What is the best medication for Generalized Anxiety Disorder (GAD)?

From the Guidelines

The best medication for Generalized Anxiety Disorder (GAD) is typically an SSRI antidepressant, with sertraline (Zoloft) or escitalopram (Lexapro) often considered first-line options. According to the most recent and highest quality study 1, SSRIs are recommended as the first-line treatment for GAD. The study suggests that the choice of SSRI should be informed by side-effect profiles, interactions, response, patient age, and preference.

Key Considerations

• Sertraline is usually started at 25-50mg daily and gradually increased to an effective dose of 50-200mg daily, while escitalopram typically starts at 5-10mg daily and may be increased to 10-20mg daily 1.
• These medications take 4-6 weeks to reach full effectiveness and should be continued for at least 6-12 months after symptoms improve to prevent relapse.
• SSRIs work by increasing serotonin levels in the brain, which helps regulate mood and anxiety.
• Side effects may include initial increased anxiety, nausea, headache, and sexual dysfunction, but these often improve with time.

Additional Treatment Options

• For more immediate relief while waiting for SSRIs to take effect, benzodiazepines like lorazepam (0.5-2mg) may be prescribed short-term (2-4 weeks maximum) due to dependency risks 1.
• Non-medication approaches like cognitive behavioral therapy should be used alongside medication for optimal results.
• Individual responses to medications vary, so treatment may need adjustment based on effectiveness and tolerability.

Guideline Recommendations

• The American Academy of Child and Adolescent Psychiatry recommends SSRIs as a first-line treatment for anxiety disorders in children and adolescents 1.
• The American Society of Clinical Oncology recommends physician-prescribed SSRIs or anxiolytics for the management of anxiety and depression in adult survivors of cancer 1.

From the FDA Drug Label

The efficacy of Escitalopram in the acute treatment of Generalized Anxiety Disorder (GAD) was demonstrated in three, 8-week, multicenter, flexible-dose, placebo-controlled studies that compared Escitalopram 10-20 mg/day to placebo in adult outpatients between 18 and 80 years of age who met DSM-IV criteria for GAD In all three studies, Escitalopram showed statistically significant greater mean improvement compared to placebo on the Hamilton Anxiety Scale (HAM-A)

The best medication for Generalized Anxiety Disorder (GAD), based on the provided information, is Escitalopram.

• The recommended dose is 10-20 mg/day.
• Escitalopram has been shown to be effective in the acute treatment of GAD in adult outpatients 2.
• However, it is essential to note that the efficacy of Escitalopram in the treatment of GAD beyond 8 weeks has not been systematically studied 2.

From the Research

Treatment Options for Generalized Anxiety Disorder (GAD)

The treatment of GAD typically involves the use of medications, with the goal of improving symptoms and achieving remission. The following are some of the treatment options for GAD:

• Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, paroxetine, and escitalopram are commonly used as first-line treatment for GAD 3, 4, 5.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine and duloxetine are also used to treat GAD 3, 4.
• Atypical antipsychotics may have a potential role in the treatment of GAD, either as monotherapy or as augmentation to standard treatment 3.
• Benzodiazepines and azapirones may also be used to treat GAD, but their use is limited due to tolerability problems and other risks 4, 5.

Efficacy of Different Medications

Studies have shown that different medications have similar efficacy in treating GAD. For example:

• A study comparing paroxetine and sertraline found that both medications resulted in significant decreases in mean Hamilton Rating Scale for Anxiety (HAM-A) scores, with no differences between medication groups on response or remission rates 6.
• A study on escitalopram found that long-term treatment led to continuing improvement on all anxiety and quality-of-life scores, with 92.0% of patients responding to treatment 7.

Considerations for Treatment

When selecting a treatment for GAD, several factors should be considered, including:

• The patient's comorbid conditions, such as depression or other anxiety disorders 5.
• The patient's medical history and potential interactions with other medications 5.
• The potential side effects and tolerability of different medications 3, 4, 5.
• The need for long-term treatment, as GAD is a chronic condition that requires ongoing management 3, 4, 5, 7.