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Long term therapy of generalized anxiety disorder

Published online by Cambridge University Press:  16 April 2020

Frédéric Rouillon
Frédéric Rouillon*
Affiliation:
Psychiatry Department, Hospital Albert Chenevier, 40, rue de Mesly, 94010 Creteil, France
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Abstract

Generalized anxiety disorder (GAD) is a common (lifetime prevalence: 5.1%), recurrent condition, which often heralds other psychiatric disorders, notably depression. As by definition it is a disorder progressing over months, treatment should be designed on a long term basis. And yet, few studies have been conducted beyond the classical 6–8 weeks characterizing the acute treatment phase. This is especially true of anxiolytics, but also of antidepressants, with the exception of paroxetine and venlafaxine, which are the only drugs approved in this indication in Western countries. The efficacy of psychotherapy, notably relaxation and cognitive-behavioral therapy, is established in the treatment of GAD, but its preferred indications and possible combination with antidepressants are still to be specified. Long term, not to say very long term studies of GAD, as well as depression, will still be required in the future to improve its management and specify therapeutic modalities (combination treatment, optimal duration, continuous or intermittent therapy, choice of psychotherapeutic techniques or agents, …). Early and adequately prolonged treatment should not only result in more numerous remission periods, but also in decreased frequency of co-morbidities whether depressive, addictive, or of another nature, and should also reduce the social impact of GAD.

Keywords

GADPharmacotherapyPsychosocial treatmentLong term
Type
Original article
Information
European Psychiatry , Volume 19 , Issue 2 , April 2004 , pp. 96 - 101
Copyright
Copyright © 2004 European Psychiatric Association

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References

Allgulander, CHackett, DSalinas, EVenlafaxine extended-release (ER) in the treatment of generalized anxiety disorder. Twenty-four week placebo controlled dose ranging study. Brit J Psychiatry 2001; 179:15–22.Google Scholar
Allgulander, CHirschfeld, RMNutt, DJLong-term treatment strategies in anxiety disorders. Psychopharmacol Bull 2002;36(Suppl 2):79–92.Google ScholarPubMed
Ballenger, JCClinical guideslines for establishing remission in patients with depresssion and anxiety. J Clin Psychiatry 1999; 60(Suppl 22):29–34.Google Scholar
Ballenger, JCDavidson, JRLecrubier, YNutt, DJBorkovec, TDRickels, Ket al.Consensus statement on generalized anxiety disorder from the International Consensus Group on Depression andAnxiety. J Clin Psychiatry 2001;62(Suppl 11):53–8.Google Scholar
Barlow, DHAnxiety and its disorders. New York: Guiford Press; 1988.Google Scholar
Barlow, DHCohen, ASWaddell, MTVermilyea, BBKosco, JSBlanchard, EBet al.Panic and generalized anxiety disorders: nature and treatment. Behav Ther 1984;15:431–49.CrossRefGoogle Scholar
Barlow, DHRapee, RBrown, TABehavioral treatment of generalized anxiety disorder. Behav Ther 1992;23:551–70.CrossRefGoogle Scholar
Beck, ATHemery, GAnxiety disorders and phobias: a cognitive perspective. New York:Basic Books; 1985.Google Scholar
Blowers, CCobb, JMathews, AGeneralized anxiety: a controlled treatment study. Behav Res Ther 1987;25(6):493–502.CrossRefGoogle Scholar
