Editorial: Treatment of generalized anxiety disorder || FREE PAPER ||

Roger M Pinder

York, UK

Abstract: Anxiety disorders—generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder (PD), post-traumatic stress disorder (PTSD), and social anxiety disorder (SAD)—are common, persistent, and cause substantial impairment. With lifetime prevalence estimates of over 25%, they constitute a group that is the most frequently occurring of psychiatric disorders (Kessler et al 1994). They are also expensive, with the annual cost of anxiety disorders in the US estimated to be US$42.3 billion in 1990 and US$65 billion in 1994 (Greenberg et al 1999), representing a substantial burden in the direct costs of medication and psychotherapy as well as indirect costs associated with impaired functioning in social, educational, and employment aspects of life. Traditionally, anxiety disorders were treated with benzodiazepines, and despite the shortcomings of these agents in terms of long-term use and habituation, they are still widely prescribed, especially diazepam and lorazepam. Newer variations like clonazepam and alprazolam have also found their place. The 5-HT1A partial agonist buspirone has proven efficacy in anxiety disorders, as do some psychological treatments, especially cognitive behavior therapy (CBT). However, treatment of all anxiety disorders has largely been taken over by the selective serotonin reuptake inhibitors (SSRI) group of antidepressants to the extent that the anxiety disorders have become known as the ‘serotonergic disorders’ (Aouizerate et al 2005). Indeed many national guidelines for the management of anxiety disorders recommend the use of SSRIs as first-line treatment (Baldwin et al 2005; CADTGI 2007).