Generalized anxiety disorder (GAD) can be seen in all clinical settings,
and in primary care, practitioners are usually good at identifying GAD
patients, Richard Swinson, M.D., said at the annual meeting of the Canadian
Psychiatric Association in St. John's, Newfoundland, in August.
"By the time [patients with GAD] see me, or other psychiatrists, they
are longstanding worriers, that is, the more difficult cases," said
Swinson, a professor emeritus of psychiatry at McMaster University and medical
director of the Anxiety Treatment Research Center at St. Joseph's Healthcare
in Hamilton, Ontario.
No matter the severity of GAD, there are effective treatments for it that
can lead patients "to full recovery," he said.
Three SSRI antidepressants and two SNRI antidepressants have been approved
for treating GAD in Canada, he noted, and there is some evidence that
anticonvulsants or antipsychotics can help GAD patients. At first
antipsychotics were used as SSRI augmenters for GAD, but a recent approach is
to use them as monotherapy, and that has been found useful in clinical
studies, he said.
Cognitive-behavioral therapy (CBT) can also benefit GAD patients, Swinson
noted. He said a good resource in this area is Michel Dugas, Ph.D., director
of the anxiety disorders laboratory at Concordia University in Montreal. Over
the past 16 years, Dugas has conducted research on the origins of GAD and has
developed a CBT treatment for it, which has been validated in a number of
trials. Dugas has also written a book called Cognitive-Behavioral
Treatment for Generalized Anxiety Disorder: From Science to Practice,
which provides a step-by-step treatment of GAD.
For patients who have both GAD and depression, the best strategy is to
place them on medications first and then to add CBT later, Swinson advised.
The combination strategy should help alleviate both their anxiety and their
depression, he indicated.
Other common comorbid conditions for GAD include another anxiety disorder,
alcohol abuse, personality disorders, and bipolar disorder, Swinson pointed