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Table 21 Recommendations for pharmacotherapy for SAD

From: Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

First-line Escitalopram, fluvoxamine, fluvoxamine CR, paroxetine, paroxetine CR, pregabalin, sertraline, venlafaxine XR
Second-line Alprazolam, bromazepam, citalopram, clonazepam, gabapentin, phenelzine
Third-line Atomoxetine, bupropion SR, clomipramine, divalproex, duloxetine, fluoxetine, mirtazapine, moclobemide, olanzapine, selegiline, tiagabine, topiramate
Adjunctive therapy Third-line: aripiprazole, buspirone, paroxetine, risperidone
Not recommended: clonazepam, pindolol
Not recommended Atenolol*, buspirone, imipramine, levetiracetam, propranolol*, quetiapine
  1. CR = controlled release; SR = sustained release; XR = extended release.
  2. *Beta-blockers have been successfully used in clinical practice for performance situations such as public speaking.
  3. Note: although there is limited evidence for citalopram in SAD, it is likely as effective as the other SSRIs, in contrast there are negative trials of fluoxetine in SAD suggesting it may be less effective than other SSRIs [382, 449].