How to Diagnose and Treat Generalized Anxiety Disorder? – Insights from Dr Sanil Rege (Psychiatrist)

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Dr Sanil Rege discusses the diagnosis and management of Generalised anxiety disorder (GAD).

GAD is characterized by persistent feelings of fear and worries about everyday things that are difficult to control. GAD is on average only diagnosed 10 years after onset at which point the patient has gone to the doctors due to comorbid issues such as panic disorder, depression, or chronic pain disorders. Therefore, all patients that are diagnosed with anxiety should be screened for depression as well.

The initial assessment should address behaviour and somatic symptoms; the evaluation of psychosocial stress and developmental issues in the context of past medical history can be used to exclude other organic causes.
As with all disorders across the anxiety spectrum, a pragmatic approach that includes psychoeducation and information on lifestyle factors (e.g. healthy lifestyle choices concerning diet, exercise, and sleep) is encouraged.

SSRIs (e.g. sertraline, paroxetine, and escitalopram) and SNRIs (e.g. venlafaxine and duloxetine) are supported by RCT data to reduce symptoms and remission rates, respectively. 

Clinicians should be aware of the myriad of comorbid disorders that often present with GAD. Evidence suggests psychoeducation and lifestyle changes as well as CBT as the most effective forms of therapy. SSRIs /SNRIs are effective medications that can be considered first-line or if CBT is ineffective.

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