Borison, RLAlbrecht, JWDiamond, BIEfficacy and safety of a putative anxiolytic agent: ipsapirone. Psychopharmacol Bull 1990;26: 207–10.Google ScholarPubMed
Borkovec, TDCostello, EEfficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. J Consult Clin Psychol 1993;61(4):611–9.CrossRefGoogle ScholarPubMed
Borkovec, TDMathews, AMTreatment of nonphobic anxiety disorders: a comparison of nondirective cognitive and desensitization therapy. J Consult Clin Psychol 1988;56(6):877–84.CrossRefGoogle ScholarPubMed
Borkovec, TDMathews, AMChambers, AEbrahimi, SLytle, RNelson, RThe effects of relaxation training with cognitive or nondi-rective therapy and the role of relaxation-induced anxiety in the treatment of anxiety generalized anxiety. J Consult Clin Psychol 1987;55:833–83.CrossRefGoogle ScholarPubMed
Borkovec, TDWhisman, MPsychosocial treatment for GAD. In: Mavissakalian, MPrien, RFeditors. Long-term treatment for anxiety disorders. Washington (DC): American Psychiatric Press; 1996. p. 171–99.Google Scholar
Borkovec, TDRuscio, AMPsychotherapy for generalized anxiety disorder. J Clin Psychiatry 2001;62(Suppl 11):43–5.Google ScholarPubMed
Boyer, PMahé, VHackett, Det al.Efficacy of venlafaxine ER in social adjustment in patients with GAD.Presented at the 13th Annual Meeting of the ECNP Congress, Munich, 9–13 September 2000. 2000.Google Scholar
Boyer, WFFeighner, JPA placebo controlled double blind multicenter trial of two doses of ipsapirone versus diazepam in generalized anxiety disorders. Int Clin Psychopharmacol 1993;8:173–6.Google Scholar
Buttler, GCullington, AHibert, GKlimes, IGelder, MAnxiety managment for persistent generalized anxiety. Brit J Psychiatry 1987; 151:535–42.CrossRefGoogle Scholar
Butler, GFennel, MRobson, PGelder, MComparison of behaviour therapy in the treatment of generalized anxiety disorder. J Consult Clin Psychol 1991;59(1):167–75.Google ScholarPubMed
Cohn, JBWilcox, CSLong-term comparison of alprazolam, lorazepam and placebo in patients with anxiety disorder. Psychophar-macotherapy 1984;4:93–8.Google ScholarPubMed
Cutler, NRSramek, JJHesselink JMK, Krol, ARoeschen, JRick-els, Ket al.A double blind, placebo controlled study comparing the efficacy and safety of ipsapirone versus lorazepam in patients with generalized anxiety disorder: a prospective multicenter trial. J Clin Psychopharmacol 1993;13:429–37.CrossRefGoogle ScholarPubMed
Davidson, JRTDupont, RLHedges, DHaskins, JTEfficacy, safety and tolerability of venlafaxine extended release and buspirone in outpatients with generalized anxiety disorder. J Clin Psychiatry 1999; 60:528–35.CrossRefGoogle ScholarPubMed
Dugas, MJLa Douceur, RTreatment of GAD targeting intolerance of uncertainty in two types of worry. Behav Modif 2000;24:635–7.CrossRefGoogle Scholar
Durham, RCChambers, JAMcDonald, RRPower, KGMajor, KDoes cognitive-behavioral therapy influence the long-term outcome of generalized anxiety disorder? An 18–14 years follow-up of two clinical trials. Psychol Med 2003;33:499–509.CrossRefGoogle Scholar
Durham, RLMurphy, TAllan, TRichard, KTreliving, LRFen- ton, GWCognitive therapy, analytic psychotherapy and anxiety management training for generalized anxiety disorder. Brit J Psychiatry 1994;165:315–23.Google Scholar
Enkelmann, RAlprazolam versus buspirone in the treatment of outpatients with generalized anxiety disorder. Psychopharmacology 1991;105:428–32.CrossRefGoogle ScholarPubMed
