Emerging treatments
Transcranial magnetic brain stimulation techniques
Two randomised controlled trials on transcranial magnetic brain stimulation (TMS) techniques in GAD have shown that they appear safe, and are associated with a reduction in symptoms of GAD, although data on their role in the management of refractory GAD are currently lacking.[205][206]
Ketamine
Preliminary proof of concept studies suggest that ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, may show promise as a treatment for refractory GAD.[207] There is evidence to suggest that a single intravenous dose of ketamine may demonstrate a rapid anxiolytic effect persisting for up to 1 week following treatment.[208] The safety and efficacy of ketamine for long-term use in GAD remain unknown. Repeated use of ketamine in other patient groups has been linked to urological and liver toxicity, cognitive deficits, and dependency.[209]
Agomelatine
Agomelatine is an antidepressant with an atypical mode of action that was found to be effective and well tolerated according to a large network meta-analysis of pharmacotherapies conducted in 2019. However, the strength and clinical applicability conclusion was limited by the relatively small number of studies available on agomelatine, and by the small sample size of the studies included.[130][210][211] Agomelatine is available for the treatment of depression in some countries, but is not available in the US.
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