A placebo-controlled trial of phenelzine, cognitive behavioral group therapy, and
their combination for social anxiety disorder.
Author(s): Blanco C, Heimberg RG, Schneier FR, Fresco DM, Chen H, Turk CL, Vermes D, Erwin
BA, Schmidt AB, Juster HR, Campeas R, Liebowitz MR.
Affiliation(s): Department of Psychiatry, New York State Psychiatric Institute, College of
Physicians and Surgeons of Columbia University,1051 Riverside Dr, Box 69, New
York, NY 10032, USA. cb255@columbia.edu
Publication date & source: 2010, Arch Gen Psychiatry. , 67(3):286-95
CONTEXT: Medication and cognitive behavioral treatment are the best-established
treatments for social anxiety disorder, yet many individuals remain symptomatic
after treatment.
OBJECTIVE: To determine whether combined medication and cognitive behavioral
treatment is superior to either monotherapy or pill placebo.
DESIGN: Randomized, double-blind, placebo-controlled trial.
SETTING: Research clinics at Columbia University and Temple University.
PARTICIPANTS: One hundred twenty-eight individuals with a primary DSM-IV
diagnosis of social anxiety disorder.
INTERVENTIONS: Cognitive behavioral group therapy (CBGT), phenelzine sulfate,
pill placebo, and combined CBGT plus phenelzine.
MAIN OUTCOME MEASURES: Liebowitz Social Anxiety Scale and Clinical Global
Impression (CGI) scale scores at weeks 12 and 24.
RESULTS: Linear mixed-effects models showed a specific order of effects, with
steepest reductions in Liebowitz Social Anxiety Scale scores for the combined
group, followed by the monotherapies, and the least reduction in the placebo
group (Williams test = 4.97, P < .01). The CGI response rates in the
intention-to-treat sample at week 12 were 9 of 27 (33.3%) (placebo), 16 of 34
(47.1%) (CBGT), 19 of 35 (54.3%) (phenelzine), and 23 of 32 (71.9%) (combined
treatment) (chi(2)(1) = 8.76, P < .01). Corresponding remission rates (CGI = 1)
were 2 of 27 (7.4%), 3 of 34 (8.8%), 8 of 35 (22.9%), and 15 of 32 (46.9%)
(chi(2)(1) = 15.92, P < .01). At week 24, response rates were 9 of 27 (33.3%), 18
of 34 (52.9%), 17 of 35 (48.6%), and 25 of 32 (78.1%) (chi(2)(1) = 12.02, P =
.001). Remission rates were 4 of 27 (14.8%), 8 of 34 (23.5%), 9 of 35 (25.7%),
and 17 of 32 (53.1%) (chi(2)(1) = 10.72, P = .001).
CONCLUSION: Combined phenelzine and CBGT treatment is superior to either
treatment alone and to placebo on dimensional measures and on rates of response
and remission.
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