Feighner, JBBuspirone in the long-term treatment of generalized anxiety disorder. J Clin Psychiatry 1987;48(Suppl 12):3–6.Google ScholarPubMed
Feighner, JBCohn, JBAnalysis of individual symptoms in generalized anxiety: a pooled multistudy double blind evaluation of bus-pirone. Neuropsychobiology 1989;21:124–30.CrossRefGoogle Scholar
Ferreri, MHantouche, EBillardon, MAdvantages of hydroxyzine in generalized anxiety disorder: a double blind controlled versus placebo study. L’Encéphale 1994;20:785–91.Google Scholar
Figueira, MLAlprazolam ER in the treatment of generalized anxiety: a multicentre controlled study with bromazepam. Hum Psychophar-macol Clin Exp 1999;14:171–7.3.0.CO;2-7>CrossRefGoogle Scholar
Fisher, PLDurham, RCRecovery rates in generalized anxiety disorder following psychological therapy: an analysis of clinically significant change in the STAI-T across outcome studies since 1990. Psychol Med 1999;29:1425–34.CrossRefGoogle ScholarPubMed
Floyd, MMcKendree- Smith, NStump, JScogin, FBowman, DTwo-year follow-up of self examination therapy for generalized anxiety disorder. J Anxiety Disord 2002;16(4):369–75.CrossRefGoogle ScholarPubMed
Gelenberg, AJLydiard, RBRudolph, RLAguiar, LHaskins, JTSalinas, EEfficacy of venlafaxine extended-release capsules in non depressed outpatients with generalized anxiety disorder. A 6 month randomized controlled trial. JAMA 2000;283:3082–8.Google Scholar
Goisman, RMWarsham, MGKeller, MBPsychosocial treatment prescriptions for generalized anxiety disorder panic disorder and social phobia 1991–1996. Am J Psychiatry 1999;156(11):1819–21.Google ScholarPubMed
Hedges, DWReimherr, FWStrong, REHalls, CHRust, CAn open trial of nefazodone in adult patients with GAD. Psychopharmacol Bull 1996;32:671–6.Google Scholar
Hoehn-Saric, RMc Leod, DRZimmerli, WDDifferential effects of alprazolam and imipramine in generalized anxiety disorder: somatic versus psychic symptoms. J Clin Psychiatry 1988;49:293–301.Google ScholarPubMed
Kahn, RJMc Nair, DMLipman, RSCovi, LRickels, KDowning, Ret al.Imipramine and chlordiazepoxide in depressive and anxiety disorders II: efficacy in anxious outpatients. Arch Gen Psychiatry 1986;43:79–85.CrossRefGoogle ScholarPubMed
Katz, IRReynolds CFI, Alexopoulos, GSHackett, DVenlafaxine (ER) as a treatment for generalized anxiety disorder in older adults: a pooled analysis of 5 randomized placebo controlled clinical trials. J Am Geriat Soc 2002;50:18–25.CrossRefGoogle ScholarPubMed
Keller, MBRaising the expectations of long term treatment strategies in anxiety disorders. Psychopharmacol Bull 2002;36(Suppl 2):166–74.Google ScholarPubMed
Kessler, RCMc Gonagle, KAZhao, KANelson, CRHughis, MEshlenan, et al.Lifetime and 12 month prevalence of DSM-III-R psychiatric disorders in the USA: results from the National Comor-bidity Survey. Arch Gen Psychiatry 1994;51:8–19.CrossRefGoogle Scholar
Klein, EColin, VStolk, JLennox, RHAlprazolam withdrawal in patients with panic disorder and generalized anxiety disorder: vulnerability and effect of carbamazepine. Am J Psychiatry 1994;151:1760–6.Google ScholarPubMed
Kupfer, DJFranck, EThe interaction of drug and psychotherapy in the long term treatment of depression. JAffective Disord 2001;62:131–7.CrossRefGoogle Scholar
Lader, MScotto, JCA multicentre double blind comparison of hydroxyzine buspirone and placebo in patients with generalized anxiety disorder. Psychopharmacology 1998;139:402–6.CrossRefGoogle ScholarPubMed
