From the FDA Drug Label
- 2 Generalized Anxiety Disorder Initial Treatment Adults The recommended starting dose of Escitalopram tablets is 10 mg once daily. If the dose is increased to 20 mg, this should occur after a minimum of one week. 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
The first-line treatment for Generalized Anxiety Disorder (GAD) is Escitalopram, with a recommended starting dose of 10 mg once daily. The second-line treatment is not explicitly stated in the provided drug labels. 1 1
From the Research
First-line treatments for Generalized Anxiety Disorder (GAD) include selective serotonin reuptake inhibitors (SSRIs) such as sertraline (50-200 mg daily), escitalopram (10-20 mg daily), or paroxetine (20-50 mg daily), and serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (75-225 mg daily) or duloxetine (30-120 mg daily), as supported by the most recent study 2. These medications typically require 4-6 weeks for full effect and should be continued for at least 6-12 months after symptom improvement. Some key points to consider when treating GAD include:
- Cognitive-behavioral therapy (CBT) is equally effective as a first-line treatment, typically delivered in 12-16 weekly sessions.
- Second-line treatments include buspirone (15-30 mg daily in divided doses), pregabalin (150-600 mg daily in divided doses), or benzodiazepines like lorazepam (0.5-2 mg 2-3 times daily) for short-term use only due to dependency risk.
- Hydroxyzine (25-100 mg up to four times daily) and tricyclic antidepressants like imipramine (75-200 mg daily) are also second-line options.
- Patients should be monitored for side effects, particularly during the initial weeks of treatment, and medication changes should be made gradually to minimize withdrawal symptoms. The most recent study 2 provides the strongest evidence for the treatment of GAD, and its findings should be prioritized when making treatment decisions. Other studies, such as 3, 4, 5, and 6, also provide valuable information on the treatment of GAD, but their findings are not as recent or robust as those of the most recent study 2. It's worth noting that novel anxiolytics, such as certain psychedelics, ketamine, oxytocin, and agents modulating the orexin, endocannabinoid, and immune systems, are being developed and may offer future treatment options for GAD, as discussed in 2.