As with CBT for GAD, there is a strong evidence base to support the use of SSRIs (in particular, sertraline, escitalopram, and paroxetine) and SNRIs (venlafaxine and duloxetine) in the treatment of GAD [1158]. The RANZCP guidelines suggest that SSRIs or SNRIs may be considered as an alternative to CBT for cases in which the response to CBT has been inadequate or if the person has a preference for medication. Similarly, the combined use of CBT and an SSRI or SNRI may be considered in cases of severe GAD, or where the response to either CBT or pharmacotherapy alone has been insufficient. SSRIs have been found to be associated with reductions in alcohol use among people with anxiety and depression [1179].
Other pharmacotherapies that have demonstrated some effectiveness in treating GAD as a single disorder include pregabalin, agomelatine, buspirone, and imipramine; however, both buspirone and imipramine are associated with significant side effects and therefore only recommended when alternatives have been ineffective [1158]. Of these medications, only buspirone has been found to be effective in producing improvements in anxiety, drinking outcomes and treatment retention in people with GAD and alcohol use disorders [1172, 1180]. However, it should be noted that at the time of writing, buspirone was not listed by the Australian Register of Therapeutic Goods nor in the MIMS Australia.
The RANZCP guidelines provide guidance on dose titration and switching within- and between- classes of anti-depressants and other medications depending on treatment response. It is important to note however, that treatment response is typically slow (at least four weeks) and it is therefore important to allow time for appreciable effects to be discerned, which may be difficult for clients who are seeking immediate relief from their symptoms.