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This revision of previous algorithms for the pharmacotherapy of generalized anxiety disorder was developed by the Psychopharmacology Algorithm Project at the Harvard South Shore Program. Algorithms from 1999 and 2010 and associated references were reevaluated. Newer studies and reviews published from 2008-14 were obtained from PubMed and analyzed with a focus on their potential to justify changes in the recommendations. Exceptions to the main algorithm for special patient populations, such as women of childbearing potential, pregnant women, the elderly, and those with common medical and psychiatric comorbidities, were considered. Selective serotonin reuptake inhibitors (SSRIs) are still the basic first-line medication. Early alternatives include duloxetine, buspirone, hydroxyzine, pregabalin, or bupropion, in that order. If response is inadequate, then the second recommendation is to try a different SSRI. Additional alternatives now include benzodiazepines, venlafaxine, kava, and agomelatine. If the response to the second SSRI is unsatisfactory, then the recommendation is to try a serotonin-norepinephrine reuptake inhibitor (SNRI). Other alternatives to SSRIs and SNRIs for treatment-resistant or treatment-intolerant patients include tricyclic antidepressants, secondgeneration antipsychotics, and valproate. This revision of the GAD algorithmresponds to issues raised by new treatments under development (such as pregabalin) and organizes the evidence systematically for practical clinical application. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 55-year-old, married Hispanic woman with panic disorder having symptoms of anxiety. She had a traumatic childhood as she was sexually molested by two neighbors from age seven through 11. It mentions treatment given to patient is Panic-focused psychodynamic psychotherapy (PFPP) a 24-session, twice-weekly for 12 weeks program, for the patients who not respond to alternative therapy like cognitive-behavioral therapy and drug therapy.