An overview of generalized anxiety disorder:
disease state - appropriate therapy

by
Lydiard RB
Institute of Psychiatry,
Medical University of South Carolina,
Charleston 29425, USA.
Clin Ther 2000; 22 Suppl A:A3-19; discussion A20-4


ABSTRACT

OBJECTIVE: This article reviews the prevalence, diagnosis, and treatment of generalized anxiety disorder (GAD). BACKGROUND: Patients with GAD often present to primary care physicians; frequently the disorder manifests with somatic symptoms that have no identifiable physiologic foundation. Accurate diagnosis and treatment often prove elusive, and health care resources are inappropriately consumed in the management of a wide array of complaints, including headache, noncardiac angina, fatigue, insomnia, or abdominal discomfort. Early diagnosis and intervention are critical; GAD is frequently associated with other anxiety and mood disorders, major depressive disorder among them. The differential diagnosis of GAD is complex, including medication side effects and substance-related dependence or withdrawal phenomena, as well as endocrine, neurologic, cardiorespiratory, and autoimmune disorders. CONCLUSIONS: GAD is differentiated from adjustment disorder with anxiety because only GAD can manifest without identifiable emotional stressors; it is differentiated from panic disorder largely on the basis of the chronicity of GAD and the episodic, abrupt nature of panic attacks, with the involvement of at least 4 autonomic, cardiopulmonary, neurologic, or other symptoms. In addition to psychotherapy, education, lifestyle modifications, and social support, several pharmacologic agents may be appropriate therapy for GAD. Given the chronic, nonremitting, relapsing character of GAD, use of benzodiazepines, which confer short-term relief, is usually ill-advised in long-term treatment because these agents can impair cognitive and psychomotor function, interact with various central nervous system depressants (eg, alcohol), and exhibit substantial potential for abuse, tolerance, dependence, and withdrawal effects. Buspirone and certain antidepressants, including the dual noradrenergic-serotonergic reuptake inhibitor venlafaxine, represent first-line therapy for GAD.
GAD
SSRIs
Stress
F11440
Gepirone
Buspirone
Alprazolam
Adinazolam
Barbiturates
Benzodiazepines
Future anxiolytics
Venlafaxine for GAD
Anxiety and depression
Subthreshold syndromes
Anxious golden hamsters
Buspirone plus venlafaxine
Anxiolytics/antidepressants
Generalised Anxiety Disorder (GAD)
Antidepressants for Generalised Anxiety Disorder (GAD)
Pregabalin: its efficacy, safety and tolerability profile in generalized anxiety


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