Generalized anxiety disorder: new concepts and psychopharmacologic therapies

Several classes of medications have been used to treat generalized anxiety disorders (GAD). Antidepressants are useful for chronic subpanic anxiety and anxiety associated with depression. Benzodiazepines are generally safe, but recent research suggests that the incidence of chronic abstinence syndromes may be higher than has been suspected. This class of medications is best used for circumscribed periods of time. Because buspirone has no significant interactions, it does not prevent benzodiazepine withdrawal and cannot be directly substituted for this class of medications. beta-Blockers are used when cardiovascular symptoms and tremor are prominent, for stage fright (propranolol) and possibly for social phobia (atenolol). Antihistamines have been used for elderly patients and for those with a history of substance abuse. Neuroleptics should only be prescribed for anxiety associated with psychosis, psychotic and possibly severe depression, and borderline personality disorder. Drug treatment of GAD should be used as part of a comprehensive treatment plan that includes assessment for medical illnesses that can aggravate anxiety, withdrawal of all unnecessary medications (especially CNS depressants) and caffeine, structured relaxation techniques, evaluation of the specific type of anxiety, and psychotherapy.