Pharmacological Treatment of Generalised Anxiety Disorder: Current Practice and Future Directions

• Published in: Expert review of neurotherapeutics Vol. 23; no. 6; pp. 535 - 548
• Main Authors: Fagan, Harry A., Baldwin, David S.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 03.06.2023
• Subjects: Anti-Anxiety Agents - therapeutic use; Anxiety Disorders - drug therapy; Anxiety Disorders - psychology; Duloxetine Hydrochloride - therapeutic use; GAD; Generalized Anxiety Disorder; Humans; novel anxiolytics; pharmacological treatment; pharmacotherapy; Pregabalin - therapeutic use; Treatment Outcome; novel anxiolytics; pharmacological treatment; GAD; Generalized Anxiety Disorder; pharmacotherapy
• ISSN: 1473-7175; 1744-8360
• DOI: 10.1080/14737175.2023.2211767

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.