Serotonin and Norepinephrine Reuptake Inhibitors in the Treatment of Generalised Anxiety Disorder: A Descriptive Review

Generalised anxiety disorder (GAD) is a prevalent condition that significantly impairs quality of life and is associated with substantial economic costs and increased use of healthcare resources. GAD is associated with numerous comorbidities, particularly psychiatric ones, which complicate therapeutic management and increase the severity and burden of the condition. Serotonin and norepinephrine reuptake inhibitors (SNRIs) are among the first-line pharmacological options for managing GAD. Their use is supported by efficacy and a favourable safety profile demonstrated in randomised clinical trials and meta-analyses. Furthermore, their dual mechanism of action has shown therapeutic benefit in a subset of patients with treatment-resistant disease. Our paper reviews the mechanism of action of these drugs, their efficacy and their safety. A non-systematic literature search was conducted in PubMed/MEDLINE, Embase and the Cochrane Central Register of Controlled Trials, prioritising randomised controlled trials, meta-analyses, systematic reviews and international clinical guidelines. Both venlafaxine and duloxetine are well tolerated and effective for the treatment of GAD, and their use is recommended in current clinical practice guidelines. Furthermore, this work summarises the available evidence on their use in patients with comorbidities and complex clinical profiles, such as those with other psychiatric conditions or older adults.