Monitoring

The chronic nature of social anxiety and associated impairments, including risk of substance misuse, should be monitored over the long term in the general practice setting. Effective treatment may require a referral to a psychiatrist and mental health professional trained in cognitive behavioral therapy (CBT) for optimal collaborative care.

Relapse rates can be common after discontinuation of medication. The benefits of CBT tend to last longer than those of pharmacotherapy. Pharmacotherapy should be continued for up to 12 months or longer to prevent relapse (with the exception of benzodiazepines, which are typically only recommended for short-term use).[61][132]​​ After this time, the patient and prescriber can discuss whether or not to continue treatment, based on adverse effects and other considerations.[132][133]​​ If there is agreement to reduce and stop the medication, do so slowly and carefully monitor for the recurrence of symptoms. Consider reviewing additional treatment options, especially CBT, to help prevent relapse following discontinuation of medication.[137]​ In practice, many patients require ongoing, long-term therapy to achieve full benefits and prevent relapse.

For children and young people (ages 6 to 24 years), the International Consortium for Health Outcomes Measurement recommends monitoring symptoms using the Revised Children's Anxiety and Depression Scale (RCADS-25) every 3 months during active treatment and at 1-year follow-up or on transition to another setting.[171]

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