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Mariam is 30 years old and comes to see you explaining she always feels anxious about most everyday issues. Her fiancé has prompted her to come to the GP as he says her concentration is poor and that she is irritable and restless. Mariam denies being low in mood and agrees anxiety is her overwhelming concern. She is not on any regular medication, has no other past medical history and systems review is normal. You suspect she has Generalised anxiety disorder and GAD-7 score is 11.

If psychological treatments fail then what medication would be first line if her symptoms continued to give marked functional impairment?

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