Фенелзин и когнитивно-поведенческая терапия в лечении социофобий

Patients with social phobia respond well to phenelzine, especially when combined with psychotherapy.

Concerns about drug and food interactions and the ease of use of newer antidepressants have so decreased the popularity of monoamine oxidase inhibitors (MAOIs) that psychiatrists can complete residency without ever using them. This study, completed almost 10 years ago, examined the effectiveness of the prototypical MAOI phenelzine, alone or combined with group cognitive-behavioral therapy (GCBT), in treating 128 patients with social anxiety disorder meeting DSM-IV criteria.

In the acute phase, patients were randomized to phenelzine (mean, 66 mg/day), weekly GCBT, phenelzine in a similar dose (mean, 62 mg/day) combined with GCBT, or pill placebo for 12 weeks. Combined treatment and phenelzine alone (but not GCBT alone) produced significantly more improvement at 12 weeks than placebo by several measures. Effect sizes varied with the measure but generally ranged between 0.28 and 1.05 for combined treatment, 0.07 to 0.60 for phenelzine, and 0.06 to 0.36 for GCBT.

In the continuation phase, patients who improved continued their treatments at a decreased frequency through week 24. Response rates were 78% for combined treatment, 53% for GCBT, 49% for phenelzine, and 33% for placebo (remission rates, 53%, 24%, 26%, and 15%, respectively). Results from a 28-week maintenance phase and a 12-month naturalistic follow-up were not reported.

Comment: By several measures, combination treatment outperformed either MAOI or psychotherapy alone. The most likely explanation for the additive effect is that the antidepressant facilitated exposure by reducing anxiety and arousal in social and performance situations, while CBT helped patients to integrate the gains promoted by the antidepressant. The latest generation of psychiatrists should bear in mind that even MAOIs that were available 10 years ago are still effective for social anxiety and atypical depression. Insurers should pay attention to the synergistic effects of medications and psychotherapy in this and other disorders.

— Steven Dubovsky, MD
Published in Journal Watch Psychiatry April 5, 201