Overview of anxiety disorders: prevalence, biology, course, and treatment

Anxiety disorders are extremely common in modern society. The Epidemiologic Catchment Area (ECA) Study reported a 1-month prevalence for anxiety disorders of 7.3%, and a lifetime prevalence of 14.6%. Three anxiety disorders were emphasized: panic disorder with a lifetime prevalence of 1.6%, phobic disorders with a lifetime prevalence of 12.5%, and obsessive compulsive disorder with a lifetime prevalence of 2.5%. Data from the ECA survey indicated that all of these disorders are more common in women than in men. Familial proclivities toward anxiety have been reported. Panic attacks may be easily provoked by lactate infusions, CO2 inhalation, and other agents in individuals with a history of panic attacks. The physiologic relevance of these findings to the treatment of anxiety disorders in general and panic disorder in particular is discussed. Effective treatment for panic disorder can be achieved with benzodiazepines, tricyclic antidepressants, and monoamine oxidase inhibitors. The advantages and disadvantages of each class are discussed. Recent data pointing to considerable morbidity for both panic attacks and panic disorder are also reviewed.