Generalised Anxiety Disorder Health Article

Conclusions

Generalised anxiety disorder is common, it has many manifestations, and it overlaps with other personality disorders. The disorder has strong genetic and environmental precursors and often becomes noticeable in early adult life. Generalised anxiety is relatively easy to detect and most management should be done in primary care. Generalised anxiety has no predictable outcome and the time to symptom resolution can vary from a period of a few days to not at all, with complete persistence of symptoms and handicaps, magnified by comorbid psychiatric and physical diagnoses. Most treatments have similar efficacy and much of the evidence for their value comes from studies of single treatments rather than combinations. The choice of intervention should be determined by the clinical features of the patient (for example, the presence of concurrent disorders and history of response to previous treatments), patients' preferences, and the local availability of individual services. With both drug and psychological treatments, patients should be told that they will not respond immediately, that symptoms can sometimes briefly worsen during treatment, and that long-term treatment might be needed to maintain an initial response. For psychological treatment, resources are in short supply, but cognitive behavioural therapy, the most effective form of psychological treatment, is being adapted for computerised use, which will reduce demands on therapists' time.

Generalised anxiety disorder can be thought of as a risk factor for the development of many other disorders, either linked disorders such as depression, or secondary disorders such as alcohol or benzodiazepine dependence. Because generalised anxiety disorder as a single condition is relatively rare and tends to persist over time, clinicians should choose treatments with potential to be given long-term, with a wide range of activity that might also be effective in treating depression, other anxiety disorders, and somatoform disorders. For these reasons, current guidelines ^73,74,85 that recommend use of either cognitive behavioural therapy or an SSRI as first choice treatments, with a preference for cognitive behavioural therapy, if readily available, should be followed. The importance of regular monitoring when treatment is first started is of the highest importance.

Search Strategy And Selection Criteria

The evidence for methods for treatment of generalised anxiety disorder was obtained by searching PubMed using the term “generalized (generalised) anxiety disorder” for each drug class (“antidepressants”, “tricyclic”, “selective serotonin reuptake inhibitor”, “benzodiazepine”, “antipsychotic”, and “beta-blocker”), and for named drugs (“citalopram”, “escitalopram”, “fluoxetine” “fluvoxamine”, “paroxetine”, “sertraline”, “amitriptyline”, “clomipramine”, “imipramine”, “alprazolam”, “diazepam”, and “lorazepam”), “randomized controlled trial”, “placebo”, and “efficacy”. We also reviewed recent national and international guidelines for the treatment of anxiety; published or draft reviews by the UK National Institute of Clinical Excellence, that referred to generalised anxiety disorder; and recent abstracts from relevant international conferences. The reference lists of articles identified by this strategy were also checked and papers were selected if judged relevant.

Conflict Of Interest Statement

Peter Tyrer is a member of the Board of the Global Initiative on Psychiatry, and is also Editor of the British Journal of Psychiatry . He has received grants from the Mental Health Foundation, Wellcome Trust, Sir Jules Thorn Charitable Trust, and Medical Research Council to assess the benefits of cognitive behavioural therapy in psychiatric disorders. David Baldwin has acted as a consultant to several companies with an interest in anxiety and depressive disorders (Asahi, Cephalon, Eli Lilly, GlaxoSmithKline, Lundbeck, Pfizer, Organon, Pharmacia, Pierre Fabre, Roche, Servier, Sumitomo, Wyeth). He holds or has held research grants on behalf of his employer from a number of companies with an interest in anxiety and depressive disorders (Cephalon, Eli Lilly, GlaxoSmithKline, Lundbeck, Organon, Pfizer, Pharmacia, Roche, Wyeth). He has accepted paid speaking engagements in industry-supported satellite symposia at international and national meetings, but does not accept hospitality or travel not related to a speaking engagement. He was co-chair of the BAP consensus group on treatment of anxiety disorders and is a medical patron of the National Phobics Society.

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