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The Treatment of Refractory Generalized Anxiety Disorder

  • Anxiety, Obsessive Compulsive, and Related Disorders (CB Nemeroff, Section Editor)
  • Published:
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Abstract

Purpose

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

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

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.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1057 Main St. W, L02, Hamilton, ON, L8S 1B7, Canada

    Michael Van Ameringen MD, FRCPC & Beth Patterson BScN, MSc

  2. MacAnxiety Research Centre, McMaster University, Hamilton, ON, Canada

    Michael Van Ameringen MD, FRCPC, Beth Patterson BScN, MSc, Jasmine Turna BSc, PhD (C), Amy Pipe MB BCh BAO (C) & Hajer Nakua BSc (C)

  3. Hamilton Health Sciences, Hamilton, ON, Canada

    Michael Van Ameringen MD, FRCPC

  4. MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada

    Jasmine Turna BSc, PhD (C)

  5. University College Cork, School of Medicine, Cork, Ireland

    Amy Pipe MB BCh BAO (C)

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  1. Michael Van Ameringen MD, FRCPC
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  2. Beth Patterson BScN, MSc
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Correspondence to Michael Van Ameringen MD, FRCPC.

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Conflict of Interest

Michael Van Ameringen reports personal fees from Purdue, Allergan, and Lundbeck and grants from Janssen-Ortho, Pfizer, and Shire, outside the submitted work.

Beth Patterson, Jasmine Turna, Amy Pipe, and Hajer Nakua declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Anxiety, Obsessive Compulsive, and Related Disorders

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Van Ameringen, M., Patterson, B., Turna, J. et al. The Treatment of Refractory Generalized Anxiety Disorder. Curr Treat Options Psych 4, 404–417 (2017). https://doi.org/10.1007/s40501-017-0129-6

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