Combining SSRI and cognitive behavioural therapy for social anxiety disorder

Selective serotonin reuptake inhibitors (SSRI) 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.

We conducted a study to evaluate if adding escitalopram to Internet-delivered CBT (ICBT) improves clinical outcome and alters brain reactivity and connectivity in SAD. It has now been accepted for publication in  British Journal of Psychiatry.

In this double-blind randomized placebo-controlled neuroimaging trial we combined ICBT with either with escitalopram (ESCIT; n=24) or placebo (n=24), including a 15-month clinical follow-up.


ESCIT+ICBT, relative to placebo+ICBT, resulted in significantly more clinical responders, larger reductions in anticipatory speech state anxiety at posttreatment and larger reductions in social anxiety symptom severity at 15-month follow-up and at a trend-level (p=0.09) at posttreatment. Right amygdala reactivity to emotional faces also decreased more in the ICBT+ESCIT combination relative to placebo+ICBT, and in treatment responders relative to nonresponders.


Adding escitalopram improves the outcome of ICBT for SAD and decreased amygdala reactivity is important for anxiolytic treatment response.

Read the full paper:

Gingnell, M., Frick, A., Engman, J., Alaie, I., Björkstrand, J., Faria, V., Carlbring, P., Andersson, G., Reis, M., Larsson, E.-M., Wahlstedt, K., Fredrikson, M., & Furmark, T. (2016). Combining escitalopram and cognitive behavioural therapy for social anxiety disorder – A randomized controlled fMRI trial. British Journal of Psychiatry, 209, 229-235. doi:10.1192/bjp.bp.115.175794