Education And Debate

Fortnightly Review: Treatment of anxiety

BMJ 1994; 309 doi: (Published 30 July 1994) Cite this as: BMJ 1994;309:321
  1. M Lader
  1. Institute of Psychiatry, Maudsley Hospital, London SE5 8AF.

    The anxiety disorders are common conditions - community surveys suggesting that at any one time about 3-5% of the adult population suffers generalised anxiety or panic disorder. However, many more suffer lesser degrees of anxiety, usually related to stresses in the environment, so that at least 15% of patients attending general practitioners' surgeries seek treatment for this unpleasant symptom.1

    For many years the stock treatment for anxiety was an anxiolytic benzodiazepine, but misgivings over side effects and dependence potential have led many prescribers to lessen or eschew their use. Instead, a variety of treatments, drug and non-drug, are being tried. The purpose of this article is to review the present status of the treatment of anxiety, in as practical a way as possible,2 in line with previously published guidelines.3

    The syndromes

    A long list of disorders (box 1) falls under the rubric of anxiety disorders.4 A few points are worth noting. Firstly, the diagnostic criteria for generalised anxiety disorders (GAD) emphasise that the worry about life circumstances produces unrealistic or excessive anxiety. This contrasts with stress related anxiety, in which the anxiety is proportional to the adverse life circumstances. In panic disorder, the panic attacks are unexpected - that is, not related to a phobic situation. In both generalised anxiety disorder and panic disorder, therefore, there is an element of inexplicability about the symptoms, but the symbolism of the anxiety provocation often becomes apparent in psychotherapy.

    Box 1 - Anxiety disorders

    • Generalised anxiety disorder

    • Panic disorder

    • Agoraphobia

    • Social phobia

    • Simple phobia

    • Post-traumatic stress disorder

    • Obsessive-compulsive disorder

    The treatment of the phobic states is primarily behavioural and the province of clinical psychologists, and obsessive-compulsive disorder sits uncomfortably among the anxiety disorders. The focus of this article will therefore be the treatment of generalised anxiety disorder and panic disorder, with an extension into stress related …

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