GuidelinesOther guideline
Summary points
These are the approved guidelines published by the South African Society of Psychiatrists to provide an overview on treatment and management of commonly diagnosed psychiatric illnesses. The guidelines include consensus recommendations, based on peer contribution and using the international evidence based guidelines that are suitable for the local South African health service.
Please note that parts of this guideline may be out of date, an update will be published as soon as it is available.
- Both pharmacotherapy and psychotherapy are efficacious first-line approaches for GAD.
- First-line pharmacotherapy of uncomplicated GAD comprises useof an SSRI or SNRI drug.
- A range of other psychotropics are useful for the treatment of GAD.
Response time to a first-line selective SSRI (e.g. fluoxetine, citalopram, escitalopram, paroxetine, sertraline) or SNRI (e.g.venlafaxine, duloxetine) is usually between 4 and 12 weeks in GAD. - Benzodiazepines (e.g. lorazepam, alprazolam, diazepam) are best reserved for short-term use (2 - 4 weeks) in the early phase of treatment of GAD with an SSRI or SNRI to provide symptomatic relief.
- Given concerns about their tolerability and side-effect profile, caution should be exercised in using atypical and typical antipsychotic medications as monotherapy in GAD.
- CBT for GAD involves techniques of cognitive restructuring, worry exposure, and behaviour modification.
- Neither augmentation nor switching strategies have been well researched in GAD. Where there is only a partial response to an optimal 12-week trial, consider switching to another antidepressant within the same class or to a different class (e.g. SSRI to SNRI or agomelatine, SNRI to SSRI or agomelatine).