Generalised anxiety disorder is characterized by excessive, exaggerated anxiety and worry about everyday life events with no obvious reasons for worry.
Diagnostic Criteria
Symptoms include
- Persistent worry
- Disturbances in sleep
- Poor concentration
- Mood disturbances
- Muscle tension
- Tremors
Non-Pharmacological Treatment
- Psychotherapy
- Most patients can be treated as outpatients
Pharmacological Treatment
Indicated where symptoms are interfering with normal functions of daily living. Where there is concomitant drug/alcohol dependence or co-morbid major depressive episode, an antidepressant may be more appropriate.
Acute management
For an acute episode or intense prolonged anxiety:
C: Diazepam 2–5 mg (PO) as a single dose.
- Repeat if required up to 12 hourly
- Duration of therapy: up to 2 weeks, taper off to zero within 6 weeks
Maintenance Therapy
S: Fluoxetine (PO) 10–40mg (PO) daily
OR
D: Citalopram (PO) 10–40mg (PO) daily
OR
A: Amitriptyline (PO) 25–75mg daily at night
- Duration of therapy: variable, although the condition tends to be chronic.
- Extended medicine treatment should be monitored by a specialist.
| Note: | |
| | Prolonged treatment with benzodiazepines often leads to tolerance and withdrawal symptoms if the medicine is discontinued abruptly |
| | Avoid combining more than one benzodiazepine. |
Referral
Refer to the next level if there is lack of improvement with treatment.