Pharmacotherapy for Anxiety Disorders: From First-Line Options to Treatment Resistance
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In this review, the author examines the evidence for psychopharmacologic treatments among adults for generalized anxiety disorder, panic disorder, and social anxiety disorder derived from clinical trials. For each disorder, major categories of drugs are reviewed, and then the evidence-based medications in each category are discussed. The author reviews key safety and tolerability considerations for each of the medications or classes. Evidence-based dosing for most specific agents is displayed in a comprehensive reference table. Subsequently, the author synthesizes the available information to suggest a pragmatic stepwise approach to treatment that accounts for patient-specific factors. To inform the guidance, the author incorporates and refines perspectives from treatment guidelines already written by clinical professional organizations. The author also briefly reviews the relatively new quantitative systematic review methodology of network meta-analysis (NMA) and discusses how NMA may help guide pharmacologic treatment sequencing decisions in the future by way of ranking treatments according to effect size and the relative amount of study to which treatments have been subject. Caveats of NMA studies are briefly discussed, as are results of recent NMAs regarding the pharmacologic treatment of anxiety disorders.
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Long-term BZD use may be indicated in patients with severe treatment-resistant generalized anxiety disorder (GAD) or bipolar spectrum disorders.
“For example, long-term BZD use may be indicated in patients with severe treatment-resistant generalized anxiety disorder (GAD) or bipolar spectrum disorders.39–41”
From Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits (2025) · cites this paper as [41]
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- Authors
- Melaragno, A. J.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- Melaragno, Andrew J.
- Venue
- Focus
- Published
- 2021-06
- Volume
- 19
- Issue
- 2
- Pages
- 145-160
- ISSN
- 1541-4094 (ISSN-L)
- 1541-4108
- PMC
- PMC8475920
- OpenAlex
- W3174948516
- Cited by
- 50
- References
- 132
- Citations by year
- 2026: 13 · 2025: 14 · 2024: 14 · 2023: 8 · 2022: 1
- FWCI
- 5.56
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- FOCUS The Journal of Lifelong Learning in Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- anxiety disorders, pharmacotherapy, generalized anxiety disorder, panic disorder, social anxiety disorder, treatment resistance, antidepressants, anxiolytics, drug safety and tolerability, dosage, stepwise treatment approach, network meta-analysis, treatment sequencing
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