Consensus statement on generalized anxiety disorder from the internationalconsensus group on depression and anxiety

Objective: To provide primary care clinicians with a better understanding o f management issues in generalized anxiety disorder (GAD) and guide clinica l practice with recommendations on the appropriate treatment strategy. Part icipants: The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R.T. Davidson, Yves L ecrubier. and David J. Nutt. Four additional faculty members invited by the chair were Karl Rickels, Hans-Ulrich Wittchen, Dan J. Stein, and Thomas D. Borkovec. Evidence: The consensus statement is based on the 6 review artic les that are published in this supplement and the scientific literature rel evant to the issues reviewed in these articles. Consensus process: Group me etings were held over a 2-day period. On day 1, the group discussed the rev iew articles and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After t he group meetings. the consensus statement was drafted by the chair and app roved by all attendees. Conclusions: GAD is the most common anxiety disorde r in primary care and is highly debilitating. Furthermore, it is frequently comorbid with depression and other anxiety disorders, which exacerbates fu nctional impairment. Antidepressants (serotonin reuptake inhibitors, seroto nin-norepinephrine reuptake inhibitors, and nonsedating tricyclic antidepre ssants) are generally the most appropriate first-line pharmacotherapy for G AD, since they are also effective against comorbid psychiatric disorders an d are suitable for long-term use. Cognitive-behavioral therapy is the prefe rred form of psychotherapy for GAD, although when GAD is comorbid with depr ession, pharmacotherapy is increasingly indicated.