Review: A psychopharmacological treatment algorithm for generalised anxiety disorder (GAD)

J. R. Davidson, Wei Zhang, K. M. Connor, J. Ji, K. Jobson, Y. Lecrubier, A. C. McFarlane, D. J. Newport, D. J. Nutt, D. N. Osser, D. J. Stein, Z. N. Stowe, O. Tajima, M. Versiani

Research output: Contribution to journalReview article

43 Scopus citations

Abstract

Generalised anxiety disorder (GAD) is defined as excessive and uncontrollable worry and anxiety about everyday life situations. It is a chronic disorder, and is associated with substantial somatisation, high rates of comorbid depression and other anxiety disorders, and significant disability. The evidence base for pharmacotherapy and psychotherapy has continued to grow, and a wide range of drug choices for GAD now exists. Current guidelines for GAD generally restrict themselves to presentation of the evidence for various treatments, which, as a result, generally do not offer detailed discussion or recommendation of strategies beyond the first level of treatment, or take into account the individual circumstances of the patient. Thus, there is a lack of algorithm-based treatment guidelines for GAD. Our aim is, therefore, to present an algorithm for the psychopharmacologic management of GAD, intended for all clinicians who treat patients with GAD, where issues of pharmacotherapy are under consideration. We also hope that these GAD algorithms and other guidelines can help to identify high-priority areas that need further study. In this algorithm, we provide a sequenced approach to the pharmacotherapy of GAD, taking into account salient symptomatology and comorbidity, levels of evidence and extent of response. Special issues, including comorbidity, insomnia, suicidality, substance abuse, treatment adherence, pregnancy and lactation, cross-cultural issues, use of medication in the elderly, psychosocial treatment and dosing issues are also addressed.

Original languageEnglish (US)
Pages (from-to)3-26
Number of pages24
JournalJournal of Psychopharmacology
Volume24
Issue number1
DOIs
StatePublished - Jan 1 2010

Keywords

  • Algorithm
  • Generalised anxiety disorder
  • International psychopharmacology algorithm project
  • Pharmacotherapy

ASJC Scopus subject areas

  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)

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    Davidson, J. R., Zhang, W., Connor, K. M., Ji, J., Jobson, K., Lecrubier, Y., McFarlane, A. C., Newport, D. J., Nutt, D. J., Osser, D. N., Stein, D. J., Stowe, Z. N., Tajima, O., & Versiani, M. (2010). Review: A psychopharmacological treatment algorithm for generalised anxiety disorder (GAD). Journal of Psychopharmacology, 24(1), 3-26. https://doi.org/10.1177/0269881108096505