Doctors call for shyness drug debate

A DRUG for extreme shyness launched yesterday to help sufferers overcome their fearshould be examined by the NHS's purse- holders, doctors leaders said. Seroxat, an antidepressant for social phobia, is the third "lifestyle" drug to be licensed in the last month after Viagra and the anti-fat treatment for obesity, Xenical.

Although it has been available as a treatment for depression and obsessive -compulsive disorder for seven years, Seroxat has obtained a licence for the treatment of social anxiety disorder, a disabling condition which can leave patients too frightened of encountering others to leave their own homes.

The British Medical Association said the pressure imposed on the NHS budget by the development of new treatments and drugs made rationing inevitable. "A debate must be led by the Government and involve the public so that they know what they can and cannot get on the NHS," said Ian Bogle, the BMA chairman.

Dr Bogle said urgent guidance was needed for GPs on the prescribing of Viagra, which has been banned on the NHS since its launch last month. And he promised to "assist" Frank Dobson, the Secretary of State for Health, with measures to limit the availability of new drugs. But he ruled out a blanket ban on so-called "lifestyle" drugs.

Viagra, characterised as a "recreational" drug by Mr Dobson, had opened up discussion of men's sexual health which had ramifications on the whole family and was far from trivial. "Where do you draw the line? Is an oral contraceptive a lifestyle drug? I wouldn't want to go down that line - it's a very dangerous pathway," Dr Bogle said.

Between two and five per cent of the population are estimated to suffer from social anxiety disorder, marked by an extreme response to ordinary social situations, such as meeting people and going out. Typical symptoms are severe blushing, sweating, trembling, a thumping heart and finding it difficult or impossible, to speak. Some sufferers cannot sign a cheque because they fear the tremor in their hand will affect their signature and it will be questioned. They cannot use a public toilet because of anxiety about being overheard.

Professor David Nutt, a consultant psychiatrist at the University of Bristol, said many patients did not seek help because they did not think anything could be done. In others, the condition was dismissed or trivialised by their family who believed the patient would grow out of it. One women, in her 40s, had been a prisoner in her own home for 15 years until she read that treatment was available. Professor Nutt said: "Social anxiety disorder is not shyness but a severe incapacitating mental disorder. It is common, often lifelong, under-recognised and undertreated."

Psychological treatments, and older types of anti-depressants, have been shown to be effective in relieving the symptoms. Seroxat, which has fewer side effects than other drugs, has been shown to be effective in half to two-thirds of patients in three trials of 860 sufferers in Europe and the US. It costs pounds 20 for a month's supply of Seroxat. It costs around pounds 2 for a month's supply of the older type of anti-depressants.

Professor David Baldwin, a consultant psychiatrist at the University of Southampton, who co-ordinated the European trial, said two-thirds of patients would need to remain on the drug for life. "I tend to recommend psychological therapies together with drug therapy," he said.

Feared

Situations

SOCIAL Attending functions

(weddings, parties)

Conversation in a group Dating Speaking on the telephone Meeting people Eating in a restaurant

PERFORMANCE

Public speaking

Writing a cheque

Using a keyboard in

public

Playing sports

Using a public lavatory

Taking a test, eg

driving

Trying on clothes in

a shop

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