Highlights
- •Anxiety disorders are the most common diagnoses in psychiatry.
- •Most individuals with anxiety, especially excessive fear and worry, will present to their primary care provider first.
- •The patient’s chief concerns are often not indicative of an underlying anxiety disorder.
- •Primary care providers should know effective ways to screen for, diagnose, and treat anxiety disorders to reduce illness burden on patients.
- •Guide to nonpharmacologic and pharmacologic treatment of anxiety disorders is presented.
Abstract
Anxiety disorders are among the most common psychiatric diagnoses and present in patients
as excessive fear and worry. Many seeking care for symptoms of anxiety disorders have
a chief concern other than anxiety. Because most individuals first seek treatment
for anxiety disorders in primary care, it is important to screen, assess, diagnose,
and potentially initiate treatment for them in these settings. If left untreated,
anxiety disorders can cause significant personal, social, and occupational impairment.
Elevated anxiety levels can lead to a fight-or-flight fear response. Evidence-based
treatment options are available in both primary care and specialty clinic settings.
Keywords
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References
- Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection.Ann Intern Med. 2007; 146: 317-325https://doi.org/10.7326/0003-4819-146-5-200703060-00004
- Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder.Aust N Z J Psychiatry. 2018; 52: 1109-1172
- Anxiety disorders in primary care.Med Clin North Am. 2014; 98: 1007-1023https://doi.org/10.1016/j.mcna.2014.06.003
- Managing Generalized Anxiety Disorder in Primary Care.J Nurse Pract. 2012; 8: 268-274
- The treatment of patients with medically unexplained symptoms in primary care: a review of the literature.Ment Health Fam Med. 2010; 7: 209-221
- Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.Arch Gen Psychiatry. 2005; 62 ([published correction appears in Arch Gen Psychiatry. 2005;62(7):768]): 593-602https://doi.org/10.1001/archpsyc.62.6.593
- The age of onset of anxiety disorders.Can J Psychiatry. 2017; 62: 237-246https://doi.org/10.1177/0706743716640757
- Severity of anxiety and work-related outcomes of patients with anxiety disorders.Depress Anxiety. 2009; 26: 1165-1171https://doi.org/10.1002/da.20624
- Quality of life in the anxiety disorders: a meta-analytic review.Clin Psychol Rev. 2007; 27: 572-581https://doi.org/10.1016/j.cpr.2007.01.015
- Suicide risk in patients with anxiety disorders: a meta-analysis of the FDA database.J Affect Disord. 2002; 68: 183-190https://doi.org/10.1016/s0165-0327(01)00354-8
- A systematic review of reviews on the prevalence of anxiety disorders in adult populations.Brain Behav. 2016; 6e00497https://doi.org/10.1002/brb3.497
- Physicians’ influence on primary care patients’ reluctance to use mental health treatment.Psychiatr Serv. 2014; 65: 541-545https://doi.org/10.1176/appi.ps.201300064
- Obesity and anxiety symptoms: a systematic review and meta-analysis [Adipositas und Angstsymptome: systematische Review und Metaanalyse].Neuropsychiatr. 2019; 33: 72-89https://doi.org/10.1007/s40211-019-0302-9
- Anxiety and diabetes: Innovative approaches to management in primary care.Exp Biol Med (Maywood). 2016; 241: 1724-1731https://doi.org/10.1177/1535370216657613
- Anxiety disorders in primary care settings.Nurs Clin North Am. 2019; 54: 473-493https://doi.org/10.1016/j.cnur.2019.07.002
- Screening assessment for anxiety and depression in primary care.J Nurse Pract. 2012; 8: 475-481
- A brief measure for assessing generalized anxiety disorder: the GAD-7.Arch Intern Med. 2006; 166: 1092-1097https://doi.org/10.1001/archinte.166.10.1092
- Diagnostic and Statistical Manual of Mental Disorders.5th ed. DSM-V. American Psychiatric Association, 2013
