1. Beta Blockers
May be useful in RX of somatic symptoms such as palpitations, sweating, tremor…
20-60mg of Propranalol/day
Not used much except in certain situations

2. Antihistamines
Hydroxizine
Little long term data

3. Quetiapine in acute treatment of GAD randomised double-blind fixed-dose placebo-controlled 8-wk study (LOCF, modified ITT)
Mean baseline HAMA scores: placebo 27.3, QUET 50 mg 26.9, QUET 150 mg 26.6, PAR 20 mg 27.1
Bandelow B et al. Int J Psychiatry Clin Pract 2007; 11: (abstract)

4. Gabapentin
Tiagabine
Riluzole
Opipramol
Kava Kava
St. John’s Wart
Valerian
Passion flower (Passiflora)
Galphimia Glauca (mexican herb)

5. Psychological Treatments
High intensity psychological RX’s delivered by trained supervised competent staff
12-15 weekly hourly sessions
Equal efficacy to drug RX
CBT, Applied Relaxation..
Need to measure outcomes (audio, video taping sessions for evaluation)
Caveat availability/accessibility

6. Cognitive-behaviour therapy in GAD
Study
Interventions
Findings
Butler et al 19911
CBT (4-14 sessions)
Behaviour therapy (BT)
Waiting list
CBT (15/16 measures and BT (4/16) significantly superior to waiting list, CBT superior to BT
Barlow et al 19922
Relaxation therapy
Cognitive therapy
CT plus relaxation
Superiority of three interventions over waiting list on observed case analysis
Borovec and Costello 19933
Applied relaxation
CBT
Non-directive intervention
At follow-up, relaxation and CBT superior to non-directive intervention (worsened)
Durham et al 19944
Anxiety management
Analytic psychotherapy
CBT superior to analytic therapy at 6 months, but not superior to anxiety management
1. Butler G et al. J Consult Clin Psychol 1991; 59:
2. Barlow DH et al. Behav Ther 1992; 23:
3. Borovec TD, Costello E. J Consult Clin Psychol 1993; 61:
4. Durham R et al. Br J Psychiatry 1994; 165:

7. When to refer to secondary care?
If you feel diagnosis is uncertain
If you feel inexperienced to treat
If 1or 2 treatments have failed (adequate doses for adequate length of time)
If there is co-morbidity (depression) and risk of suicide
If psychological treatments are not available at primary care

8. Prediction of response to treatment