Nonresponse to initial pharmacotherapy for generalised anxiety disorder in children

Refer children with generalised anxiety disorder to a child psychiatrist, or an age-appropriate mental health service for multidisciplinary input, if their symptoms persist despite:

• using an effective dose of at least 2 selective serotonin reuptake inhibitors (SSRIs) as sequential monotherapy, each for a minimum of 4 weeks (full benefit may take 6 weeks or longer); and
• discounting alternative reasons for treatment nonresponse.

While quetiapine or a benzodiazepine may be considered for adults or young people who have failed to respond to initial treatment, they should be avoided in children. Quetiapine is associated with metabolic adverse effects and there is insufficient evidence to support benzodiazepine use.