From the Guidelines
Selective serotonin reuptake inhibitors (SSRIs) or anxiolytics are recommended for the management of generalized anxiety, with the choice informed by side-effect profiles, interactions, response, patient age, and preference, as suggested by the most recent guideline update 1.
Medication Options
Medications commonly used for generalized anxiety disorder include:
- Selective serotonin reuptake inhibitors (SSRIs) like escitalopram (10-20mg daily), sertraline (50-200mg daily), or paroxetine (20-50mg daily)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (75-225mg daily) or duloxetine (30-120mg daily)
- Benzodiazepines like lorazepam (0.5-2mg, 2-3 times daily) or clonazepam (0.25-1mg, twice daily) for short-term use
- Buspirone (15-30mg daily, divided doses) as a non-addictive alternative
- Pregabalin (150-600mg daily, divided doses) in some countries These medications work by regulating neurotransmitters like serotonin, norepinephrine, and GABA that influence anxiety levels in the brain.
Treatment Duration and Monitoring
Treatment typically continues for 6-12 months after symptom improvement, with gradual tapering to prevent withdrawal, and regular monitoring for adherence, side effects, and adverse events 1.
Combination Therapy
Combining medication with cognitive behavioral therapy often provides the best outcomes, as suggested by various studies 1.
Side Effects
Side effects vary by medication class but commonly include initial nausea, headache, or sleep disturbances that typically improve over time.
From the FDA Drug Label
Buspirone hydrochloride tablets are indicated for the management of anxiety disorder or the short-term relief of the symptoms of anxiety. The efficacy of buspirone hydrochloride tablets has been demonstrated in controlled clinical trials of outpatients whose diagnosis roughly corresponds to Generalized Anxiety Disorder (GAD).
Buspirone is a medication used for the management of anxiety disorder, including Generalized Anxiety Disorder (GAD).
- It is indicated for the short-term relief of anxiety symptoms.
- The efficacy of buspirone has been demonstrated in controlled clinical trials for patients with GAD 2.
From the Research
Medication Options for Generalized Anxiety Disorder
- Selective serotonin reuptake inhibitors (SSRIs) have proven efficacy in the treatment of generalized anxiety disorder, as shown in studies 3, 4, 5.
- SSRIs, such as paroxetine and sertraline, have been found to be effective and well-tolerated in the treatment of generalized anxiety disorder, with no significant differences between them 5.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) are also recommended as a first-line treatment for generalized anxiety disorder, due to their proven efficacy and reasonable tolerability 4, 6.
- Other medication options, such as benzodiazepines, azapirones, and anticonvulsant and antipsychotic drugs, may also be considered for the treatment of generalized anxiety disorder, although their efficacy and tolerability may vary 4, 6.
Efficacy and Tolerability of Medications
- Studies have shown that SSRIs and SNRIs can be effective in reducing symptoms of generalized anxiety disorder, with response rates ranging from 56% to 57% 5.
- The tolerability of SSRIs and SNRIs has been found to be comparable, with both medication classes being generally well-tolerated 5, 7.
- However, some patients may experience troublesome adverse effects or worry about becoming dependent on medication, which can limit the effectiveness of pharmacological treatments in clinical practice 6.
Treatment Duration and Augmentation
- The optimal duration of treatment for generalized anxiety disorder is uncertain, with some studies suggesting that treatment should be continued for at least 12 months after a satisfactory initial response 4.
- There is a need for further research on the management of patients who have not responded to first-line treatment, including augmentation studies with other medications 6.