13. What to Do After Two Failed Trials: Tried an SNRI? (Node 5)
Key Points
- The patient is very treatment-resistant to pharmacotherapy by this point, having had two good, adequate trials of medication
- We add two alternatives:
- Second-generation antipsychotics: they have a substantial side effect burden and we would still avoid olanzapine
- Valproate is also an option with a small evidence base for GAD
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