Sosyal Anksiyete Bozukluğu’nun Farmakolojik Tedavisi
Özet
Sosyal anksiyete bozukluğunun (SAB) farmakolojik tedavisinde, seçici serotonin geri alım inhibitörleri (SSRI) en sık reçete edilen ve üzerinde en çok klinik çalışma yapılan ajanlardır; tedavide tam etkinlikleri 16 haftayı bulabilir. Serotonin-norepinefrin geri alım inhibitörleri (SNRI) sınıfından venlafaksinin de benzer bir etkiye sahip olduğu bilinmektedir. Eski bir geçmişe sahip monoamin oksidaz inhibitörleri (MAOI) ise ciddi yan etkileri ve tiramin içeren gıdalarla ölümcül etkileşim riskinden dolayı diyet kısıtlaması gerektirdiği için sınırlı durumlarda tercih edilir. Benzodiazepinler ile gabapentin ve pregabalin gibi antikonvülzanlar da tedavide etkilidir ancak sedasyon, tolerans ve bağımlılık riskleri nedeniyle madde kullanım geçmişi olan hastalarda dikkatle izlenmelidir. Monoterapi ajanlarına kısmi yanıt veren hastalarda buspiron veya klonazepam ile güçlendirme tedavisi uygulanabilir. Hastalığın "yalnızca performans sırasında" ortaya çıkan alt tipinde ise genel tedavilerin aksine, performanstan 30 ila 60 dakika önce lüzum halinde kullanılmak üzere benzodiazepinler (klonazepam, lorazepam) veya fizyolojik belirtileri azaltan propranolol gibi beta-blokerler birinci basamak tedavi olarak reçete edilir.
Pharmacological treatment of social anxiety disorder (SAD) primarily utilizes selective serotonin reuptake inhibitors (SSRIs), which are the most frequently prescribed agents, though their full efficacy may take up to 16 weeks to manifest. Venlafaxine, a serotonin-norepinephrine reuptake inhibitor (SNRI), demonstrates comparable therapeutic effectiveness to SSRIs. While monoamine oxidase inhibitors (MAOIs) have a long history of use, their clinical utility remains limited by adverse effects and the strict requirement for a low-tyramine diet due to the risk of fatal hypertensive crises. Benzodiazepines, along with anticonvulsants like gabapentin and pregabalin, are effective but require careful monitoring due to risks of sedation, tolerance, and physical dependence. For patients showing partial response to monotherapy, augmentation strategies with buspirone or clonazepam can be implemented. Conversely, for the "performance-only" subtype of SAD, standard daily treatments are avoided; instead, short-acting benzodiazepines or beta-blockers such as propranolol are prescribed on an as-needed basis to be taken 30 to 60 minutes prior to a performance to manage acute physiological symptoms.
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