Clinical Review Extracts from “Best Treatments”

Treating generalised anxiety disorderCommentary: Putting research into practiceCommentary: A patient's story of living with anxietyCommentary: Information for patients receiving cognitive therapy

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7391.700 (Published 29 March 2003) Cite this as: BMJ 2003;326:700

Treating generalised anxiety disorder

  1. Alison Tonks (atonks@bmj.com), freelance medical editor
  1. BMJ Unified, London WC1H 9JR
  2. Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
  3. BMJ Unified, London WC1H 9JR

    Description Generalised anxiety disorder is a chronic, disabling mental illness affecting 1-2% of adults.1 It is characterised by worry and anxiety that are hard to control and that interfere with daily functioning. Although common and treatable, it remains underdiagnosed and undertreated.2 Only half of people with the disorder consult a doctor for it. Those who do are rarely offered the most effective treatment—cognitive therapy. Most patients are seen and treated by primary care doctors, who may be unfamiliar with the condition. About 8% of patients consulting primary care professionals have generalised anxiety disorder.3 Treatment involves cognitive therapy or medication. There are large gaps in the evidence on treatments, such as on their long term effects or on the value of combining cognitive therapy with medication.

    Research Several factors complicate research into treatment of generalised anxiety disorder:

    • Drug trials have high dropout rates, partly because of side effects4

    • The disorder has a relapsing and remitting course; improvements are not always due to treatment

    • The placebo effect is powerful—trials have to be large to show a treatment effect5

    • Most treatments take several weeks or even months to work2

    • The definition of generalised anxiety disorder has changed four times since 1980.6

    Prognosis Complete recovery is rare. Explain to your patients that you are aiming for remission rather than cure. A reasonable goal is to reduce symptoms by about 50% and improve quality of life.7 Patients shouldn't expect any benefit until eight to 12 weeks after starting treatment.2

    Treatment

    These articles, and the patients' version, will help you and your patients discuss treatment options together and choose treatments that are supported by evidence from randomised controlled trials. Clear, concise information is important for people with generalised anxiety disorder, who may have difficulty concentrating or making …

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