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Treatment of Generalized Anxiety Disorder

Jack M. Gorman, MD

Published: August 1, 2002

Article Abstract

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

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