These patients may also suffer from agoraphobia as a result of their fear of places and situations from which they cannot escape in the event of a panic attack. Patients with panic disorder regularly experience acute episodes of intense fear and discomfort that are associated with symptoms of autonomic arousal, such as tachycardia, sweating, dizziness, shortness of breath, and chest pain. Some anxiety disorders occur when anxiety is experienced during discrete periods (e.g., panic disorder) or in specific situations (e.g., social phobia). With the exception of OCD, anxiety disorders generally occur more frequently in women than in men and usually have their first onset during adolescence or young adulthood. 5 Other less common anxiety disorders include obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and acute stress disorder. Panic disorder had a lifetime prevalence of 3.5%. Simple phobias were next, at 11.3%, and generalized anxiety disorder (GAD) followed with a lifetime prevalence of 5.1% and a 1-year prevalence of 3.1%. 5 found that social phobia was the most common type of anxiety disorder, with a lifetime prevalence of 13.3%. In the early 1990s, the National Comorbidity Survey 5 indicated that the 1-year prevalence of all anxiety disorders in the general population was 17.2%, and the lifetime prevalence was 24.9%. These disorders are very common in patients seen by primary care physicians. Toward this end, this article reviews these clinical disorders and summarizes current information on the drug therapies available to treat them.Īll of the different types of recognized anxiety disorders are characterized by the presence of clinically significant degrees of chronic anxiety. Now more than ever, new, more user-friendly pharmacologic options demonstrate robust efficacy simplified treatment with monotherapy can provide the necessary tools to manage anxiety and depression in the primary care setting both efficaciously and cost effectively. As a result, it is crucial for the generalist physician to be well versed in recognizing and managing such cases. 3Īnxiety and depression are often manifested initially as physical ailments rather than the classic symptom of altered mood thus, it is not surprising that many of these patients turn to their primary care physicians for care. Furthermore, increased health care resource utilization and decreased productivity are more significant in patients with comorbid anxiety and depression. For example, according to the National Comorbidity Survey, 4 58% of those with lifetime depression were also observed to have at least one anxiety disorder. Their diagnosis and management are complicated by the considerable overlap of symptomatology. 1, 3 Despite the availability of proven treatments, both disorders remain underrecognized and undertreated. 1, 2 In addition, these disorders are associated with significant decreases in patient well-being and social functioning and can cause considerable pain and suffering, not only for affected individuals but for their family and friends as well. Characteristics such as robust efficacy, speed of onset of activity, the potential for drug-drug interactions, dose response, and tolerability are important considerations in optimizing treatment.Īnxiety and depression are significant public health problems, affecting a wide segment of the general population and accounting for multibillion-dollar expenditures directly related to health care and hospitalizations and indirectly related to morbidity and mortality. The specific profiles of individual agents may assist the clinician in individualizing treatment. Of the newer agents, the selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors have been studied quite extensively in these patient populations. These new choices enable our goal of treatment to encompass not only improvement but also sustained complete remission. The newer antidepressants, in particular, are playing an increasingly important role in the treatment of both anxiety disorders alone and comorbid anxiety and depression. Fortunately, many new therapies are available to assist the clinician in managing these patients. Comorbid anxiety and depression is often more resistant to pharmacologic treatment, and patients with coexisting disorders have a poorer medical prognosis than do patients with either disorder alone. In addition, there is significant overlap between anxiety and depression in this patient population. Patients often present with somatic complaints rather than classic psychiatric symptoms. Properly diagnosing and treating patients with anxiety, depression, or both is a challenging aspect of practicing medicine in the primary care setting.
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