Clinical Guidance: Next-Step Strategies for Social Anxiety Disorder
Adding clonazepam increases the likelihood of response in patients with social anxiety disorder who remain symptomatic after a trial of a selective serotonin reuptake inhibitor (SSRI). Research by Pollack et al. (CME, p. 44) supports the common clinical practice of combining a benzodiazepine with an SSRI. Among 181 nonresponders to sertraline alone, those who had up to 3 mg/day of clonazepam added to sertraline had a response rate of 56% after 12 weeks, compared with 36% for those who continued to take sertraline alone and 46% for patients switched to venlafaxine. Remission rates were 27%, 17%, and 19%, respectively, but did not show a statistical difference. In an editorial, Peter Roy-Byrne (p. 1) points out there is also value of longer SSRI treatment, as a third of the patients who simply stayed on the same sertraline regimen continued to improve.