Jack M. Gorman, MD
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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
© Copyright 2002 Physicians Postgraduate Press, Inc.