What are first-line pharmacotherapies for GAD?

• A. SSRIs or SNRIs; buspirone is an alternative; benzodiazepines are not first-line due to dependency risk.
• B. MAO inhibitors
• C. Tricyclic antidepressants
• D. Antipsychotics

Answer: (A)

First-line pharmacotherapies for generalized anxiety disorder rely on medications with solid, long-term efficacy and favorable safety for chronic use. SSRIs and SNRIs fit this role because they consistently reduce excessive worry and anxiety symptoms over weeks of treatment, and they’re suitable for ongoing management. Examples include SSRIs like sertraline and escitalopram, and SNRIs like venlafaxine and duloxetine.

Buspirone serves as an alternative when a non-sedating anxiolytic with low abuse potential is preferred, though it may take several weeks to become fully effective and isn’t always as potent for all patients. Benzodiazepines, while they work quickly, carry risks of dependence, tolerance, withdrawal, and cognitive impairment, so they’re not considered first-line for long-term treatment and are usually reserved for short-term use or bridging until an SSRI/SNRI takes effect.

MAO inhibitors, tricyclic antidepressants, and antipsychotics are not first-line for GAD because of safety concerns, adverse effect profiles, or weaker evidence in this specific condition compared with SSRIs/SNRIs.