Diagnosis and management of generalized anxiety disorder

To review the epidemiology, etiology, clinical presentation, diagnosis, clinical course, and treatment of generalized anxiety disorder (GAD).

Controlled studies conducted in humans and published in English as identified through a MEDLINE search of the years 1975-1999 using the search terms generalized anxiety disorder, treatment, epidemiology, outcomes.

Not applicable.

By the author.

GAD is now a clearly identified psychiatric illness. Patients often suffer from this disorder from childhood into adult years. Treatment includes benzodiazepines, buspirone, and extended-release venlafaxine. The nonbenzodiazepines have a longer time to onset of therapeutic effects but are equivalent to benzodiazepines by the third or fourth week of treatment. All agents have a favorable side effect profile with cautions exercised in the use of benzodiazepines and chemical dependency. Long-term outcome may be better with nonbenzodiazepine agents. Buspirone efficacy studies have not been performed in patients diagnosed with GAD using current criteria. The most extensively studied antidepressant is extended-release venlafaxine, which has been effective in acute and long-term studies. In comparison with buspirone and placebo, extended-release venlafaxine demonstrated equal to greater efficacy.

Antidepressants, especially extended-release venlafaxine, may be considered first-line therapy for GAD. Buspirone may be indicated in individuals with histories of chemical dependency who have failed or could not tolerate antidepressants. While benzodiazepines have faster onset of effect, their use should be limited to short-term situations because of the possibility of dependence.