title: Diagnosis and management of generalized anxiety disorder and panic disorder in adults.
abstract: Generalized anxiety disorder (GAD) and panic disorder (PD) are among the most common mental disorders in the United States, and they can negatively impact a patient's quality of life and disrupt important activities of daily living. Evidence suggests that the rates of missed diagnoses and misdiagnosis of GAD and PD are high, with symptoms often ascribed to physical causes. Diagnosing GAD and PD requires a broad differential and caution to identify confounding variables and comorbid conditions. Screening and monitoring tools can be used to help make the diagnosis and monitor response to therapy. The GAD-7 and the Severity Measure for Panic Disorder are free diagnostic tools. Successful outcomes may require a combination of treatment modalities tailored to the individual patient. Treatment often includes medications such as selective serotonin reuptake inhibitors and/or psychotherapy, both of which are highly effective. Among psychotherapeutic treatments, cognitive behavior therapy has been studied widely and has an extensive evidence base. Benzodiazepines are effective in reducing anxiety symptoms, but their use is limited by risk of abuse and adverse effect profiles. Physical activity can reduce symptoms of GAD and PD. A number of complementary and alternative treatments are often used; however, evidence is limited for most. Several common botanicals and supplements can potentiate serotonin syndrome when used in combination with antidepressants. Medication should be continued for 12 months before tapering to prevent relapse.
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Amy B
authors.initials: AB
authors.lastname: Locke
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Nell
authors.initials: N
authors.lastname: Kirst
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Cameron G
authors.initials: CG
authors.lastname: Shultz
mesh_terms: D000328:Adult; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D015897:Comorbidity; D003937:Diagnosis, Differential; D019587:Dietary Supplements; D006801:Humans; D008019:Life Style; D016584:Panic Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D010353:Patient Education as Topic; D008517:Phytotherapy; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D012017:Referral and Consultation; D012064:Relaxation Therapy; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors