First-line pharmacotherapy for generalized anxiety disorder often includes which class of medication?

• A. Benzodiazepines alone
• B. SSRIs or SNRIs with cognitive-behavioral therapy
• C. MAO inhibitors
• D. SSRIs or SNRIs with cognitive-behavioral therapy

Answer: (D)

For generalized anxiety disorder, the strongest first-line approach combines a medication that modulates mood and worry with a proven psychotherapy. SSRIs or SNRIs are preferred pharmacotherapy because they help reduce excessive worry and physical symptoms over several weeks, with a favorable safety profile compared with older drugs. Pairing an SSRI or SNRI with cognitive-behavioral therapy adds structured skills to manage anxious thoughts, cope with stress, and challenge avoidance patterns, leading to better and longer-lasting improvement than medication alone.

Benzodiazepines can relieve symptoms quickly but carry risks of dependence, tolerance, and withdrawal, and they don’t address underlying worry in the long term. MAO inhibitors are effective but come with significant dietary restrictions and side effects, making them a less favored option as first-line therapy.