A 40-year-old businessman presents with excessive, uncontrollable worry about multiple domains — finances, health, family, and work performance — occurring more days than not for the past 18 months. He reports muscle tension, restlessness, difficulty concentrating, irritability, and sleep-onset insomnia. He has tried relaxation techniques without benefit. Physical examination and routine labs are normal. Which medication is specifically approved for this disorder and has a non-addictive profile?
- A Clonazepam
- B Hydroxyzine
- C Diazepam
- D Buspirone ✓
Correct answer: D. Buspirone
Explanation
Buspirone is a partial 5-HT1A agonist that is FDA-approved for generalized anxiety disorder and has no addictive potential, making it preferable to benzodiazepines for long-term use in GAD. Its onset of action is 2–4 weeks, so patients must be counseled about delayed response. SSRIs and SNRIs are also first-line options. Benzodiazepines provide rapid relief but carry risks of dependence, cognitive impairment, and rebound anxiety upon discontinuation, particularly for a chronic condition like GAD.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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