Combining escitalopram and cognitive–behavioural therapy for social anxiety disorder: Randomised controlled fMRI trial. (September 2016)

• Record Type: Journal Article
• Authors: Gingnell, Malin; Frick, Andreas; Engman, Jonas; Alaie, Iman; Björkstrand, Johannes; Faria, Vanda; Carlbring, Per; Andersson, Gerhard; Reis, Margareta; Larsson, Elna-Marie; Wahlstedt, Kurt; Fredrikson, Mats; Furmark, Tomas
• Is Part Of: British journal of psychiatry. Volume 209:Number 3(2016)
• Page Start: 229
• Page End: 235
• Publication Date: 2016-09
• Subjects: Psychiatry -- Periodicals; Psychology, Pathological -- Periodicals; 616.89005
• DOI: 10.1192/bjp.bp.115.175794
• Languages: English
• ISSNs: 0007-1250

Abstract

Abstract : Background: Selective serotonin reuptake inhibitors (SSRIs) and cognitive–behavioural therapy (CBT) are often used concomitantly to treat social anxiety disorder (SAD), but few studies have examined the effect of this combination. Aims: To evaluate whether adding escitalopram to internet-delivered CBT (ICBT) improves clinical outcome and alters brain reactivity and connectivity in SAD. Method: Double-blind, randomised, placebo-controlled neuroimaging trial of ICBT combined either with escitalopram ( n = 24) or placebo ( n = 24), including a 15-month clinical follow-up (trial registration: ISRCTN24929928). Results: Escitalopram+ICBT, relative to placebo+ICBT, resulted in significantly more clinical responders, larger reductions in anticipatory speech state anxiety at post-treatment and larger reductions in social anxiety symptom severity at 15-month follow-up and at a trend-level ( P = 0.09) at post-treatment. Right amygdala reactivity to emotional faces also decreased more in the escitalopram+ICBT combination relative to placebo+ICBT, and in treatment responders relative to non-responders. Conclusions: Adding escitalopram improves the outcome of ICBT for SAD and decreased amygdala reactivity is important for anxiolytic treatment response.