How should I monitor and follow up with patients who are being treated for GAD to assess treatment efficacy and side effects?

Monitoring and follow-up for patients treated for generalized anxiety disorder (GAD) should be tailored based on clinical judgment, patient preference, severity of symptoms, comorbidities, and response to treatment.

For patients starting pharmacological treatment, review efficacy and side effects within 2 weeks of initiation, then again at 4, 6, and 12 weeks. At 12 weeks, assess overall treatment effectiveness and decide whether to continue, adjust, or change treatment. If treatment continues beyond 12 weeks, reviews should occur every 8 to 12 weeks depending on clinical progress and individual circumstances. During reviews, check adherence, inquire about adverse effects, and consider using anxiety rating scales such as GAD-2 or GAD-7 to compare symptom severity over time. For patients under 30 starting SSRIs or SNRIs, monitor for suicidal ideation weekly for the first month, with an initial review within 1 week of starting medication.

For patients receiving psychological interventions, practices should have a process to assess progress, with contact frequency typically every 4 to 8 weeks, adjusted case-by-case. Self-help interventions should include access to primary care professionals for monitoring and consideration of alternative treatments if needed.

Throughout follow-up, be alert to suicidal ideation, especially if comorbid depression is present, and reassess suicide risk regularly. If there is no response or only a partial response to treatment, consider alternative or combined psychological and pharmacological interventions.