BACKGROUND Cardiovascular side-effects are less frequent with moclobemide than with tricyclic or monoamine oxidase inhibitor antidepressants. We performed a detailed assessment of cardiovascular reflexes in 15 patients meeting DSM-III-R criteria for social phobia, before treatment and whilst taking a stable dose of moclobemide for a median of 7 weeks. METHODS Cardiovascular reflex responses to standing, deep breathing and the Valsalva manoeuvre were assessed using beat-by-beat blood pressure and heart rate recording. RESULTS Moclobemide produced a statistically significant, but clinically modest, degree of improvement in social phobia symptoms. Only the maximum change in heart rate from supine to standing showed a change from before to after treatment, which was not statistically significant after Bonferroni correction, and there was no consistent pattern of altered sympathetic or parasympathetic function. CONCLUSIONS Moclobemide is relatively devoid of cardiovascular autonomic effects in physically healthy subjects with social phobia. ( Int J Psych Clin Pract 2001; 5:27-31).