Currently, there are several pharmacological options for the management of General Anxiety Disorder (GAD). First of all the treatment may include the use of serotonergic or norepinephrinergic antidepressants (Garakani et al., 2020). Among the approved selective serotonin reuptake inhibitors (SSRIs) is Escitalopram; approved selective norepinephrine reuptake inhibitors (SNRIs) are Duloxetine and Venlafaxine (Garakani et al., 2020; Stein, 2021). SSRIs and SNRIs are “considered as first-line agents for GAD; each agent has a specific adverse event profile” (Stein et al., 2021, p. 54). The most widespread medication for GAD in the world is gamma aminobutyric acid (GABA), including Benzodiazepines, which is often prescribed before SSRIs due to their effectiveness. However, these drugs have an increased risk of developing dependence, tolerance, and misuse episodes (Ansara, 2020; Garakani et al., 2020). Hydroxyzine is the only antihistamine medication approved by the FDA for the treatment of GAD. It can be used to safely manage the condition in children and adolescents (Ansara, 2020; Garakani et al., 2020). Other drugs used in the world for the treatment of GAD are not approved for use by the FDA.
Factors that may alter the expected response to pharmacological treatment include primarily the individual tolerability of the components. For many patients, SSRIs and SSNIs are ineffective, requiring the inclusion of second-line inhibitors (Ansara, 2020). The factors influencing the effectiveness of treatment are mainly the age and genetic characteristics of patients (Ansara, 2020). Additionally, the outcomes of pharmacological treatment may be affected by the patient’s behavior and discipline in taking the prescribed treatment. With the development of resistance, the most effective means of pharmacological treatment are drugs of the GAMA class as a second-line treatment option (Ansara, 2020). To overcome the development of resistance to first-line drugs, the duration of the course and dosage should be selected depending on individual indicators.
References
Ansara, E. D. (2020). Management of treatment-resistant generalized anxiety disorder.The Mental Health Clinician, 10(6), 326-334.
Garakani, A., Murrough, J. M., Feire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of anxiety disorders: Current and emerging treatment options.Frontiers in Psychiatry, 11.
Stein, D. J. (2021). Evidence-based pharmacotherapy of generalised anxiety disorder: Focus on Agomelatine. Advances in Therapy, 38, 52-60.