Areas of uncertainty
Resistant generalized anxiety disorder
The optimal management of generalized anxiety disorder that is resistant to either psychotherapy alone or pharmacotherapy alone is uncertain. If the patient’s initial response to medication is inadequate, the dose should be increased as tolerated and then maintained for at least eight weeks. A patient’s partial response to a medication may warrant a longer trial, given data that suggest further improvement with longer use. Combining psychotherapy and pharmacotherapy should also be considered, although data are lacking on whether the combination results in a better outcome than either approach alone. The possibility of an underlying medical condition or a coexisting psychiatric illness should be reconsidered in resistant cases.
Little research has been done on the effects of combining medications. For patients who have a partial response to one medication, combination treatment with antidepressants and benzodiazepines or buspirone, or augmentation with other agents, including anticonvulsants (e.g., gabapentin or tiagabine), may be helpful