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Dtsch Arztebl Int. 2013 Apr;110(17):300-9; quiz 310. doi: 10.3238/arztebl.2013.0300. Epub 2013 Apr 26.

The diagnosis and treatment of generalized anxiety disorder.

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Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany.



Generalized anxiety disorder (GAD) is a common and serious disease with a lifetime prevalence of 4.3% to 5.9%. It is underdiagnosed in primary care.


Recommendations on the treatment of GAD are given on the basis of all available findings from pertinent randomized trials, retrieved by a selective search of the literature.


Among psychotherapeutic techniques, various kinds of cognitive behavioral therapy (CBT) have been found useful in controlled trials. The drugs of first choice include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephine reuptake inhibitors (SNRIs), and the calcium-channel modulator pregabalin. Tricyclic antidepressants are also effective but have more adverse effects than SSRIs. Although benzodiazepines are effective anxiolytic agents for short-term use, they should not be given over the long term because of the danger of addiction. Buspirone, an azapirone, was found to be effective in a small number of trials, but the findings across trials are inconsistent. The response rate of GAD to CBT in published studies lies between 47% and 75%, while its response rate to drug treatment lies between 44% and 81%.


The treatment of GAD with CBT and drugs is evidence-based and has a good chance of improving the manifestations of the disorder.

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