Many RCTs and meta-analyses have demonstrated that SSRIs are significantly more effective than placebos for the treatment of social anxiety disorder (SAD). There is sufficient evidence supporting the use of SSRIs for the first-line pharmacological treatment of SAD. The response rate is 60-70% following the long-term (about one year) administration of the SSRIs fluvoxamine, paroxetine, and escitalopram in patients with SAD in Japan. A further step of pharmacotherapy is needed for the remaining patients, about 30-40%. Evidence-based treatment guidelines for SAD indicate second- and third-line pharmacotherapies, but much more work is needed to establish treatment for patients with refractory SAD. Cognitive behavioral therapy (CBT) is considered to be the standard psychological treatment for SAD. There is a report that CBT was an effective treatment adjunct to standard care for SAD patients showing an insufficient response to SSRIs. In a neuroimaging study of SAD, pretreatment responses to social stimuli were significantly correlated with subsequent CBT treatment outcomes, particularly in regions of the higher-order visual cortex. In the future, such biomarkers may offer personalized medicine approaches for optimally selecting treatment options for patients.
 <Author's abstract>