Treatment resistance in anxiety disorder: Generalized anxiety disorder and social anxiety disorder

Abstract

Evidence-based treatments are suggested for generalized anxiety disorder (GAD) and social anxiety disorder (SAD). Pharmacological treatments such as selective serotonin reuptake inhibitors (SSRIs) and psychological treatment including cognitive-behavioral treatment (CBT) have been used as first-line treatments. However, many patients do not improve despite successful delivery of standard therapeutic interventions. The definition of treatment resistance is that standard treatments have been effectively delivered, but the results are ineffective. Overcoming treatment resistance requires reevaluation of the diagnosis and optimization of the treatments. Options for treatment-resistant GAD and SAD include augmentation with other antidepressants, atypical antipsychotics, benzodiazepines, and pregabalin. A partial NMDA agonist D-cycloserine was studied as a newer treatment option with exposure therapy in anxiety disorders.