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

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


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.

Publication types

  • Review

MeSH terms

  • Adult
  • Antidepressive Agents / therapeutic use
  • Antipsychotic Agents / therapeutic use
  • Anxiety Disorders / drug therapy*
  • Anxiety Disorders / pathology
  • Child
  • Evidence-Based Practice
  • Humans
  • Monoamine Oxidase Inhibitors / therapeutic use
  • Selective Serotonin Reuptake Inhibitors / therapeutic use*
  • Serotonin and Noradrenaline Reuptake Inhibitors / therapeutic use*


  • Antidepressive Agents
  • Antipsychotic Agents
  • Monoamine Oxidase Inhibitors
  • Serotonin Uptake Inhibitors
  • Serotonin and Noradrenaline Reuptake Inhibitors