Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov 5;10(6):326-334.
doi: 10.9740/mhc.2020.11.326. eCollection 2020 Nov.

Management of treatment-resistant generalized anxiety disorder

Elayne D Ansara

Management of treatment-resistant generalized anxiety disorder

Elayne D Ansara. Ment Health Clin. .

Abstract

Generalized anxiety disorder (GAD) is characterized by persistent and excessive worry. Around half of the patients treated for GAD will fail to respond to initial treatment. Treatment-resistant (or refractory) GAD is defined as failure to respond to at least 1 trial of antidepressant therapy at adequate dose and duration. Review of the literature indicates several potential medication classes and individual agents that can be used as augmentation strategies to treat residual symptoms when recommended therapy per clinical practice guidelines fails. A thorough literature search revealed 2 medication classes with the largest amount of data to support their use in treatment-resistant GAD treatment: gamma-aminobutyric acid-related agents and atypical antipsychotics. This article focuses on evidence-based recommendations for the use of these agents as adjunctive therapies for patients with treatment-resistant GAD. Different pharmacologic approaches to use these agents are demonstrated through 2 patient cases in which patients have failed first-line treatment options.

Keywords: atypical antipsychotics; generalized anxiety disorder; pregabalin; tiagabine; treatment-resistant.

PubMed Disclaimer

Conflict of interest statement

Disclosures: I have nothing personal to disclose. Psychopharmacology Pearls are review articles intended to highlight both the evidence base available and/or controversial areas of clinical care for psychiatric and neurologic conditions as well as strategies of clinical decision-making used by expert clinicians. As pearls, articles reflect the views and practice of each author as substantiated with evidence-based facts as well as opinion and experience. Articles are edited by members of the Psychopharmacology Pearls Editorial Board as well as peer reviewed by MHC reviewers. This article was developed as part of the 2020 Psychopharmacology Pearls product for BCPP recertification credit. The course information and testing center is at https://cpnp.org/415126.

References

    1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders 5th ed. Arlington (VA): American Psychiatric Association;; 2013.
    1. Nutt DJ. Neurobiological mechanisms in generalized anxiety disorder. J Clin Psychiatry. 2001;62(Suppl 11):22–7. discussion 28. PubMed PMID: 11414547. - PubMed
    1. Abejuela HR, Osser DN. The psychopharmacology algorithm project at the Harvard South Shore Program: an algorithm for generalized anxiety disorder. Harv Rev Psychiatry. 2016;24(4):243–56. DOI: 10.1097/HRP.0000000000000098 PubMed PMID: 27384395. - DOI - PubMed
    1. Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen H-U. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res. 2012;21(3):169–84. DOI: 10.1002/mpr.1359 PubMed PMID: 22865617. - DOI - PMC - PubMed
    1. Patterson B, van Ameringen M. Augmentation strategies for treatment-resistant anxiety disorders: a systematic review and meta-analysis. Depress Anxiety. 2016;33(8):728–36. DOI: 10.1002/da.22525 PubMed PMID: 27175543. - DOI - PubMed

LinkOut - more resources