Vol 5 n° 3 - Anxiety II
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Anxiety disorders nxiety is a universal response to threatening or frightening situations.Those individuals who present with more pronounced or persistent symptomatology, or with- out any reasonable context, may in fact meet the diagnos- tic criteria for an anxiety disorder. Such disorders include generalized anxiety disorder (GAD) and panic disorder (PD), as well as obsessive compulsive disorder (OCD), social anxiety disorder, posttraumatic stress disorder, pho- bias, and a number of other diagnoses.1 Universal estimates of prevalence are difficult to obtain, but among US resi- dents age 18 to 54, the National Institute of Mental Health reports that 19 million Americans (approximately 13%) have anxiety disorders.2 In the case of GAD,for which diag- nostic criteria were first introduced in the Diagnostic and Statistical  Manual  of  Mental  Disorders, Third  Edition3 (DSM-III)  and  later  also  added  to  the  International Classification of Mental and Behavioral Disorders4 (ICD- 10), there has been some question as to whether this is indeed  a  separate  disorder  or  part  of  a  continuum  of another disorder, such as depression.5 Investiga-tions sug- gest that GAD is a distinct and common disorder,5,6 with lifetime prevalences reported up to 7%.7-11 PD and the other diagnoses appear less common.8 Some data indicate that anxiety disorders result in more occupational disability and cost society more than affective disorders or schizophrenia, and yet are vastly undertreated.12 Estimates suggest that both psychiatrists and primary care physicians encounter GAD and other anxiety disorders frequently.13-15 Making an accurate diagnosis can be difficult—particularly in primary care settings—because of time constraints on patient con- tact and the fact that patients often present with physical rather than psychological or emotional complaints. After the diagnosis of any anxiety disorder has been estab- lished, treatment of patients with either acute or chronic P h a r m a c o l o g i c a l   a s p e c t s 2 3 7 Medication dependence and anxiety Lisa L. von Moltke, MD; David J. Greenblatt, MD A Anxiety disorders are common and costly psychiatric ill- nesses. Pharmacological treatment was enhanced with the introduction of benzodiazepines, which proved safer and more effective than older drugs. The risk of dependence, however, has made clinicians reluctant to use these med- ications. In fact, few patients appear to develop signifi- cant difficulties with these drugs, given how widely they are used. Careful planning for discontinuation of therapy is  important.  In  addition,  for  some  individuals,  there appears to be a complex and as yet unelucidated rela- tionship between dependence on drugs or alcohol and anxiety. The newer antidepressants offer efficacy without abuse or dependence liability, but are expensive and have side  effects  that  are  intolerable  for  some  patients. Pharmacological therapy for anxiety should be prescribed and managed so as to minimize any existing risk, while aiming to restore the patient to wellness in terms of symp- toms and function. © 2003, LLS SAS Dialogues Clin Neurosci. 2003;5:237-245. Keywords: anxiety; dependence; benzodiazepine; selective serotonin reuptake inhibitor; discontinuation Author   affiliations:   Department   of   Pharmacology   and Experimental Therapeutics,  Tufts  University  School  of  Medicine  and  Tufts–New  England Medical Center, Boston, Mass, USA Address  for  correspondence: Lisa L. von Moltke,   MD, Department of Pharmacology  and  Experimental  Therapeutics,  Tufts  University  School  of Medicine, 136 Harrison Avenue, Boston, MA 02141, USA (e-mail: lisa.vonmoltke@tufts.edu) Copyright © 2003 LLS SAS.  All rights reserved www.dialogues-cns.org