What the evidence says about Generalized Anxiety Disorder

Generalized anxiety disorder, or GAD, has a solid evidence base for both psychological and medication treatment. CBT shows moderate to large effects for GAD in meta-analyses, and GAD is among the anxiety disorders where CBT performs most strongly. On the medication side, the 2019 Lancet network meta-analysis by Slee and colleagues compared drug treatments for GAD directly and found several agents more effective than placebo, including the SSRIs escitalopram and sertraline, the SNRIs duloxetine and venlafaxine, and pregabalin.

Pregabalin has consistent evidence in GAD and is approved for the condition in Europe, though it isn't FDA-approved for GAD in the United States. Buspirone has older supporting evidence in GAD and is sometimes used, particularly when SSRIs aren't tolerated or as an add-on. Hydroxyzine, an antihistamine, has some evidence for short-term symptom relief. Quetiapine has trial evidence in GAD but is rarely a first-line choice because of its metabolic and other side-effect burden.

A consistent finding across GAD studies is that relapse is common after treatment stops. Continued treatment, whether therapy skills or medication, is often needed to maintain gains.