Generalized anxiety disorder
Second line
Lorazepam is second-line therapy for GAD, used short-term (2-4 weeks) for severe anxiety or panic attacks. Meta-analyses (Mitte 2005, Reinhold 2015) show efficacy comparable to other benzodiazepines. Lorazepam's advantage is absence of active metabolites and glucuronidation metabolism (not CYP) – convenient in older adults, hepatic impairment, and polypharmacy (no significant CYP interactions). CG113 and GAD guidelines list SSRIs/SNRIs and CBT as first-line; benzodiazepines short-term only. Dose 1-6 mg/day in 2-3 doses. In older adults, start at 0.5-1 mg/day.