Movatterモバイル変換

[0]ホーム
URL:

Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
Thehttps:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

NIH NLM Logo
Log inShow account info
Access keysNCBI HomepageMyNCBI HomepageMain ContentMain Navigation
pubmed logo
Advanced Clipboard
User Guide

Full text links

Atypon full text link Atypon Free PMC article
Full text links

Actions

Review
.2018 Jul;19(10):1057-1070.
doi: 10.1080/14656566.2018.1491966.

Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review

Affiliations
Review

Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review

Jeffrey R Strawn et al. Expert Opin Pharmacother.2018 Jul.

Abstract

Generalized anxiety disorder (GAD) often begins during adolescence or early adulthood and persists throughout the lifespan. Randomized controlled trials support the efficacy of selective serotonin and selective serotonin norepinephrine reuptake inhibitors (SSRIs and SNRIs, respectively), as well as benzodiazepines, azapirones, anti-adrenergic medications, melatonin analogs, second-generation antipsychotics, kava, and lavender oil in GAD. However, psychopharmacologic treatment selection requires clinicians to consider multiple factors, including age, co-morbidity, and prior treatment. Areas covered: The authors review the literature concerning pharmacotherapy for pediatric and adult patients with GAD with specific commentary on the efficacy and tolerability of selected agents in these age groups. The authors describe an algorithmic approach to the pediatric and adult patient with GAD and highlight considerations for the use of selected medications in these patients. Expert opinion: In adults with GAD, SSRIs and SNRIs represent the first-line psychopharmacologic treatment while second-line pharmacotherapies include buspirone, benzodiazepines, SGAs, and pregabalin. In pediatric patients with GAD, SSRIs should be considered the first line pharmacotherapy and psychotherapy enhances antidepressant response.

Keywords: Selective Serotonin Norepinephrine Reuptake Inhibitor (SNRI); Selective Serotonin Reuptake Inhibitor (SSRI); adult; antidepressants; benzodiazepine; buspirone; pediatric.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:. Structures of antidepressant medications that have been systematically evaluated in patients with generalized anxiety disorder (GAD).
Structurally, SSRIs and SNRIs share many similarities and contain halogen atoms at specific positions, which are key determinants of their specificity for the serotonin transporter. The position and type of the specific substitution on an aromatic component of the antidepressant molecule determines the specificity at the serotonin transporter. Halogen substitutions at this ring are associated with the most binding specificity at the serotonin transporter and are mediated through binding within the halogen binding pocket (HBP). Colors represent specific atoms: nitrogen (blue); oxygen (red); halogens (fluorine and chloride) (green); sulfur (yellow); carbon (gray).
Figure 2:
Figure 2:. Psychopharmacologic Treatment algorithm for moderate to severe generalized, anxiety disorder in adults (A) and in children and adolescents (B).
Cooler colors represent higher levels of evidence and reflect greater evidence of tolerability and safety. Trials of SSRI and SNRIs should be ≥8 weeks, although if there is no response by week 8, there is a low likelihood of additional improvement. In the pediatric population, clinicians should note that for buspirone, guanfacine, antihistamines, and maintenance administration of benzodiazepines, the evidence base is very weak or conflicting. SSRI, selective serotonin reuptake inhibitor; SNRI, selective serotonin norepinephrine reuptake inhibitor; TCA, tricyclic antidepressant.
See this image and copyright information in PMC

Comment in

References

    1. Ramsawh HJ, Chavira DA, Stein MB. Burden of anxiety disorders in pediatric medical settings: prevalence, phenomenology, and a research agenda. Arch. Pediatr. Adolesc. Med 2010;164:965–972. - PMC - PubMed
    1. Baxter AJ, Vos T, Scott KM, et al. The global burden of anxiety disorders in 2010. Psychol. Med 2014;44:2363–2374. - PubMed
    1. Beesdo-Baum K, Knappe S. Developmental Epidemiology of Anxiety Disorders. Child Adolesc. Psychiatr. Clin. N. Am 2012;21: 457–478. - PubMed
    1. Beesdo K, Pine DS, Lieb R, et al. Incidence and risk patterns of anxiety and depressive disorders and categorization of generalized anxiety disorder. Arch. Gen. Psychiatry 2010;67:47–57. - PubMed

    2. • This study describes the course of generalized anxiety disorder and its categorization.

    1. Nutt DJ, Wittchen HU, Ballenger JC, et al. Generalized anxiety disorder: Nature and course. J. Clin. Psychiatry 2001:15–21. - PubMed

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full text links
Atypon full text link Atypon Free PMC article
Cite
Send To

NCBI Literature Resources

MeSHPMCBookshelfDisclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

[8]ページ先頭
©2009-2026 Movatter.jp