Rate of social anxiety disorder, its comorbidity with depression and paroxetine effects in outpatients in Japan

Yukihiko Shirayama, Michio Takahashi, Masatoshi Suzuki, Atsushi Kimura, Koichi Sato

Department of Psychiatry, Teikyo University Chiba Medical Center, Ichihara, Japan.

DOI: 10.4236/ojpsych.2013.31A015                

Abstract

The prevalence of persons with social anxiety disorder (SAD) in Japan remains unknown. This study examined 293 patients with age between 20 and 60 at first visit on the outpatient clinic of psychiatry by the section of social phobia of M.I.N.I. and DSM-IV. After that, 10 patients with both SAD out of 16 patients (trial recruited) completed 12 weeks of treatment with paroxetine. Among 63 patients with 4 points and 40 patients with 3 points on the M.I.N.I., 21 patients (33%) and 16 patients (40%) were diagnosed as SAD on DSM-IV criteria, respectively. Together, 37 patients (12.6%) were diagnosed as SAD out of the 293 outpatients. Among 37 patients with SAD, 23 patients (62%) had comorbid depression. As for 10 patients after treatment with paroxetine, 8 patients improved from the point of recovery of depression (HAM-D scores below 10), whereas only 4 patients improved from the point of recovery of social phobia (L-SAS scores below 30). Three points as well as 4 points on the M.I.N.I. is meaningful for the diagnosis of SAD. For a while, paroxetine exerted less beneficial effects on SAD rather than on depression.

