A psychopharmacological treatment algorithm for generalised anxiety disorder (GAD) JR Davidson (Professor Emeritus), Dept. of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. W Zhang Dept. of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. KM Connor Clinical Neuroscience and Ophthalmology, Merck Research Laboratories, Merck & Co., Inc., North Wales, PA 19454, USA. J Ji Dept. of Mental Health, Shanghai Medical School, Fudan University, Dept. of Psychological Medicine, Zhongshan Hospital, Shanghai 200032, China. K Jobson Department of Psychiatry, University of Tennessee, Knoxville, TN 37996, USA. Y Lecrubier European College of Neuropsychopharmacology, Hôpital La Salpetriere, Paris, France. AC McFarlane The University of Adelaide, Centre for Military and Veterans’ Health, Adelaide, SA 5000, Australia. DJ Newport Women’s Mental Health Program, Emory University School of Medicine, Atlanta, Georgia 30322, USA. DJ Nutt Psychopharmacology Unit, Dept. of Community-based Medicine, University of Bristol, Bristol BS1 3NY, United Kingdom. DN Osser Department of Psychiatry, Harvard Medical School, VA Boston Healthcare System, Brockton Campus, 940 Belmont Street, Brockton, MA 02301, USA. DJ Stein Dept. of Psychiatry and Mental Health, University of Capetown, Cape Town, South Africa. ZN Stowe Women’s Mental Health Program, Emory University School of Medicine, Atlanta, Georgia 30322, USA. O Tajima Dept. of Mental Health, Kyorin University, School of Health Sciences, Tokyo, Japan . M Versiani Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. Abstract Generalised anxiety disorder (GAD) is defined as excessive and uncontrollable worry and anxiety about everyday life situations. It is a chronic disorder, and is associated with substantial somatisation, high rates of comorbid depression and other anxiety disorders, and significant disability. The evidence base for pharmacotherapy and psychotherapy has continued to grow, and a wide range of drug choices for GAD now exists. Current guidelines for GAD generally restrict themselves to presentation of the evidence for various treatments, which, as a result, generally do not offer detailed discussion or recommendation of strategies beyond the first level of treatment, or take into account the individual circumstances of the patient. Thus, there is a lack of algorithm-based treatment guidelines for GAD. Our aim is, therefore, to present an algorithm for the psychopharmacologic management of GAD, intended for all clinicians who treat patients with GAD, where issues of pharmacotherapy are under consideration. We also hope that these GAD algorithms and other guidelines can help to identify high-priority areas that need further study. In this algorithm, we provide a sequenced approach to the pharmacotherapy of GAD, taking into account salient symptomatology and comorbidity, levels of evidence and extent of response. Special issues, including comorbidity, insomnia, suicidality, substance abuse, treatment adherence, pregnancy and lactation, cross-cultural issues, use of medication in the elderly, psychosocial treatment and dosing issues are also addressed. Key words algorithm; generalised anxiety disorder; international psychopharmacology algorithm project; pharmacotherapy Review Journal of Psychopharmacology 00(00) (2008) 1–24 © 2008 British Association for Psychopharmacology ISSN 0269-8811 SAGE Publications Ltd, Los Angeles, London, New Delhi and Singapore 10.1177/0269881108096505 Corresponding author: Dr Wei Zhang, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3812, Durham, NC 27710, USA. Email: wei.zhang@duke.edu J Psychopharmacol OnlineFirst, published on October 2, 2008 as doi:10.1177/0269881108096505