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Introduction to the GAD Algorithm David N. Osser, MD, Associate Professor of Psychiatry Harvard Medical School Brockton Division of the VA Boston Healthcare System General Editor - Psychopharmacology Algorithm Project Harvard South Shore Residency Training Program

Generalized Anxiety Disorder Most common anxiety disorder in primary care 7 million in the US High comorbidity • 50% have depression • 60% have other anxiety disorders Davidson, J. R. , Zhang, W. , Connor, K. M. , Ji, J. , Jobson, K. , Lecrubier, Y. , . . . & Stein, D. J. (2010). A psychopharmacological treatment algorithm for generalised anxiety disorder (GAD). Journal of Psychopharmacology, 24(1), 3 -26.

GAD - Treatment Psychosocial interventions Combination: Unclear effectiveness Psychopharmacology interventions Bandelow, B. , Seidler-Brandler, U. , Becker, A. , Wedekind, D. , & Rüther, E. (2007). Meta-analysis of randomized controlled comparisons of psychopharmacological and psychological treatments for anxiety disorders. The World Journal of Biological Psychiatry, 8(3), 175 -187.

Medications for GAD FDA approved: • • SSRIs: escitalopram, paroxetine SNRIs: venlafaxine, duloxetine Benzodiazepine: alprazolam Azapirone: buspirone Abejuela, H. R. , & Osser, D. N. (2016). The Psychopharmacology Algorithm Project at the Harvard South Shore Program: an algorithm for generalized anxiety disorder. Harvard review of psychiatry, 24(4), 243 -256.

Medications for GAD Off-label options: o Other SSRIs and benzodiazepines • Hydroxyzine • Pregabalin • Buproprion • Kava • Lavender oil • ? Gabapentin Abejuela, H. R. , & Osser, D. N. (2016). The Psychopharmacology Algorithm Project at the Harvard South Shore Program: an algorithm for generalized anxiety disorder. Harvard review of psychiatry, 24(4), 243 -256.

Key Points There are FDA-approved medications and off-label options to consider

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