Clinical Review

Generalized anxiety disorder: diagnosis and treatment

BMJ 2012; 345 doi: (Published 27 November 2012) Cite this as: BMJ 2012;345:e7500

Re: Generalized anxiety disorder: diagnosis and treatment

Any discussion of the causes of GAD, however brief, may benefit from a mention of the historical trend of anxiety symptoms, in recent decades.

Twenge reviewed more than 250 studies, involving 52,000 people, which measured anxiety levels in the USA between 1952 and 1993. (1) They showed a continuous upward trend. By the late 1980s, the average North American child was more anxious than child psychiatric patients in the 1950s.

Wilkinson and Pickett have described interesting cultural changes, possibly associated with these trends. (2)

In their account of management options, Hoge and colleagues give equal space to the role of psychological and pharmacological approaches. (3)

Thirty and more years ago, doctors were encouraged to prescribe “safe” benzodiazepines to their anxious patients. They had none of the problems associated with barbiturates, we were assured.

It was recently reported that 1 million people in the UK are dependent on benzodiazepines. (4)

The NHS faces financial restrictions that have decimated psychological services, the prescribing of SSRIs increases annually, and politicians talk, occasionally, of the need for a measurement of national happiness to replace GNP as the arbiter of last resort.

Might there be a lesson here ?

Primary care practices who encourage their doctors and other staff to use and teach meditative and mindfullness techniques might find that the wellbeing of staff improves along with patients’ coping mechanisms, to the benefit of all, not forgetting the size of the NHS drug bill.

1 J.M.Twenge, ‘The age of anxiety ? Birth cohort change in anxiety and neuroticism,1952-1993, ‘ Journal of Personality and Social Psychology (2007) 79 (6):1007-21.

2 Wilkinson and Pickett, ‘The Spirit Level’ Allen Lane, (2009)

3 Hoge et al BMJ 2012;345:e7500

4 The Times, 1.10.2012

Competing interests: No competing interests

06 December 2012
Noel Thomas
retd GP
Bronygarn Maesteg, CF34 9AL