drugs Buspirone has been shown to Inhibitors,research,lifescience,medical be effective as a primary treatment in two thirds of patients in early trials,114,115 as well as an augmenting agent Inhibitors,research,lifescience,medical with SSRIs.116 One controlled trial failed to find significant, differences between buspirone and placebo.117 Also the P-blocker atenolol, despite early promise, proved ineffective when tested in patient populations with generalized symptoms of social Inhibitors,research,lifescience,medical phobia.90,118 Pindolol was no more effective than placebo in augmenting the effects of paroxetine treatment for generalized social phobia.119 High doses of gabapentin (3600 mg/day) provided encouraging

preliminary results in a 14-week, placebo-controlled study.120 Pregabalin, a follow-up compound of the G ABA agonist, gabapentin, is being developed for the potential treatment of several central nervous system disorders and anxiety, including social anxiety disorder.121 Posttraumatic stress disorder Benzodiazepines PTSD is a complex syndrome occurring after one or more traumatic events and involves multiple anxiety symptoms, including flashbacks, emotional numbing, avoidance of the Bay 11-7085 reminders of the event, and so forth. This disorder was first recognized after military combat, but is now seen frequently after rape, assault, and accidents. Although there is no established pharmacotherapy for PTSD, there are multiple medications that seem to be effective in reducing these symptoms, particularly flashbacks, phobic avoidance, depression, anxiety, startle reaction, impulsivity, and hypervigilance (Table IV).