CNS Drugs

, Volume 23, Issue 2, pp 103–120 | Cite as

Current Considerations in the Treatment of Generalized Anxiety Disorder

Review Article

Abstract

Generalized anxiety disorder (GAD) is a chronic disorder that frequently co-occurs with a variety of co-morbidities in patients with somatic conditions and other mental disorders. GAD is highly prevalent and is one of the most common anxiety disorders seen by primary care physicians. The individual and societal cost associated with GAD is high and the marked level of impairment experienced by patients with this disorder is equivalent in magnitude to that reported in patients with major depressive disorder. Furthermore, patients with GAD are at risk of suicide or suicide attempts, and are frequent users of healthcare services. Thus, GAD is a serious and chronic condition that requires appropriate long-term treatment.

The focus of acute treatment for patients with GAD is the improvement of symptoms, while the primary goal of long-term clinical management is remission, i.e. the complete resolution of both symptoms and functional impairment. The consensus across current treatment guidelines is that first-line treatment for patients with GAD should consist of an antidepressant, either a selective serotonin reuptake inhibitor (SSRI) such as sertraline, paroxetine or escitalopram, or a selective serotonin noradrenaline (norepinephrine) reuptake inhibitor (SNRI) such as venlafaxine or duloxetine. However, the SSRIs and SNRIs have efficacy limitations, such as lack of response in many patients, a 2- to 4-week delay before the onset of symptom relief, lack of full remission, and risk of relapse. In addition, there are troublesome adverse effects associated with both the SSRIs and SNRIs.

Evidence from early clinical studies of the atypical antipsychotics in the treatment of anxiety and GAD indicate that they may have a potential role in the treatment of GAD, either as monotherapy or as augmentation to standard treatment.

Keywords

Major Depressive Disorder Anxiety Disorder Paroxetine Quetiapine Generalize Anxiety Disorder 

Notes

Acknowledgements

The author would like to thank Jocelyn Woodcock, MPhil, from Complete Medical Communications, who provided editorial assistance in the preparation of this review. An unrestricted educational grant was provided by AstraZeneca. Dr Martin Katzman has received grants from Lundbeck, Wyeth, GlaxoSmithKline, Eli Lilly, AstraZeneca, Solve, Genome Health and Pfizer. Dr Katzman has also consulted for GlaxoSmithKline, Wyeth, Lundbeck, AstraZeneca, Eli Lilly, Janssen, Bristol-Myers Squibb and Shire, and has received honoraria from Wyeth, GlaxoSmithKline, Lundbeck, AstraZeneca, Eli Lilly, Janssen, Solve, Bristol Myers-Squibb and Abbott.

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© Adis Data Information BV 2009

Authors and Affiliations

  1. 1.START (Stress, Trauma, Anxiety, Rehabilitation, and Treatment) Clinic for Mood and Anxiety DisordersTorontoCanada

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