The WFSBP guidelines recommend an SSRI or SNRI as first-line pharmacological treatment of GAD, with imipramine or pregabalin monotherapy as second-line options. Augmentation with either olanzapine or pregabalin may be considered if treatment resistance is present.1
References:
1. Bandelow B, Allgulander C, Baldwin DS, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders – Version 3. Part I: Anxiety disorders. World J Biol Psychiatry 2023; 24 (2): 79–117.
2. Slee A, Nazareth I, Bondaronek P, et al. Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-analysis. Lancet 2019; 393 (10173): 768–777.
3. Jakubovski E, Johnson JA, Nasir M, et al. Systematic review and meta-analysis: dose–response curve of SSRIs and SNRIs in anxiety disorders. Depress Anxiety 2019; 36 (3): 198–212.
4. Batelaan NM, Bosman RC, Muntingh A, et al. Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials. BMJ 2017; 358: j3927.
