Cited by 50Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesTreatment of Major DepressionMental Health Treatment and Access

Pharmacotherapy for Anxiety Disorders: From First-Line Options to Treatment Resistance

Open access
Melaragno, Andrew J.·2021·Focus

Abstract

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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Crossref · 10.1176/appi.focus.20200048

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132 of 132 references verified0 citation errors · 0 not checkable

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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
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
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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