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Combining escitalopram and cognitive–behavioural therapy for social anxiety disorder: Randomised controlled fMRI trial

  • Malin Gingnell (a1), Andreas Frick (a1), Jonas Engman (a1), Iman Alaie (a1), Johannes Björkstrand (a1), Vanda Faria (a2), Per Carlbring (a3), Gerhard Andersson (a4), Margareta Reis (a5), Elna-Marie Larsson (a6), Kurt Wahlstedt (a1), Mats Fredrikson (a7) and Tomas Furmark (a1)...
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.

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Copyright
Corresponding author
Malin Gingnell, Department of Psychology, Uppsala University, Box 1225, SE-751 42 Uppsala, Sweden. Email: malin.gingnell@psyk.uu.se
Footnotes
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These authors contributed equally to the work.

Declaration of interest

None.

Footnotes
References
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Combining escitalopram and cognitive–behavioural therapy for social anxiety disorder: Randomised controlled fMRI trial

  • Malin Gingnell (a1), Andreas Frick (a1), Jonas Engman (a1), Iman Alaie (a1), Johannes Björkstrand (a1), Vanda Faria (a2), Per Carlbring (a3), Gerhard Andersson (a4), Margareta Reis (a5), Elna-Marie Larsson (a6), Kurt Wahlstedt (a1), Mats Fredrikson (a7) and Tomas Furmark (a1)...
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