General anxiety disorder: The Daily PANCE Blueprint

The answer is D. SSRIs or SNRIs

General anxiety disorder is characterized by severe anxiety or worry about multiple topics, events or tasks that occur on most days. To make a diagnosis the anxiety/related symptoms have to last for over 6 months. The patients have to have 3 or more of the following symptoms: restlessness, fatigue, trouble keeping thoughts focused, irritability, muscle tension, and sleep problems. 1st line pharmacological treatment is SSRIs, SNRIs, or buspirone. Benzodiazepines can be given short term.

Incorrect Answer Explanations:

• A. Benzodiazepines – While effective for acute anxiety symptoms, benzodiazepines are not recommended as first-line treatment for GAD due to their potential for tolerance, dependence, and withdrawal. They may be appropriate for short-term use during initiation of SSRI/SNRI therapy but should generally be limited to 2-4 weeks.
• B. Tricyclic antidepressants – These older antidepressants are considered second or third-line treatments for GAD due to their less favorable side effect profile, including anticholinergic effects, cardiac conduction abnormalities, and lethality in overdose, despite showing efficacy for anxiety disorders.
• C. Antipsychotics – These medications are not first-line for uncomplicated GAD. They may be used as adjunctive therapy in treatment-resistant cases or when psychotic features are present, but their side effect profile (metabolic syndrome, extrapyramidal symptoms) limits their use as primary therapy.
• E. Cognitive behavioral therapy – While CBT is considered a first-line treatment for GAD with efficacy comparable to medication, it is not a pharmacological intervention. The question specifically asked for a pharmacological treatment, making this answer incorrect despite CBT’s important role in GAD management.