The Treatment of Refractory Generalized Anxiety Disorder

Abstract

Purpose Generalized anxiety disorder (GAD) is one of the most common anxiety disorders, afflicting approximately 6% of the general population in their lifetime. It has a chronic and episodic course, requiring a long-term treatment approach. A variety of pharmacological agents and psychological treatments have been shown to be efficacious as GAD treatments; however, remission effect sizes for first-line treatments are small. This review aims to examine the existing evidence for next-step pharmacological and psychological treatments for individuals who remain symptomatic after first-line treatment. Recent Findings Relatively few studies have examined next-step treatments for treatment-resistant GAD (TR-GAD). The bulk of the available treatment-resistant literature has investigated augmentation with atypical antipsychotics or pregabalin. Summary Unfortunately, there is little information to guide clinicians in this area. The strongest evidence supports augmentation with pregabalin, however, this is based primarily upon one study. Approaches to consider when treating patients with TR-GAD are discussed.