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Anxiety disorders are common psychiatric
disorders. Despite their high prevalence rates however, they are
often under-recognised and undertreated.
One major controversy surrounding the topic is whether anxiety
disorders and depressive disorders can be reliably distinguished,
or if they lie on a single continuum of affective disorders.
Historically, they were thought to be more similar than different
and the current classificatory systems also reflect this view.
Empirical observations have yielded rates of lifetime and
12-month comorbidity between each anxiety disorder and major
depression that range from 10% to 30%: when one considers the
comorbidity between depression and any of the anxiety disorders,
rates of comorbidity exceed 50%.
The lack of discontinuity between anxiety
disorders and depressive illness has led some critics to conclude
that pharmacotherapy for anxiety is efficacious only in the
presence of co-existing depressive illness. However, this is not
so. One non-systematic review of epidemiological and clinical
studies found a marked reduction in the quality of life and
psychosocial functioning of people with anxiety disorders. It
also found that people with generalised anxiety disorder (GAD) had
low overall life satisfaction and some impairment in ability to
fulfil roles, social tasks, or both.
It is very important that these disorders are
clearly diagnosed and appropriately treated in accordance with the
latest, critically appraised evidence for management that is
currently available.
This module concerns the practical
pharmacotherapy of the primary anxiety disorders of generalised
anxiety, panic and generalised social phobia. The focus will be on
the efficacy, and, to a lesser extent effectiveness of treatment
(evidence about the cost effectiveness of drug treatment, in
particular comparison with non-drug treatments, is only now
becoming available).
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