Generalized anxiety disorder: acute and chronic treatment

CNS Spectr. 2004 Oct;9(10):716-23. doi: 10.1017/s1092852900022367.


Clinical and epidemiological data suggest that generalized anxiety disorder (GAD) is a chronic illness causing patients to suffer for many years leading to significant distress in daily life functioning. The literature suggests the several conclusions. GAD is a disorder in need of appropriate treatment and often has a chronic course with comorbid conditions, such as major depression and other anxiety disorders. Benzodiazepines, while effective anxiolytic agents acutely, when prescribed for >4 weeks cause rebound anxiety and following prolonged therapy may lead to withdrawal symptoms. Antidepressants cause significant anxiety relief compared with placebo and for psychosocial treatment cognitive-behavioral therapy is an efficacious psychosocial treatment. Many GAD patients are in need of long-term medication management. Furthermore, there is limited data for patients diagnosed with GAD the treatment outcome with the combination of medication and psychotherapy both acutely and long-term; how to best sequence these treatments; for those patients who do not meet remission criteria what is the ideal approach for augmentation; and for patients with treatment-refractory GAD the empirical evidence is lacking on medication switching and augmentation strategies. Research is needed in the area of developing treatment strategies for patients suffering from treatment-refractory GAD. There is still an urgent need to explore treatment combinations and duration strategies in the management of patients suffering with GAD.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Anti-Anxiety Agents / therapeutic use*
  • Anxiety Disorders / drug therapy
  • Anxiety Disorders / therapy*
  • Chronic Disease
  • Combined Modality Therapy
  • Humans
  • Psychotherapy / methods*
  • Remission Induction
  • Serotonin Uptake Inhibitors / therapeutic use*


  • Anti-Anxiety Agents
  • Serotonin Uptake Inhibitors