Pharmacotherapy of generalized anxiety disorder.
Less than one third of people afflicted with generalized anxiety disorder (GAD) experience spontaneous remission, and the symptoms of GAD wax and wane throughout a person's life. The burden of GAD may be reduced with psychopharmacologic therapy. The medications with the most evidence of efficacy in GAD are the benzodiazepines, including a new long-acting formulation of alprazolam. These drugs have a low incidence of side effects but may cause physical dependence, withdrawal, and sedation. Antidepressants are also efficacious in GAD but act less quickly than benzodiazepines. Tricyclic antidepressants such as imipramine may substantially reduce symptoms of anxiety but are not considered a first-line therapy because of their side effects spectrum. The extended-release formulation of venlafaxine and selective serotonin reuptake inhibitors such as paroxetine and sertraline are also efficacious in GAD. While their association with sexual dysfunction may be intolerable for some adults, these drugs may be more appropriate than the benzodiazepines because their chronic use does not lead to dependence. Buspirone also significantly reduces symptoms of GAD and is associated with less sexual dysfunction than SSRIs and less sedation than benzodiazepines. Combining antidepressant and benzodiazepine therapy or medication treatment and psychotherapy may lead to an increase in improvement in patients not responding to 1 treatment approach alone. The most effective treatment for managing the recurrent symptoms of this chronic disorder will remain unknown until more long-term studies using both drug and nondrug therapies are conducted. Remission rates are still only about 40%, signifying the need for improved treatment interventions.
Rickels
Karl
K
Department of Psychiatry, University of Pennsylvania, Philadelphia, USA. krickels@mail.med.upenn.edu
Rynn
Moira
M
D000465:Algorithms; D000525:Alprazolam / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000188:drug therapy* / Q000523:psychology; D001569:Benzodiazepines / Q000627:therapeutic use*; D002065:Buspirone / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003511:Cyclohexanols / Q000627:therapeutic use; D003692:Delayed-Action Preparations; D004334:Drug Administration Schedule; D006801:Humans; D017374:Paroxetine / Q000627:therapeutic use; D013811:Psychotherapeutic Processes; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D020280:Sertraline / Q000627:therapeutic use; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride
D000525:Alprazolam; D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D001569:Benzodiazepines; D002065:Buspirone; D003511:Cyclohexanols; D003692:Delayed-Action Preparations; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline; D000069470:Venlafaxine Hydrochloride