Table 21.

Recommendations for pharmacotherapy for SAD

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

CR = controlled release; SR = sustained release; XR = extended release.

*Beta-blockers have been successfully used in clinical practice for performance situations such as public speaking.

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].