Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review

ABSTRACT

Introduction: Generalized anxiety disorder (GAD) often begins during adolescence or early adulthood and persists throughout the lifespan. Randomized controlled trials support the efficacy of selective serotonin and selective serotonin norepinephrine reuptake inhibitors (SSRIs and SNRIs, respectively), as well as benzodiazepines, azapirones, anti-adrenergic medications, melatonin analogs, second-generation antipsychotics, kava, and lavender oil in GAD. However, psychopharmacologic treatment selection requires clinicians to consider multiple factors, including age, co-morbidity, and prior treatment.

Areas covered: The authors review the literature concerning pharmacotherapy for pediatric and adult patients with GAD with specific commentary on the efficacy and tolerability of selected agents in these age groups. The authors describe an algorithmic approach to the pediatric and adult patient with GAD and highlight considerations for the use of selected medications in these patients.

Expert opinion: In adults with GAD, SSRIs and SNRIs represent the first-line psychopharmacologic treatment while second-line pharmacotherapies include buspirone, benzodiazepines, SGAs, and pregabalin. In pediatric patients with GAD, SSRIs should be considered the first line pharmacotherapy and psychotherapy enhances antidepressant response.

KEYWORDS:

• Selective Serotonin Reuptake Inhibitor (SSRI)
• Selective Serotonin Norepinephrine Reuptake Inhibitor (SNRI)
• antidepressants
• pediatric
• adult
• benzodiazepine
• buspirone

Declaration of interest

JR Strawn has received research support from the National Institutes of Health as well as Edgemont, Eli Lilly and Company, Forest Laboratories, Shire, Lundbeck and Neuronetics. He has also received material support and consulted for Genesight/Assurex Health as well as having received royalties from publications from Springer. Finally, this author has served as an author for UpToDate and is an Associate Editor for Current Psychiatry. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript is funded by the National Institute of Mental Health.