- The Psychiatric Interview.Wolters Kluwer, 2017
- Social anxiety disorder.N Engl J Med. 2017; 376: 2255-2264https://doi.org/10.1056/NEJMcp1614701
- Treatment of anxiety disorders.Dialogues Clin Neurosci. 2017; 19: 93-107
- Rates of detection of mood and anxiety disorders in primary care: a descriptive, cross-sectional study.Prim Care Companion CNS Disord. 2011; 13 (PCC.10m01013)https://doi.org/10.4088/PCC.10m01013
- Generalized anxiety and depression in primary care: prevalence, recognition, and management.J Clin Psychiatry. 2002; 63: 24-34
- Modulation of anxiety and fear via distinct intrahippocampal circuits.Elife. 2016; 5e14120https://doi.org/10.7554/eLife.14120
- Neuronal circuits for fear and anxiety.Nat Rev Neurosci. 2015; 16 ([published correction appears in Nat Rev Neurosci. 2015;16(7):439]): 317-331https://doi.org/10.1038/nrn3945
- Fear Generalization and anxiety: behavioral and neural mechanisms.Biol Psychiatry. 2015; 78: 336-343https://doi.org/10.1016/j.biopsych.2015.04.010
- Anxiety and cognitive performance: attentional control theory.Emotion. 2007; 7: 336-353https://doi.org/10.1037/1528-3542.7.2.336
- Generalized anxiety disorder.Handb Clin Neurol. 2012; 106: 343-362https://doi.org/10.1016/B978-0-444-52002-9.00019-X
- Panic disorder.Curr Psychiatry Rep. 2001; 3: 295-301https://doi.org/10.1007/s11920-001-0022-1
- Panic disorder.Handb Clin Neurol. 2012; 106: 363-374https://doi.org/10.1016/B978-0-444-52002-9.00020-6
- Panic disorder.Lancet. 2006; 368: 1023-1032https://doi.org/10.1016/S0140-6736(06)69418-X
- Panic symptoms and elevated suicidal ideation and behaviors among trauma exposed individuals: moderating effects of post-traumatic stress disorder.Compr Psychiatry. 2015; 61: 42-48https://doi.org/10.1016/j.comppsych.2015.05.006
- Delivery of evidence-based treatment for multiple anxiety disorders in primary care: a randomized controlled trial.JAMA. 2010; 303: 1921-1928https://doi.org/10.1001/jama.2010.608
- Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample.J Abnorm Psychol. 2001; 110: 585-599https://doi.org/10.1037//0021-843x.110.4.585
- DSM-IV generalized anxiety disorder in the Australian National Survey of Mental Health and Well-Being.J Abnorm Psychol. 2002; 32: 649-659https://doi.org/10.1017/s0033291702005512
- Co-occurrence of 12-month mood and anxiety disorders and personality disorders in the US: results from the national epidemiologic survey on alcohol and related conditions.J Psychiatr Res. 2005; 39: 1-9https://doi.org/10.1016/j.jpsychires.2004.05.004
- Diagnosis and management of generalized anxiety disorder and panic disorder in adults.Am Fam Physician. 2015; 91: 617-624
- The German guidelines for the treatment of anxiety disorders.Eur Arch Psychiatry Clin Neurosci. 2015; 265: 363-373https://doi.org/10.1007/s00406-014-0563-z
- Epidemiology of anxiety disorders in the 21st century.Dialogues Clin Neurosci. 2015; 17: 327-335
- Cognitive behavioral therapy for anxiety and related disorders: a meta-analysis of randomized placebo-controlled trials.Depress Anxiety. 2018; 35: 502-514https://doi.org/10.1002/da.22728
- Interpersonal problems and the outcome of interpersonal-psychodynamic treatment of generalized anxiety disorder.Psychotherapy. 2005; 42: 211-224https://doi.org/10.1037/0033-3204.42.2.211
- A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder.Am J Psychiatry. 2007; 164 ([published corrections appear in Am J Psychiatry. 2007;64(7):1123 and 2007;164(3):529]): 265-272https://doi.org/10.1176/ajp.2007.164.2.265
- Psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder: a multicenter randomized controlled trial.Am J Psychiatry. 2013; 170 ([published correction appears in Am J Psychiatry. 2013;170(11):1373]): 759-767https://doi.org/10.1176/appi.ajp.2013.12081125
- Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: effects on anxiety and stress reactivity.J Clin Psychiatry. 2013; 74: 786-792https://doi.org/10.4088/JCP.12m08083
