Approach to managing generalised anxiety disorder in adults and young people

Psychosocial interventions, including psychotherapy (eg cognitive behavioural therapy), are first-line treatments for generalised anxiety disorder in adults and young people. Ongoing supportive psychosocial treatment is required in all patients.

Pharmacotherapy may be used when psychotherapy is not available, not effective or not preferred, or if symptoms are severe. If pharmacotherapy is appropriate, start an antidepressant for maintenance therapy. Short-term treatment with a benzodiazepine may also be needed initially because it can take several weeks before an effect is seen with an antidepressant.

When evaluating treatment options for a young person, also consider:

• there are few data on psychotropic use in young people because young people are poorly represented in clinical trials
• young people are more susceptible to developing activation and suicidal thoughts when starting treatment with an antidepressant; this effect has been most often observed with selective serotonin reuptake inhibitors (SSRIs)
• if pharmacotherapy is used, it should ideally be started by a clinician with expertise in using psychotropics in young people.

For treatment considerations for females of childbearing potential, including advice on contraception, preconception planning and psychotropic use, see here.

For considerations in managing anxiety disorders such as generalised anxiety disorder in the perinatal period, see here or for considerations in partners, see here.

For patients presenting during an acute crisis, if possible use nonpharmacological measures to reduce the risk of harm. If the patient remains acutely agitated and is at risk of harming themselves or others, see the advice on drug therapy for acute behavioural disturbance in adults or older people. If the patient is agitated but not at risk of harming themselves or others, consider using a short-term benzodiazepine.