From the Guidelines
Selective serotonin reuptake inhibitors (SSRIs) are the first-line medication treatment for generalized anxiety disorder, with serotonin-norepinephrine reuptake inhibitors (SNRIs) being an additional effective option, as supported by the most recent clinical practice guideline 1. When treating generalized anxiety disorder, it's essential to consider the patient's overall health, comorbidities, and potential side effects.
- The medication options include:
- These medications usually take 2-4 weeks to show initial benefits and should be continued for at least 6-12 months after symptom improvement.
- For more immediate relief, benzodiazepines like lorazepam (0.5-2 mg, 2-3 times daily) may be prescribed short-term (2-4 weeks) due to their risk of dependence.
- Treatment should be individualized based on symptom severity, comorbidities, and potential side effects, with regular follow-up to assess effectiveness and adjust dosing as needed, as recommended by the clinical practice guideline 1.
From the FDA Drug Label
In a pooled analysis of four eight-week, double-blind, placebo-controlled, flexible dose outpatient trials for major depressive disorder (MDD) and generalized anxiety disorder (GAD), venlafaxine HCI extended-release-treated patients lost an average of 0. 45 kg (n = 333), while placebo-treated patients gained an average of 0.77 kg (n = 333). More patients treated with Venlafaxine Hydrochloride Extended-Release Tablets than with placebo experienced a weight loss of at least 3.5% in both the MDD and the GAD studies (18% of venlafaxine HCI extended-release-treated patients vs. 3.6% of placebo-treated patients; p<0. 001).
Venlafaxine is used in the medical treatment of Generalized Anxiety Disorder (GAD).
- The medication has been studied in eight-week, double-blind, placebo-controlled trials.
- Venlafaxine HCI extended-release has been shown to be effective in treating GAD, with patients experiencing a weight loss of at least 3.5% compared to placebo-treated patients 2.
From the Research
Medical Treatment for Generalized Anxiety Disorder
- The primary goal of treatment for generalized anxiety disorder (GAD) is to improve symptoms and achieve remission, which is the complete resolution of both symptoms and functional impairment 3.
- First-line treatment for GAD typically consists of an antidepressant, such as a selective serotonin reuptake inhibitor (SSRI) or a selective serotonin noradrenaline (norepinephrine) reuptake inhibitor (SNRI) 3, 4.
- SSRIs, such as sertraline and paroxetine, have been shown to be effective in treating GAD, with significant decreases in symptoms and improvement in quality of life 5, 6.
- SNRIs, such as venlafaxine and duloxetine, are also effective in treating GAD, although they may have efficacy limitations, such as lack of response in some patients and risk of relapse 3.
- Benzodiazepines (BZs) are also commonly prescribed for GAD, and have been shown to be effective in reducing symptoms, although they may have a higher risk of dependence and withdrawal 7.
- Other treatment options for GAD include azapirones, antihistamines, alpha(2)delta Ca++ channel modulators, and atypical antipsychotics, although the evidence for these treatments is less robust 4.
- Cognitive therapy is also an effective first-line treatment for GAD, and can be used in conjunction with medication or as a standalone treatment 4.
Comparison of Treatment Options
- A meta-analytic review found that BZs had a significantly higher effect size than SSRIs and SNRIs in reducing symptoms of GAD, although the overall combined effect size was modest to moderate 7.
- The study also found that effect sizes decreased significantly over time, suggesting that treatment may need to be ongoing to maintain efficacy 7.
- Another study found that paroxetine and sertraline were similarly effective and well-tolerated in treating GAD, with significant decreases in symptoms and improvement in quality of life 6.