A 55-year-old man presents with uncontrollable worry about work, health, and finances for 8 months, accompanied by muscle tension, irritability, fatigue, and insomnia. The FIRST-LINE pharmacological agent supported by the broadest evidence for GAD is:

• A Diazepam long-term
• B Buspirone
• C Pregabalin as monotherapy
• D SSRIs (escitalopram/paroxetine) or SNRIs (venlafaxine/duloxetine) ✓

Explanation

For GAD, SSRIs (escitalopram, paroxetine, sertraline) and SNRIs (venlafaxine XR, duloxetine) are considered first-line pharmacotherapy based on the largest evidence base from RCTs and established safety profiles. Benzodiazepines (diazepam) are effective acutely but carry dependence risk and cognitive side effects, making them unsuitable for long-term use. Buspirone is effective but has delayed onset (2–4 weeks), poor patient acceptance, and limited evidence compared to SSRIs/SNRIs. Pregabalin has evidence for GAD but is third-line due to dependence concerns.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.