Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

Table 23 Strength of evidence for pharmacotherapy for GAD

Agent	Level of evidence	Agent	Level of evidence
Antidepressants
SSRIs		TCAs
Escitalopram [544–552]	1	Imipramine [553, 581–583]	1
Paroxetine [546, 547, 553–558]	1	Other antidepressants
Sertraline [556, 559–561]	1	Agomelatine [584, 585]	1
Citalopram [562]	3	Vortioxetine [586, 587]	1*
Fluoxetine [563]	3	Bupropion XL [549]	2
Paroxetine CR [564, 565]	3	Trazodone [583]	2
SNRIs		Mirtazapine [588]	3
Duloxetine [566–571]	1
Venlafaxine XR [548, 553, 570–580]	1
*Other therapies*
Anxiolytics		Atypical antipsychotics
Benzodiazepines		Quetiapine XR [551, 557, 602, 603]	1
Alprazolam [589–593]	1	Adjunctive quetiapine [565, 604, 605]	1*
Bromazepam [589, 594]	1	Adjunctive risperidone [606, 607]	1*
Diazepam [583, 589, 595, 596]	1	Adjunctive olanzapine [608]	2
Lorazepam [589, 593, 597–601]	1	Adjunctive aripiprazole [269, 609]	3
		Adjunctive quetiapine XR [610]	3
		Adjunctive or monotx ziprasidone [611, 612]	2 (-ve)
Anticonvulsants		Other treatments
Pregabalin [576, 577, 592, 593, 597, 613]	1	Buspirone [108, 561, 572, 589, 598, 618, 619]	1
Divalproex chrono [614]	2	Hydroxyzine [594, 619, 620]	1
Tiagabine [615, 616]	1 (-ve)	Pexacerfont [552]	2 (-ve)
Adjunctive pregabalin [617]	2	Propranolol [621]	2 (-ve)
		Memantine [622]	4 (-ve)

*Conflicting data. SNRI = serotonin–norepinephrine reuptake inhibitor; SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant; XL = extended release; XR=extended release; (-ve) = negative.

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