Table 2. The pharmacotherapy of anxiety disorders. according to the German guidelines (20).

Evidence level/ recommendation grade *1	Active substance class	Drug	Daily dose
Social phobia
Ia; A	SSRI	Escitalopram	10–20 mg
		Paroxetine	20–50 mg
		Sertraline	50–150 mg
Ia; A	SNRI	Venlafaxine	75–225 mg
CCP	MAO inhibitors	Moclobemide	300–600 mg
Panic disorder
Ia; A	SSRI	Citalopram	20–40 mg
		Escitalopram	10–20 mg
		Paroxetine	20–50 mg
		Sertraline	50–150 mg
Ia; A	SNRI	Venlafaxine	75–225 mg
Ia; B	TCA	Clomipramine	75–250 mg
Generalized anxiety disorder
Ia; A	SSRI	Escitalopram	10–20 mg
		Paroxetine	20–50 mg
Ia; A	SNRI	Venlafaxine	75–225 mg
		Duloxetine	60–120 mg
Ia; B*2	Anticonvulsants	Pregabalin	150–600 mg
Ib; 0	Anxiolytic drugs (tricyclic)	Opipramol	50–300 mg
Ib; 0	Azapirones	Buspirone	15–60 mg

*¹ according to the German guidelines

*² Case studies indicate that pregabalin has a potential for abuse. mainly in patients with substance-related disorders and above all in opiate-dependent patients (26). It is accordingly recommended in the German guidelines that patients with substance-related disorders. and particularly those who are addicted to multiple drugs. should not be treated with pregabalin. If a patient does not respond to a drug or cannot tolerate it. the next step may be a switch from one standard drug to another (e.g.. from an SSRI to an SSNRI; in generalized anxiety disorder. from an SSRI to pregabalin) or a switch to a nonstandard drug. such as one with a lower evidence level or recommendation grade (e.g.. moclobemide in social phobia). or to one that is not approved for the treatment of anxiety disorders. but has ?nonetheless been reported to be clinically effective (e.g.. quetiapine. agomelatine. lavender oil. and. in some cases. mirtazapine).

CCP = clinical consensus point; SSRI = selective serotonin reuptake inhibitors; SNRI = selective serotonin and norepinephrine reuptake inhibitors;

MAO = monoamine oxidase; TZA = tricyclic antidepressants