Selecting Pharmacotherapy for Generalized Anxiety Disorder

Selection of appropriate treatment for generalized anxiety disorder (GAD) is influenced by severalconsiderations, including psychiatric comorbidity. Emerging data suggest that GAD has a chroniccourse and a high comorbidity with depression. Successful treatment can be facilitated by first establishingtreatment goals, which include managing acute anxiety and following through to remission.Prevention of GAD recurrence should be the ultimate objective. Many treatments exist to aid in therealization of treatment goals, including benzodiazepines, hydroxyzine, buspirone, selective serotoninreuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs). Some SSRIsand an SNRI have been demonstrated effective in both acute and long-term trials, establishing them asfirst-line therapies. Benzodiazepines are helpful because of their rapid onset of action and efficacy insomatic and autonomic symptoms of GAD. Other medications in the pipeline include γ-aminobutyricacid (GABA) modulators, which may have lower abuse potential than currently available agents thatact at the GABA receptor; corticotropin-releasing hormone (CRH) antagonists; and pregabalin. Therecent realization of the chronic nature of GAD and the recognition of its frequent comorbidity withdepression, coupled with data from randomized clinical trials of newer generation agents, should helpphysicians better diagnose GAD and achieve the goal of bringing patients to full remission.