La Douceur, RDugas, MJFreeston, MHLeger, EGagnont, FThi- bodeau, NEfficacy of a cognitive-behavioral treatment for generalized anxiety disorder: evaluation in a controlled clinical trial. J Consult Clin Psychol 2000;68:957–65.CrossRefGoogle Scholar
Léger, ELa Douceur, RDugas, MJFreeston, MHCognitive-behavioral treatment of generalized anxiety disorder among adolescents: a case series. J Am Acad Child Adolesc Psychiatry 2003;42(3):327–30.CrossRefGoogle ScholarPubMed
Llorca, PMSpadone, CSol, ODanniau, ABougerol, TCor-ruble, Eet al.Efficacy and safety of hydroxyzine in the treatment of generalized anxiety disorder: a 3 months double blind study. J Clin Psychiatry 2002;63:1020–7.CrossRefGoogle Scholar
Maier, WGaensicke, MFreyberger, HJLinz, MLecrubier, YGeneralized anxiety disorder (I.C.D.10) in primary care from a cross cultural perspective. A valid diagnostic entity? Acta Psychiat Scand 2000;101:29–36.Google Scholar
Manassis, KMendlowitz, SLScapillato, DAvery, DFiksenbauml, LFreire, Met al.Group and individual cognitive-behavioral therapy for chilhoud anxiety disorders: a randomized trial. J Am Acad Child Adolesc Pschiatry 2002;41:1423–30.CrossRefGoogle ScholarPubMed
Mohlman, JGorenstein, EEKleber, MDe Jesus, MGorman, JMPapp, LAStandard and enhanced cognitive-behavior therapy for late-life generalized anxiety disorder: two pilot investigations. Am J Geri-atr Psychiatry 2003;11(1):24–32.Google ScholarPubMed
Möller, HJVolz, HPReimann, IWet al.Opipramol for the treatment of generalized anxiety disorder: a placebo controlled trial including an alprazolam-treatment group. J Clin Psychopharmacol 2001;21:59–65.CrossRefGoogle ScholarPubMed
Montgomery, SASheehan, DVMeoni, PHaudiquet, VHackett, DCharacterization of the longitudinal course of improvement in generalized anxiety disorder during long term treatment with venlafaxine XRJ. Psychiatry Res 2002;36(3):209–17.CrossRefGoogle Scholar
Morselli, PLOn the therapeutic action of alpidem in anxiety disorders: an overview of European data. Pharmacopsychiatry 1990; 23(Suppl):129–34.CrossRefGoogle ScholarPubMed
Murphy, SMOwen, RTyrer, PComparative assessment of efficacy and withdrawal symptoms after 6 and 12 weeks treatment with diaz-epam or buspirone. Br J Psychiatry 1989;154:529–34.CrossRefGoogle ScholarPubMed
Ninan, PTDissolving the burden of generalized anxiety disorder. J Clin Psychiatry 2001;62(Suppl 19):5–10.Google ScholarPubMed
Pande, ACCrockatt, JGFeltner, DEJanney, CASmith, WTWeisler, Ret al.Pregabalin in generalized anxiety disorder: a placebo-controlled trial. Am J Psychiatry 2003;160(3):533–40.CrossRefGoogle ScholarPubMed
Pelissolo, AAndré, CChignon, JMDutoit, DMartin, PRichard- Berthe, Cet al.Anxiety disorders in private practice psychiatric outpatients: prevalence comorbidity and burden. L’Encéphale 2002; 28:510–9.Google Scholar
Pollack, MHZaninelli, RGodard, AMc Cafferty, JPBellew, KMBurnham, DBet al.Paroxetine in the treatment of generalized anxiety disorder: results of a placebo-controlled flexible dosage trial. J Clin Psychiatry 2001;62:350–7.CrossRefGoogle ScholarPubMed
Power, KGSimpson, RJSwanson, VWallace, LA(a) Controlled comparison of pharmacological and psychological treatment of generalized anxiety disorder in primary care. Brit J Gen Pract 1990;40: 289–94.Google ScholarPubMed
Power, KGSimpson, RJSwanson, VWallace, LAFeistner, ATCSharp, DAA controlled comparison of cognitive-behaviour therapy, diazepam and placebo alone and in combination for the treatment of generalized anxiety disorder. J Anxiety Disord 1990;4:267–92.CrossRefGoogle Scholar
