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1. General social phobias

i. Cognitive behavioural therapy

OR

ii. Reversible monoamine oxidase inhibitors (MAOIs)

moclobemide
300 mg/day, divided bid to tid; increase to 600 mg/day, divided bid to tid
$1.14-2.28/day

OR

iii. Selective serotonin reuptake inhibitors (SSRIs)

sertraline
50-200 mg, once daily with evening meal
$1.60-3.50/day

or fluvoxamine
150 mg, hs
$2.20/day

OR

iv. Benzodiazepines

alprazolam
0.25 mg, tid
$0.23/day

or clonazepam
1.5-3.0 mg/day, divided tid
$0.37-0.32/day

2. For performance anxiety only, use beta-blockers

propranolol
40 mg, given 2-4 h before a performance
$0.04/dose

or nadolol
40 mg, given 2-4 h before a performance
$0.25/dose

or oxprenolol
40 mg, given 2-4 h before a performance
$0.26/dose

or atenolol
100 mg, given 2-4 h before a performance
$0.62/dose

Second-line therapies:

General social phobias - classical MAOIs

phenelzine
15 mg, tid; increase to 75 mg, divided tid
$0.90-1.50/day

Additional instructions and notes

-Preliminary research suggests that cognitive behavioural treatment is at least as effective as medications in the short-term and probably more effective in the long-term.

-Social phobias are often accompanied by other problems such as alcoholism, panic disorder, major depression and obsessive-compulsive disorder. Treatment of the comorbid disorders may require polypharmacy.

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