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Anxiety disorders are some of the most common mental health conditions seen in primary care, with generalized anxiety disorder (GAD) and panic disorder (PD) being the most common anxiety disorders in adults. 1 Patients with anxiety disorders are more likely than those unaffected to also have other chronic medical problems and are twice as likely to present with somatic symptoms. 2 Integrating mental health services with primary care decreases treatment costs and increases access to care. 3 This article summarizes the diagnosis and management of GAD and PD in the general adult population.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
| There is insufficient evidence supporting universal screening for GAD in the general adult population. 10–12 | C | Systematic review, NICE guidelines, and USPSTF recommendation evaluating accuracy of tools but not on improving patient outcomes when used for screening |
| SSRIs and SNRIs are recommended as first-line medications for treating GAD and PD. 12,37,38,45 | A | Systematic review data and NICE guideline |
| Antidepressants should be continued for at least six to 12 months after achieving treatment response to decrease the rate of relapse. 12,34,35 | B | Systematic review of double-blind RCTs, review article, and guideline |
| Benzodiazepines are not more effective than anti-depressants for anxiety disorders and should not be used as first-line therapy. 12,37 | B | Systematic review data and NICE guidelines |
| Psychotherapy can be as effective as medication for GAD and PD; for PD, evidence of benefit is strongest for cognitive behavior therapy. 12,26,52,53 | A | Systematic review data and NICE guideline |
| Physical activity reduces symptoms of anxiety. 60–63 | B | Systematic review of low- to moderate-quality RCTs and low-quality RCTs |
GAD = generalized anxiety disorder; NICE = National Institute for Health and Care Excellence; PD = panic disorder; RCT = randomized controlled trial; SNRI = serotonin-norepinephrine reuptake inhibitor; SSRI = selective serotonin reuptake inhibitor; USPSTF = U.S. Preventive Services Task Force.
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
Typical Presentation and Diagnostic Criteria
GENERALIZED ANXIETY DISORDER
GAD is defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) as excessive worry that occurs on most...