Treatment Guidelines for Generalized Anxiety Disorder

Psychotherapy     

Reassurance

Self-help and psychoeducation

à Pure self-help, guided self-help, group psychoeducation

Relaxation therapy

à applied relaxation, progressive muscle relaxation, deep breathing exercises

Cognitive behavior therapy

Exercise

Pharmacotherapies

Indications of pharmacotherapy

While on psychotherapy, short-term

Psychotherapy ineffective,

Psychotherapies not available

First-line       

Selective Serotonin Reuptake Inhibitors

àThese and SNRIs may initially exacerbate symptoms; a lower starting dose is often required.  Fluoxetine and sertraline are preferred options.  Sertraline is the most tolerable and cost effective, recommended as first choice by NICE. Fluoxetine is most effective choice.

Effexor (venlafaxine) SR up to 225 mg/day

Dulan/Duron (duloxetine) up to 60 mg/day

pregabalin 150–600 mg/day

Second-line choices           

Agoviz (agomelatine) 25 mg                2 x nocte

Agoviz (agomelatine) 25 mg                4 x nocte

Busron (buspirone) 5 mg                      1 x TDS

Steer (buspirone) 10 mg                       2 x TDS

Atarax (hydroxyzine) 25 mg                 1 x BD

Atarax (hydroxyzine) 25 mg                1+ 1 + 2

Qusel (quetiapine)  

Tofranil (imipramine)

Clomixet (clomipramine)

Ramargon (mirtazapine)

Beta-blockers for somatic symptoms, Vortioxetine 2.5–10 mg