hardbuspironeaugmentationgeneralized anxiety disorderGAD-7escitalopramdose optimizationadherence
A 52-year-old female with generalized anxiety disorder and comorbid major depressive disorder has been on escitalopram 20 mg daily for 16 weeks with good antidepressant response but persistent anxiety. Her PHQ-9 decreased from 18 to 7, but her GAD-7 has only decreased from 19 to 14. The PMHNP added buspirone 10 mg twice daily six weeks ago as an augmentation strategy. At today's visit, her GAD-7 is 12, representing only a 2-point improvement since buspirone addition. She reports taking the medication consistently but finds it difficult to remember the twice-daily dosing, occasionally missing the afternoon dose. She states she does not feel the buspirone is making any noticeable difference. Her depressive symptoms remain well-controlled. The PMHNP is evaluating the buspirone augmentation response. Which of the following best represents the appropriate evaluation?