Until fairly recently, most publications spoke only of psychotherapeutic interventions, and only a few spoke of pharmacological treatments. Some of the problem is that many patients fear medications and their side effects just as they do any other new experience. They can also be misused or used in suicide attempts. Nevertheless, recent data indicates that some aspects of extreme social anxiety may be highly drug responsive since APD overlaps greatly with generalized social phobia (which is very responsive to MAOIs - a type of antidepressant). There are many documented cases of the successful treatment of APD with MAOIs (such as Parnate, Marplan, and Nardil). The use of Nardil (phenelzine) often shows improvement in specific fears and in confidence and assertiveness in social settings. The best medication intervention should be accompanied by psychotherapeutic methods appropriate to the individual patient. Medication alone is not able to produce permanent changes in the brain. By actually learning new ways to think and by slowly (and in a non-pressuring way) acting on these thoughts, the APD brain pathways actually change physiologically, and this brings about a gradual, permanent change in feelings.
It is important to remember that medications are not always indicated in every case and that other considerations (such as general physical health, dietary restrictions, etc) matter in determining the need for, and possible efficacy, of medications. Psychotherapy alone works best with the higher functioning APDs, but combined treatment (psychotherapy and medications) seems to provide the best results for moderate and more severely disordered patients.