Skip to main content

Treatment Guidelines for Generalized Anxiety Disorder



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



Indications of pharmacotherapy

While on psychotherapy, short-term

Psychotherapy ineffective,

Psychotherapies not available


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


Popular posts from this blog

ADVOKATE: A Tool for Assessment of Eyewitness Evidence

ADVOCATE: A Tool for Assessment of Eyewitness Evidence It is a tool designed to assess the eyewitness evidence that how much it is reliable. It requires the user to respond to several statements/questions. Forensic psychologist, police or investigative officer can do it. The mnemonic ADVOKATE stands for: A = amount of time under observation (event and act) D = distance from suspect V = visibility (night-day, lighting) O = obstruction to the view of the witness K = known or seen before when and where (suspect) A = any special reason for remembering the subject T = time-lapse (how long has it been since witness saw suspect) E = error or material discrepancy between the description given first or any subsequent accounts by a witness.  Working with suspects (

Diagnostic test for catatonia, the lorazepam challenge test

Benzodiazepines are the mainstay of the treatment of catatonia and are also helpful as a diagnostic probe. A positive Lorazepam Challenge Test validates the diagnosis of catatonia. After we examine the patient for signs of catatonia, 1 or 2 mg of lorazepam is administered intravenously. After 5 minutes, the patient is re-examined. If there has been no change, a second dose is given, and the patient is again reassessed (46, 78). A positive response is a marked reduction (e.g., at least 50%) of catatonic signs and symptoms, as measured with a standardized rating scale. Favorable responses usually occur within 10 min (46). If lorazepam is given intramuscularly or per os, the interval for the second dose should be longer: 15′ and 30′, respectively. Many clinicians will share the experience that a “lorazepam test” not only confirms the diagnosis of catatonia but that it also makes the underlying psychopathology apparent “by permitting mute patients to speak” (79). Analogous to the lorazepa

Classification of Depression According to the ICD-10

A first depressive episode, duration at least15 days →depressive episode (F32)  A first depressive episode, severe and rapid onset, duration less than 15 days →still depressive episode (F32) A depressive episode can be mild (2 core symptoms, 2 other symptoms from the list) (32.0) moderate (2 core symptoms, 3 or preferably 4 other symptoms) (32.1) Severe (3 core symptoms, 4 other symptoms) without psychotic symptoms (32.2) (no delusion, hallucination or stupor) Severe with psychotic symptoms (above plus either delusions, hallucinations or stupor) (F32.3) Delusions can be mood-congruent or incongruent (neutral delusions e.g. delusions of reference are considered mood incongruent. None of them count towards schizoaffective disorder unless one of the first-rank)  A mild and moderate depressive episode can be  with somatic syndrome (four or more somatic symptoms, or three very severe somatic symptoms) without somatic syndrome (three or less somatic symptoms, not severe)  A severe depressi