Pharmacologic therapy
Pharmacologic interventions are helpful in decreasing anxious reactivity in the brain, which increases the opportunity for patients to learn and practice more adaptive responses to stressful stimuli. Pharmacotherapy is safe to start concurrently with CBT or may be started before or after therapy initiation. Selective serotonin reuptake inhibitors (SSRIs) are the first-line (off-label use for GAD) medications used to treat GAD (see Medications used in GAD treatment).20Numerous studies have shown that SSRIs and serotonin norepinephrine reuptake inhibitors (SNRIs) have a clear benefit in relieving symptoms of anxiety disorders in adolescent populations, specifically in GAD. Tricyclic antidepressants (TCAs) have been less studied in GAD treatment (off-label use for GAD), but may be an option for patients who are intolerant to SSRIs.33 Benzodiazepines have been shown to be effective as short-term treatments but should be used with extreme caution in adolescent populations because of the adverse reaction profile and the high risk of physical and psychological dependence.20 The healthcare provider should closely monitor the use of any antidepressant medication in pediatric populations. The FDA has issued a black box warning for the increased risk of suicide with the use of these medications.20 When initiating medication use, the provider should see the patient for follow-up visits every 2 to 4 weeks to monitor effectiveness, tolerance, and to identify any issues with adverse reactions of medication use. The provider should educate the parents/caregivers on the possible adverse reactions of the medications, as they play a major role in monitoring the everyday health status of the patient. Medications should be maintained for 1 year after the resolution of symptoms followed by gradual tapering of the dosage