- Internet-delivered acceptance-based behaviour therapy for generalized anxiety disorder: a randomized controlled trial.Behav Res Ther. 2016; 77: 86-95https://doi.org/10.1016/j.brat.2015.12.007
- Randomized clinical trial of adapted mindfulness-based stress reduction versus group cognitive behavioral therapy for heterogeneous anxiety disorders.Behav Res Ther. 2013; 51: 185-196https://doi.org/10.1016/j.brat.2013.01.003
- Treating treatment-resistant patients with panic disorder and agoraphobia using psychotherapy: a randomized controlled switching trial.Psychother Psychosom. 2015; 84: 100-109https://doi.org/10.1159/000370162
- Nonpharmacological alternatives to benzodiazepine drugs for the treatment of anxiety in outpatient populations: a literature review.J Psychosoc Nurs Ment Health Serv. 2016; 54: 35-42
- Revise the revised? New dimensions of the neuroanatomical hypothesis of panic disorder.J Neural Transm (Vienna). 2013; 120: 3-29https://doi.org/10.1007/s00702-012-0811-1
- Guidelines for the pharmacological treatment of anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder in primary care.Int J Psychiatry Clin Pract. 2012; 16 ([published corrections appear in Int J Psychiatry Clin Pract. 2012;16(3):242 and in 2013;17(1):76]): 77-84https://doi.org/10.3109/13651501.2012.667114
- Psychiatrists’ treatment preferences for generalized anxiety disorder.Hum Psychopharmacol. 2018; 33: e2643https://doi.org/10.1002/hup.2643
- Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology.J Psychopharmacol. 2014; 28: 403-439https://doi.org/10.1177/0269881114525674
- Medication Fact Book for Psychiatric Practice.Fifth ed. Carlat Publishing, LLC, 2020
- Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders.BMC Psychiatry. 2014; 14: S1https://doi.org/10.1186/1471-244X-14-S1-S1
- Mania associated with antidepressant treatment: comprehensive meta-analytic review.Acta Psychiatr Scand. 2010; 121: 404-414https://doi.org/10.1111/j.1600-0447.2009.01514.x
- Do antidepressants increase the risk of mania and bipolar disorder in people with depression? A retrospective electronic case register cohort study.BMJ Open. 2015; 5e008341https://doi.org/10.1136/bmjopen-2015-008341
- A review of antidepressant-induced hypomania in major depression: suggestions for DSM-V.Bipolar Disord. 2004; 6: 32-42https://doi.org/10.1046/j.1399-5618.2003.00084.x
- Efficacy of treatments for anxiety disorders: a meta-analysis.Int Clin Psychopharmacol. 2015; 30: 183-192https://doi.org/10.1097/YIC.0000000000000078
- SSRI antidepressant medications: adverse effects and tolerability.Prim Care Companion J Clin Psychiatry. 2001; 3: 22-27https://doi.org/10.4088/pcc.v03n0105
- SSRI adverse events: how to monitor and manage.Int Rev Psychiatry. 2008; 20: 203-208https://doi.org/10.1080/09540260801889211
- Side effects of antidepressants during long-term use in a naturalistic setting.Eur Neuropsychopharmacol. 2013; 23: 1443-1451https://doi.org/10.1016/j.euroneuro.2013.05.001
- SSRI efficacy-finding the right dose.J Psychiatr Pract. 2002; 8: 33-40https://doi.org/10.1097/00131746-200201000-00005
- Management of treatment-resistant panic disorder.Psychiatry (Edgmont). 2007; 4: 48-59
- Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions: a narrative literature review.Ment Health Clin. 2016; 6: 191-196https://doi.org/10.9740/mhc.2016.07.191
- A meta-analysis of effects of selective serotonin reuptake inhibitors on blood pressure in depression treatment: outcomes from placebo and serotonin and noradrenaline reuptake inhibitor controlled trials.Neuropsychiatr Dis Treat. 2017; 13: 2781-2796https://doi.org/10.2147/NDT.S141832
- The Psychopharmacology Algorithm Project at the Harvard South Shore Program: an algorithm for generalized anxiety disorder.Harv Rev Psychiatry. 2016; 24: 243-256https://doi.org/10.1097/HRP.0000000000000098
