Table 1.
Non-psychiatrists’ guide to pharmacotherapy interventions for the anxiety disorders.
| SP | PTSD | PD | SAD | GAD | OCD | |
| Selective serotonin reuptake inhibitor (SSRI) | 1 | 1 | 1 | 1 | 1a | |
| Shift to different SSRI or SNRI | 2 | 2 | 2 | 2 | 2 | |
| Augmentation with additional SSRI or SNRI | 3 | 3 | 3 | 3 | 3 | |
| Other antidepressants (MAOIs, other)c | 4 | 3 | 3 | 2 | 4 | |
| Tricyclic antidepressants | 3 | 2 | 3 | 3 | 1b | |
| Augmentation with atypical antipsychotics | 4 | 4 | 4 | 4 | 4 | |
| Anticonvulsants | 4 | 4 | 4 | |||
| Azapirones | 3 | |||||
| Beta blockers | 2 | 3 | ||||
| Benzodiazepines | 2 | 3 | 3 | 4 |
Note: 1 = First-line intervention:multiple randomized control trials (RCTs) showing efficacy.
2 = Secondary intervention:often used as an intervention for non- or partial-response of first-line intervention, with some RCTs showing efficacy, though evidence may be mixed.
3 or 4 = Alternative intervention after 1st and 2nd line interventions, often with less RCT support or more significant side effect profile.
SP = specific phobia; PTSD = posttraumatic stress disorder; PD = panic disorder; SAD = social anxiety disorder; GAD = generalized anxiety disorder; OCD = obsessive–compulsive disorder; SNRI = serotonin norepinephrine reuptake inhibitor; MAOI = monoamine oxidase inhibitor.
Higher dosage than for other anxiety disorders.
Clomipramine (Anafranil).
Examples include bupropion (Wellbutrin), mirtazpine (Remeron), nefazodone (Serzone).