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Treating Generalized Anxiety Disorder

Jack M. Gorman, MD

Published: February 1, 2003

Article Abstract

Generalized anxiety disorder (GAD) is characterized by chronically persistent worry and thereforerequires effective long-term treatment. This article reviews the benefits and risks associated withvarious pharmacologic and psychological therapies to assess their ability to achieve the eliminationof GAD symptomatology and restoration of normal function. Psychotherapeutic approaches such asapplied relaxation, cognitive therapy, and cognitive-behavioral therapy have all been shown to beeffective when used as monotherapies and may be beneficial when used adjunctively. Current effectivepharmacotherapies for patients with GAD include anxiolytic benzodiazepines, buspirone, and antidepressantsincluding venlafaxine and paroxetine. Benzodiazepines have long been used to treatanxiety and are particularly appropriate in short-term treatment situations; however, their adverseside-effect profile and their inability to treat depression commonly comorbid with GAD rendersthem less than ideal in many situations. Buspirone has demonstrated anxiolytic benefits but, like benzodiazepines,shows negligible antidepressant action. Antidepressants like paroxetine and venlafaxineare not only effective antidepressants but also effective anxiolytics, thus implying their special abilityto treat GAD and concurrent depression, even over the long-term.

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