- Treatment of generalized anxiety disorder: a comprehensive review of the literature for psychopharmacologic alternatives to newer antidepressants and benzodiazepines.Prim Care Companion CNS Disord. 2011; 13 (PCC.08r00709)https://doi.org/10.4088/pcc.08r00709blu
- Drug-induced QT interval prolongation: mechanisms and clinical management.Ther Adv Drug Saf. 2012; 3: 241-253https://doi.org/10.1177/2042098612454283
- Oral erythromycin and the risk of sudden death from cardiac causes.N Engl J Med. 2004; 351: 1089-1096https://doi.org/10.1056/NEJMoa040582
- Suicide and antidepressants.Ann N Y Acad Sci. 1997; 836: 329-338https://doi.org/10.1111/j.1749-6632.1997.tb52368.x
- “Torsione di punta” da antidepressivi triciclici. Descrizione di un caso clinico [Torsade de pointes caused by tricyclic antidepressive agents. Description of a clinical case].G Ital Cardiol. 1986; 16: 1058-1061
- Patterns of benzodiazepines use in primary care adults with anxiety disorders.Heliyon. 2018; 4e00688https://doi.org/10.1016/j.heliyon.2018.e00688
- Benzodiazepines revisited—will we ever learn?.Addiction. 2011; 106: 2086-2109https://doi.org/10.1111/j.1360-0443.2011.03563.x
- Refractory generalized anxiety disorder.J Clin Psychiatry. 2009; 70: 32-38https://doi.org/10.4088/jcp.s.7002.06
- Benzodiazepine withdrawal seizures and management.J Okla State Med Assoc. 2011; 104: 62-65
- Depression and anxiety.Med J Aust. 2013; 199: S28-S31
- Association between benzodiazepine use and dementia: a meta-analysis.PLoS One. 2015; 10e0127836https://doi.org/10.1371/journal.pone.0127836
- A pharmacist-physician collaboration to optimize benzodiazepine use for anxiety and sleep symptom control in primary care.J Pharm Pract. 2017; 30: 425-433https://doi.org/10.1177/0897190016660435
- Bon usage des traitements médicamenteux dans les troubles anxieux [Drug treatment of anxiety disorders].Rev Prat. 2019; 69: 981-984
- Gabapentin and pregabalin for the treatment of anxiety disorders.Clin Pharmacol Drug Dev. 2018; 7: 228-232https://doi.org/10.1002/cpdd.446
- Pregabalin for generalized anxiety disorder: an updated systematic review and meta-analysis.Int Clin Psychopharmacol. 2017; 32: 49-55https://doi.org/10.1097/YIC.0000000000000147
- Abuse and misuse of pregabalin and gabapentin.Drugs. 2017; 77: 403-426https://doi.org/10.1007/s40265-017-0700-x
- Azapirones for generalized anxiety disorder.Cochrane Database Syst Rev. 2006; 3: CD006115https://doi.org/10.1002/14651858.CD006115
- Buspirone: back to the future.J Psychosoc Nurs Ment Health Serv. 2015; 53: 21-24https://doi.org/10.3928/02793695-20151022-01
Wilson TK, Tripp J. Buspirone. In: StatPearls. StatPearls Publishing; 2020.
- Proximal psychiatric risk factors for suicidality in youth: the Great Smoky Mountains Study.Arch Gen Psychiatry. 2006; 63: 1017-1024https://doi.org/10.1001/archpsyc.63.9.1017
- Psychiatric impairment among adolescents engaging in different types of deliberate self-harm.J Clin Child Adolesc Psychol. 2008; 37: 363-375https://doi.org/10.1080/15374410801955771
- Use of antidepressants during pregnancy?: What to consider when weighing treatment with antidepressants against untreated depression.Matern Child Health J. 2016; 20: 2268-2279https://doi.org/10.1007/s10995-016-2038-5
- Psychotropics in pregnancy: safety and other considerations.Pharmacol Ther. 2012; 135: 71-77https://doi.org/10.1016/j.pharmthera.2012.03.008
Biography
Anand Brahmbhatt, MSN, RN is at Vanderbilt University, Nashville, TN and can be contacted at [email protected]
Biography
Luann Richardson, PhD, FNP, PMHNP, is a professor at Robert Morris University School of Nursing, Moon Township, Pennsylvania.
Biography
Sejal Prajapati, PsyD is a consultant.
Article info
Publication history
Published online: December 10, 2020
Footnotes
In compliance with national ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
