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Treatment-Resistant Generalized Anxiety Disorder 

Treatment-Resistant Generalized Anxiety Disorder
Treatment-Resistant Generalized Anxiety Disorder

Victoria Osman-Hicks

, John Potokar

, and David J. Nutt

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date: 21 November 2018

Generalized anxiety disorder (GAD) is a highly comorbid and chronic anxiety disorder when left untreated or undertreated. The importance of diagnosis in primary care, hospital medicine, and psychiatry is the first barrier for many patients. This chapter gives a review for professionals of the epidemiology, risk factors, heritability, comorbidity, principles of recognition and diagnosis, first-line treatments, and extent of impairment and disability from GAD. However, the main focus is on treatment-resistant disease, that is to say, treatments for patients who have not responded to first-line strategies. We summarize the evidence in adults for the current pharmacological and nonpharmacological strategies, with special consideration separately to the evidence in older adults and in the common troublesome comorbidity insomnia. We also review the evidence for novel treatment strategies, including traditional medicines.

The key messages around treatment are as follows:

(1) The evidence base of treatment-resistant GAD is lagging behind that of depressive disorder, but there are five licensed medications (in the United Kingdom) with evidence that they can bring about remission along with cognitive-behavioral therapy.

(2) There is increasing evidence for second-line treatments along with considering any of the usual first-line therapies not already tried.

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