This article provides a brief review of the practical implications of the current diagnostic conceptualisation of generalised anxiety disorder (GAD) and an update on its pharmacotherapy.
Conclusions:
The diagnostic criteria for GAD need to be refined, to better reflect its clinical features and to make GAD more clinically useful. Various pharmacological agents are effective for GAD and to some extent, allow a tailored treatment approach. In addition to effectiveness, the choice of medication is influenced by the speed of therapeutic action, tolerability and habit-forming properties.
StarcevicV.Generalised anxiety disorder: Rescuing the prototypical anxiety disorder from marginalisation and neglect. In: CastleDHoodSStarcevicV (eds) Anxiety disorders: Current understandings, novel treatments. Melbourne: Australian Postgraduate Medicine, 2012, pp.95–105.
2.
StarcevicVPortmanME.The status quo as a good outcome: How the DSM-5 diagnostic criteria for generalised anxiety disorder remained unchanged from the DSM-IV criteria. Austral NZ J Psychiatry2013; 47: 995–997.
3.
StarcevicVPortmanMEBeckAT.Generalized anxiety disorder: Between neglect and an epidemic. J Nervous Mental Dis2012; 200: 664–667.
4.
DestoopMVan den EedeFAnsseauM. Prevalence and clinical characteristics of remission during treatment in generalized anxiety. Int J Psychiatry Clin Pract2013; 17: 90–97.
5.
WoodmanCLNoyesRBlackDW. A 5-year follow-up study of generalized anxiety disorder and panic disorder. J Nervous Mental Dis1999; 187: 3–9.
6.
HettemaJM. The nosologic relationship between generalized anxiety disorder and major depression. In: GoldbergDKendlerKSSirovatkaPJ. (eds) Diagnostic issues in depression and generalized anxiety disorder: Refining the research agenda for DSM-V. Arlington: American Psychiatric Association, 2010, pp.15–39.
7.
BaldwinDSAndersonIMNuttDJ. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol2014; 28: 403–439.
8.
KatzmanMABleauPBlierP. Canadian clinical practice guidelines for the management of anxiety, post-traumatic stress and obsessive-compulsive disorders. BMC Psychiatry2014; 14 (Suppl. 1).
9.
BaldwinDSSteinDJDolbergOT. How long should a trial of escitalopram treatment be in patients with major depressive disorder, generalised anxiety disorder or social anxiety disorder? An exploration of the randomised controlled trial database. Human Psychopharmacol2009; 24: 269–275.
10.
NielsenMHansenEHGøtzschePC.What is the difference between dependence and withdrawal reactions? A comparison of benzodiazepines and selective serotonin re-uptake inhibitors. Addiction2012; 107: 900–908.
11.
BoschenMJ.Pregabalin: Dose-response relationship in generalized anxiety disorder. Pharmacopsychiatry2012; 45: 51–56.
12.
SteinDJBaldwinDSBaldinettiF. Efficacy of pregabalin in depressive symptoms associated with generalized anxiety disorder: A pooled analysis of six studies. Eur Neuropsychopharmacol2008; 18: 422–430.
13.
SteinDJAhokasAMárquezMS. Agomelatine in generalized anxiety disorder: An active comparator and placebo-controlled study. J Clin Psychiatry2014; 75: 362–368.
14.
StarcevicV.The reappraisal of benzodiazepines in the treatment of anxiety and related disorders. Expert Rev Neurotherapeut2014; 14: 1275–1286.
