Therapy may be as effective as Prozac for anxiety.

* THE QUESTION The idea of being around other people -- having to talk to them, possibly being embarrassed by something you say or do -- can provoke intense fear in some people. Both medications and psychotherapy can help ease the symptoms of social phobia, also called social anxiety disorder. Is one approach more effective than the other?

* THIS STUDY randomly assigned 295 adults diagnosed with social phobia to one of five types of treatment for 14 weeks: a daily dose of the antidepressant Prozac (fluoxetine); a placebo; weekly group sessions of cognitive behavior therapy; a combination of Prozac and therapy; or a placebo/therapy combination. Therapy focused on social skills training, such as how to start a conversation with a stranger, with participants evaluated during role-playing. Those who received any treatment that included medication or therapy scored better on standard scales than did those who took the placebo, but the results for drug treatment were about the same as those for therapy. In the Prozac group, 51 percent were rated "much" or "very much" improved, as were 52 percent of the therapy group, 54 percent for therapy/Prozac and 51 percent for therapy/placebo, compared with 32 percent for placebo alone.

* WHO MAY BE AFFECTED BY THESE FINDINGS? Anyone with social phobia, which affects an estimated 5 million Americans, women more than men.

* CAVEATS Other medications used to treat this disorder could produce different results. Symptoms remained in most participants after treatment ended; longer-term treatment was not tested. Drugs and placebos were provided by Eli Lilly, which makes Prozac; the company reviewed the manuscript of the study before publication.

* BOTTOM LINE People seeking treatment for social phobia may want to ask a psychiatrist about cognitive behavior therapy or Prozac.

* FIND THIS STUDY October issue of Archives of General Psychiatry; abstract available online at

* LEARN MORE ABOUT social phobia at and

breast cancer

Reconstructive surgery need not delay chemotherapy.

* THE QUESTION A woman scheduled for a mastectomy can choose to have her breast reconstructed during the same surgery, a decision that can lessen the psychological impact of having a breast removed. But some fear that common adverse effects of the reconstructive surgery -- like skin infections and poor healing of wounds -- might delay the start of vital chemotherapy. Might postponing reconstruction be wiser?

* THIS STUDY reviewed the medical records of 128 women who had a mastectomy for breast cancer. About half had reconstructive surgery at the same time. More of these women had complications than did women who delayed reconstructive surgery (22 percent vs. 8 percent). However, the average start of chemotherapy varied by just a few days.

* WHO MAY BE AFFECTED BY THESE FINDINGS? Women with breast cancer, which is expected to strike about 215,000 U.S. women this year. About half will have mastectomies, and most will undergo chemotherapy.

* CAVEATS The study was not randomized or prospective. It also did not assess whether reconstruction affected the benefits of chemotherapy.

* BOTTOM LINE Women with breast cancer may want to ask an oncologist or plastic surgeon about immediate breast reconstruction after mastectomy.

* FIND THIS STUDY September issue of the Archives of Surgery; abstract available online at

* LEARN MORE ABOUT treatments for breast cancer at and

-- Linda Searing