GENERALIZED ANXIETY DISORDER

For less severe forms of GAD, treatment involves a mixture of brief benzodiazepine therapy, supportive techniques and psychoeducational intervention. Where indicated, the following medications may be useful as well.

Benzodiazepines
Traditionally considered first-line therapy for GAD, response occurs within the first week for 60 to 80% of patients.

However, newer agents are now replacing the benzodiazepines for treatment of GAD due to the chronicity of this disorder and the potential to become addicted to the benzodiazepine if used for longer terms of treatment.

Drugs with longer elimination half-lives tend to be preferred for GAD due to the need for persistent anxiolytic action. As a rule, patients with anxiety disorders do not need to increase the dose to maintain a good response; in fact, they tend to reduce their dosage, often prematurely. Nevertheless, periodic dosage tapering should be done to determine the need for continued treatment.

Buspirone
In the following clinical situations, buspirone should be considered over benzodiazepines:

Buspirone does not produce an immediate calming effect, as do benzodiazepines, and some patients find it difficult to switch to buspirone from a benzodiazepine. To mitigate against this, try pretreating patients with 20 to 40 mg of buspirone for 2 to 4 weeks, prior to tapering the benzodiazepine at a slow rate of 25% or less per week. Buspirone is usually initiated at 5 mg tid and increased by 5 mg every few days to an average therapeutic dose of 20 to 30 mg/day. Of note: Patients who are subject to panic attacks or who did not respond well to benzodiazepines do not respond well to buspirone.

Cognitive Behavioural Therapy
Studies indicate that behavioural cognitive techniques help about 50% of patients completing treatment to achieve normal function. Used concurrently, CBT may also help reduce the need for recurrent courses of medication.

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