Pharmacological Treatment of Generalised Anxiety Disorder: Current Practice and Future Directions.
Expert review of neurotherapeutics – June 01, 2023
Source: PubMed
Summary
Over 30% of individuals with Generalized Anxiety Disorder (GAD) do not respond to first-line pharmacological treatments. Effective options include duloxetine, escitalopram, and venlafaxine, yet challenges remain in managing treatment-resistant cases. Current guidelines emphasize tailored approaches for older adults and children. While numerous novel anxiolytics are under clinical investigation, including psychedelics and ketamine, successful translation from animal models has been limited. Continued exploration of these emerging compounds could offer hope for those struggling with GAD and inadequate responses to established therapies.
Abstract
Generalized Anxiety Disorder (GAD) is a common psychiatric condition, characterized by the presence of general apprehensiveness and excessive worry. Current management consists of a range of pharmacological and psychological treatments. However, many patients do not respond to first-line pharmacological treatments and novel anxiolytic drugs are being developed. In this review, the authors first discuss the diagnostic criteria and epidemiology of GAD. The effective pharmacological treatments for GAD and their tolerability are addressed. Current consensus guidelines for treatment of GAD are discussed, and maintenance treatment, the management of treatment resistance, and specific management of older adults and children/adolescents are considered. Finally, novel anxiolytics under development are discussed, with a focus on those which have entered clinical trials. A range of effective treatments for GAD are available, particularly duloxetine, escitalopram, pregabalin, quetiapine, and venlafaxine. There is a limited evidence base to support the further pharmacological management of patients with GAD who have not responded to initial treatment. Although many novel anxiolytics have progressed to clinical trials, translation from animal models has been mostly unsuccessful. However, the potential of several compounds including certain psychedelics, ketamine, oxytocin, and agents modulating the orexin, endocannabinoid, and immune systems merits further study.