title: Pharmacological treatment for generalized anxiety disorder in adults: an update.
abstract: BACKGROUND
  Modest response and remission rates for the selective serotonin reuptake inhibitors and the serotonin-norepinephrine reuptake inhibitors, coupled with mounting evidence that the tolerability of the antidepressants (ADs) may have been overstated in the literature, has contributed to changes in prescribing patterns for generalized anxiety disorder (GAD). New interest in the absence of evidence that supports these standard therapies as superior to benzodiazepines stimulated a review of the literature.
  
  
  METHODS
  A literature search was conducted in the MedLine database with search terms 'generalized anxiety disorder' and 'treatment' for purposes of including relevant literature related to pharmacologic treatment of GAD. Aside from a review of pivotal literature, the authors also included newer studies that evaluated novel drug treatments. Last, the database was searched for benzodiazepine comparisons to standard therapy secondary to concerns that such literature is sparse. The review of newer modalities and the decision to include related literature was also based on the strength of the evidence and the status of their approval for the treatment of GAD.
  
  
  CONCLUSIONS
  Although ADs remain the most frequently prescribed medications for GAD, alternative and off-label therapies such as pregabalin, the atypical antipsychotics and vortioxetine are garnering interest. Based on the evidence available to us, it is our recommendation that along with the ADs, benzodiazepines be considered a possible first-line therapy in eligible patients based on the discretion and clinical judgment of the treating physician.
authors.affiliation: University of the Sciences in Philadelphia, Department of Pharmacy Practice/Pharmacy Administration , 600 South 43rd Street, Philadelphia, PA 19104-4495 , USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Reinhold
authors.forename: Karl
authors.initials: K
authors.lastname: Rickels
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000188:drug therapy*; D001569:Benzodiazepines / Q000627:therapeutic use; D006801:Humans; D056687:Off-Label Use; D010879:Piperazines / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013440:Sulfides / Q000627:therapeutic use; D000078784:Vortioxetine
chemical_list: D018759:Adrenergic Uptake Inhibitors; D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D001569:Benzodiazepines; D010879:Piperazines; D017367:Selective Serotonin Reuptake Inhibitors; D013440:Sulfides; D000078784:Vortioxetine
keywords: atypical antipsychotics; benzodiazepines; generalized anxiety disorder; pharmacotherapy; selective serotonin reuptake inhibitors; serotonin-norepinephrine reuptake inhibitors