Generalised Anxiety Disorder (GAD) Treatment encompasses evidence-based psychotherapeutic and pharmacological interventions for excessive, uncontrollable worry lasting ≥6 months with ≥3 accompanying symptoms (restlessness, fatigue, poor concentration, irritability, muscle tension, sleep disturbance). Lifetime prevalence ranges 0.2–4.3%, with a female-to-male ratio of 1.7–2.6. First-line treatment comprises Cognitive Behavioural Therapy (CBT), SSRIs/SNRIs, or their synergistic combination.
Psychotherapeutic Interventions
CBT is the gold-standard psychological treatment, with combination therapy (CBT + medication) producing the lowest anxiety scores (mean = 17.72) compared to CBT alone (20.46) or medication alone (22.75). Digital CBT (an 8-week automated text intervention) for young adults demonstrated a large effect size (Cohen d = 0.83), with 25% of the treatment group achieving minimal symptoms, compared with 5.5% of controls. Stepped care models (parent-focused intervention → family-based CBT) maximise resources by providing low-intensity interventions first, stepping up only for non-responders.
Pharmacological Interventions
- SSRIs/SNRIs (First-Line): Antidepressants increase treatment response by 41% vs. placebo (RR 1.41, NNTB = 7). Response rates: SSRIs 34–54% higher, SNRIs 51% higher. Discontinuation due to adverse events is 118% higher (NNTH = 17).
- Pregabalin (Alternative First-Line): Significant HAM-A reductions at 2 weeks (MD -1.23), 4 weeks (MD -1.12), and 8 weeks (MD -2.50). Response OR = 1.51; lower discontinuation rates (OR = 0.80) with a superior adverse event profile.
- Benzodiazepines (Adjunctive/Short-Term): Significantly better than placebo; guidelines recommend BZD as an add-on to antidepressants during the first weeks or as short-term (2-4 weeks) monotherapy.
- Silexan (Lavender Oil): Only phytopharmaceutical with high efficacy; comparable to lorazepam and paroxetine in reducing HAM-A scores; among only four treatments with fewer adverse events than placebo.
Treatment Algorithm (per BMJ Best Practice)
- Step 1 (Mild-Moderate): CBT or SSRI/SNRI monotherapy; psychotherapy preferred 3:1 over medication
- Step 2 (Moderate-Severe/Non-Response): Combine CBT + pharmacotherapy; consider pregabalin or short-term BZD adjunct
- Step 3 (Refractory): Switch antidepressant class; consider off-label quetiapine or clomipramine; reassess diagnosis and adherence
Pediatric Considerations: First-line is family-based CBT with exposure focus; SSRIs (sertraline ≥6 years, fluoxetine ≥8 years) with careful monitoring for refractory cases. Key clinical pearls are;
- Monitoring: GAD-7 scale (scores 5,10,15 = mild, moderate, severe)
- Prognosis: Chronic without treatment; 60–80% achieve significant symptom reduction with appropriate intervention
- Comorbidity: Frequently co-occurs with major depression, panic disorder, and social anxiety disorder
GAD treatment has evolved from monolithic pharmacotherapy to a pluralistic, patient-centred paradigm. Whether through CBT’s cognitive restructuring, SSRIs’ serotonergic modulation, pregabalin’s calcium-channel blockade, or silexan’s phytotherapeutic action, the shared goal remains liberation from uncontrollable worry. With response rates exceeding 70% with first-line interventions, the prognosis is favourable—underscoring the critical importance of accurate diagnosis and access to stepped, evidence-based care.
