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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 à These 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