Treatment of Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is characterized by chronic worry that may persist for many years. It is a debilitating disorder, and effective long-term treatment is required. Psychotherapy, particularly relaxation, cognitive therapy, and cognitive-behavioral therapy, has shown long-term benefit in GAD and may be a useful approach alone and as an adjunct to pharmacotherapeutic options. Available medications for GAD include benzodiazepine anxiolytics, buspirone, and antidepressants. Although benzodiazepines are effective as short-term anxiolytics, their use is compromised by a poor adverse event profile and, like buspirone, they lack the antidepressant efficacy important for addressing the comorbid depression experienced by many patients with GAD. Antidepressants, including paroxetine and the serotonin-norepinephrine reuptake inhibitor venlafaxine, are effective anxiolytics and resolve symptoms of depression in patients with GAD. The benefit of venlafaxine is sustained long term, enabling increased numbers of patients to attain remission from symptoms and experience restoration of normal functioning. Although further clinical studies are required to establish the use of psychosocial therapy in the treatment of GAD, preliminary results are encouraging. At present, the use of psychosocial therapy and second-generation antidepressants, such as some selective serotonin reuptake inhibitors and venlafaxine, offer the best approach to attaining long-term benefit for patients with GAD.

J Clin Psychiatry 2002;63(suppl 8):17-23