Rakel, RELong-term buspirone therapy for chronic anxiety: a multi-center international study to determine safety. South Med J 1990; 83(2):195–8.CrossRefGoogle Scholar
Rickels, KCase, WGDowning, RWWinokur, ALong term diazepam therapy and clinical outcome. JAMA 1983;250:767–71.CrossRefGoogle ScholarPubMed
Rickels, KDowning, RSchweizer, EHassman, HAntidepressants for the treatment of generalized anxiety disorder: a placebo controlled comparison of imipramine, trazodone and diazepam. Arch Gen Psychiatry 1993;50:884–95.CrossRefGoogle ScholarPubMed
Rickels, KSchweizer, ECanalosi, ICase, WGChung, HLong term treatment of anxiety and risk of withdrawal: a prospective comparison of clorazepate and buspirone. Arch Gen Psychiatry 1988;45:445–50.CrossRefGoogle ScholarPubMed
Rickels, KRynn, MPharmacotherapy of generalized anxiety disorder. J Clin Psychiatry 2002;63(Suppl 14):9–16.Google ScholarPubMed
Rocca, PFonzo, VScotta, MZanalda, ERavizza, LParoxetine efficacy in the treatment of GAD. Acta Psychiatr Scand 1997;95(5):445–50.CrossRefGoogle Scholar
RUPPASG (Research Unit on Pediatric PsychopharmacologyAnxiety Study Group). Fluvoxamine for the treatment of anxiety disorders in children and adolescents. Engl J Med 2001;344:1279–85.Google Scholar
Rynn, MASiqueland, LRickels, KPlacebo-controlled trial of sertra-line in the children with GAD. Am J Psychiatry 2001;158:2008–14.CrossRefGoogle Scholar
Schweizer, ERickels, KThe long-term management of generalized anxiety disorder: issues and dilemmas. J Clin Psychiatry 1996; 57(Suppl 7):9–12.Google ScholarPubMed
Shader, RIGreenblatt, DJUse of benzodiazepines in anxiety disorders. N Engl J Med 1993;328:1398–405.Google ScholarPubMed
Shader, RIGreenblatt, DJUse of benzodiazepines in anxiety disorders. N Engl J Med 1993;328:1398–405.Google ScholarPubMed
Sheehan, DVRaj, ABHarnett- Sheehan, KSoto, SKnapp, EThe relative efficacy of high-dose buspirone and alprazolamin the treatment of panic disorder: a double-blind placebo-controlled study. Acta Psychiatr Scand 1993;89:1–11.CrossRefGoogle Scholar
Stocchi, FNordera, GJokinen, Ret al.Efficacy and tolerability of paroxetine for the long-term treatment of generalized anxiety disorder. J Clin Psychiatry 2003;64:250–8.CrossRefGoogle ScholarPubMed
Varia, IRauscher, FTreatment of generalized anxiety disorder with citalopram. Int Clin Psychopharmacol 2002;17(3):103–7.CrossRefGoogle ScholarPubMed
Westen, DMorrison, KA multidimensional meta analysis of treatments for depression, panic and generalized anxiety disorder: an empirical examination of the status of empirically supported therapies. J Consult Clin Psychol 2001;69:875–99.CrossRefGoogle ScholarPubMed
Wetherell, JLGatz, MCraske, MGTreatment of generalized anxiety disorder in older adults. J Consult Clin Psychol 2003;71(1):31–40.CrossRefGoogle ScholarPubMed
Wittchen, HUKessler, RCPfister, HLieb, MWhy do people with anxiety disorders become depressed?A prospective longitudinal community study. Acta Psychiatr Scand 2000;102(Suppl 406):14–23.CrossRefGoogle Scholar
Yonkers, KAWarshaw, MMassion, AOKeller, MBPhenomenology and course of generalized anxiety disorder. Br J Psychiatry 1996;168: 308–11.CrossRefGoogle Scholar
Yonkers, KADick, IRWarshaw, MKeller, MBFactors predicting the clinical course of generalized anxiety disorder. Brit J Psychiatry 2000;176:544–9.CrossRefGoogle Scholar
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