Pharmacologic Therapy

Several pharmacologic agents have demonstrated effectiveness in SAD, including SSRIs, venlafaxine, phenelzine, RIMAs, benzodiazepines, gabapentin, and pregabal-

in. SSRIs are considered the drugs of choice based on their tolerability and efficacy for SAD and comorbid depression if present. The onset of response for antidepressants may be as long as 8 to 12 weeks.25,61 Patients responding to medication should be continued on treatment for at least 1 year. Many will relapse when medication is discontinued, and there are no clear predictive factors for who will maintain re-sponse61 Some patients may elect more long-term treatment owing to fear of relapse. A suggested treatment algorithm is shown in Figure 40-4.

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