Keywords

Social Anxiety Disorder; Depression; Paroxetine; Comorbidity

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders. 4th Edition, Text Revision, American Psychiatric Association Inc., Washington DC.
[2]	Davidson, J.R., Hughes, D.L., George, L.K. and Blazer, D.G. (1993) The epidemiology of social phobia: Findings from the duke epidemiological catchment area study. Psychological Medicine, 23, 709-718. doi:10.1017/S0033291700025484
[3]	Schneider, F.R., Heckelman, L.R., Garfinkel, R., Campeas, R., Fallon, B.A., Gitow, A., Street, L., Del Bene, D. and Liebowitz, M.R. (1994) Functional impairment in social phobia. Journal of Clinical Psychiatry, 55, 322-331.
[4]	Den Boer, J.A. (1997) Social phobia: Epidemiology, recognition, and treatment. British Medical Journal, 315, 796-800. doi:10.1136/bmj.315.7111.796
[5]	Van Ameringen, M., Mancini, C., Styan, G. and Donison, D. (1991) Relationship of social phobia with other psychiatric illness. Journal of Affective Disorders, 21, 93-99. doi:10.1016/0165-0327(91)90055-W
[6]	Stein, M.B., Tancer, M.E., Gelernter, C.S., Vittone, B.J. and Uhde, T.W. (1990) Major depression in patients with social phobia. American Journal of Psychiatry, 147, 637-639.
[7]	Souery, D., Oswald, P., Massat, I., Bailer, U., Bollen, J., Demyttenaere, Y., Montgomery, S., Serretti, A., Zohar, J. and Mendlewicz, J. (2007) Clinical factors associated with treatment resistance in major depressive disorder: Results from a European multicenter study. Journal of Clinical Psychiatry, 68, 1062-1070. doi:10.4088/JCP.v68n0713
[8]	Tsuchiya, M., Kawakami, N., Ono, Y., Nakane, Y., Na- kamura, Y., Tachimori, H., Iwata, N., Uda, H., Nakane, H., Watanabe, M., Naganuma, Y., Furukawa, T.A., Hata, Y., Kobayashi, M., Miyake, Y., Takeshima, T., Kikkawa, T. and Kessler, R.C. (2009) Lifetime comorbidities between phobic disorders and major depression in Japan: Results from the world mental health Japan 2002-2004 survey. Depression and Anxiety, 26, 949-955. doi:10.1002/da.20508
[9]	Stein, M.B., Fuetsch, M., Müller, N., H?fler, M., Lieb, R. and Wittchen, H.U. (2001) Social anxiety disorder and the risk of depression. Archives of General Psychiatry, 58, 251-256. doi:10.1001/archpsyc.58.3.251
[10]	Holma, K.M., Holma, I.A.K., Melartin, T.K., Rytsala, H.J. E. and Isometsa, T. (2008) Long-term outcome of major depressive disorder in psychiatric patients is variable. Journal of Clinical Psychiatry, 69, 196-205. doi:10.4088/JCP.v69n0205
[11]	Dalrymple, K.L. and Zimmerman, M. (2011) Treatment-seeking for social anxiety disorder in a general outpatient psychiatry setting. Psychiatry Research, 187, 375-381. doi:10.1016/j.psychres.2011.01.004
[12]	Van Vliet, I.M., den Boer, J.A. and Westenberg, H.G. (1994) Psychopharmacological treatment of social phobia; a double blind placebo controlled study with fluvoxamine. Psychopharmacology, 115, 128-134. doi:10.1007/BF02244762
[13]	Fedoroff, I.C. and Taylor, S. (2001) Psychological and pharmacological treatments of social phobia: A meta-analysis. Journal of Clinical Psycopharmacology, 21, 311-324. doi:10.1097/00004714-200106000-00011
[14]	Sheehan, D.V., Lecrubier, Y., Sheehan, K.H., Sheehan, H.K., Amorim, P., Janavas, J., Weiller, E., Hergueta, T., Baker, R. and Dunber, G.C. (1998) The mini-international neuropsychiatric interview (MINI): The development and validation of structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22-33.
[15]	Liebowitz, M.R. (1987) Social phobia. In: Ban, T.A., Pichot, P. and Poldinger, W., Eds., Modern Problems of Pharmacopsychiatry, Karger, New York, 141-173.
[16]	Asakura, S., Inoue, S., Sasaki, F., Sasaki, Y., Kitagawa, N., Inoue, T., Denda, K., Ito, M., Matsubara, R. and Koyama, T. (2002) Reliability and validity of the Japanese version of the Liebowitz Social Anxiety Scale. Seishin Igaku, 44, 1077-1084.
[17]	Van Ameringen, M. and Mancini, C. (2001) Pharmacotherapy of social disorder at the turn of the millennium. Psychiatric Clinics of North America, 24, 783-803. doi:10.1016/S0193-953X(05)70263-X
[18]	Eaddy, M., Bramley, T. and Regan, T. (2003) Time to antidepressant discontinuation: A comparison of controlled-release paroxetine and immediate-release selective serotonin-reuptake inhibitors. Managed Care Interactive, 16, 22-27.
[19]	Golden, R.N., Nemeroff, C.B., McSorley, P., Pitts, C.D. and Dubé, E.M. (2002) Efficacy and tolerability of controlled-release and immediate release paroxetine in the treatment of depression. Journal of Clinical Psychiatry, 63, 577-584. doi:10.4088/JCP.v63n0707
[20]	Allgulander, C. (1999) Paroxetine in social anxiety disorder: A randomized placebo-controlled study. Acta Psychiatrica Scandinavica, 100, 193-198. doi:10.1111/j.1600-0447.1999.tb10845.x
[21]	Stein, M.B., Liebowitz, M.R., Lydiard, R.B., Pitts, C.D., Bushnell, W. and Gerbel, I. (1998) Paroxetine treatment of generalized social phobia (social anxiety disorder): A randomized controlled trial. Journals of American Medical Association, 280, 708-713. doi:10.1001/jama.280.8.708
[22]	Baldwin, D., Bobes, J., Stein, D.J., Scharwachter, I. and Faure, M. (1999) Paroxetine in social phobia/social anxiety disorder. Randomized double-blind, placebo-controlled study. Paroxetine study group. British Journal of Psychiatry, 175, 120-126. doi:10.1192/bjp.175.2.120
[23]	Tancer, M.E., Mailman, R.B., Stein, M.B., Mason, G.A., Carson, S.W. and Golden, R.N. (1994-1995) Neuroendocrine responsivity to monoaminergic system probes in generalized social phobia. Anxiety, 1, 216-223.
[24]	Duval, F., Mokrani, M.C., Correa, H., Bailey, P., Valdebenito, M., Monreal, J., Crocq, M.A. and Macher, J.P. (2001) Lack of effect of HPA axis hyperactivity on hormonal responses to d-fenfluramine in major depressed patients: Implications for pathogenesis of suicidal behaviour. Psychoneuroendocrinology, 26, 521-537. doi:10.1016/S0306-4530(01)00011-7