Anxiety Disorders

Abstract

ImportanceAnxiety disorders have a lifetime prevalence of approximately 34% in the US, are often chronic, and significantly impair quality of life and functioning.ObservationsAnxiety disorders are characterized by symptoms that include worry, social and performance fears, unexpected and/or triggered panic attacks, anticipatory anxiety, and avoidance behaviors. Generalized anxiety disorder (6.2% lifetime prevalence), social anxiety disorder (13% lifetime prevalence), and panic disorder (5.2% lifetime prevalence) with or without agoraphobia are common anxiety disorders seen in primary care. Anxiety disorders are associated with physical symptoms, such as palpitations, shortness of breath, and dizziness. Brief screening measures applied in primary care, such as the Generalized Anxiety Disorder–7, can aid in diagnosis of anxiety disorders (sensitivity, 57.6% to 93.9%; specificity, 61% to 97%). Providing information about symptoms, diagnosis, and evidence-based treatments is a first step in helping patients with anxiety. First-line treatments include pharmacotherapy and psychotherapy. Selective serotonin reuptake inhibitors (SSRIs, eg, sertraline) and serotonin-norepinephrine reuptake inhibitors (SNRIs, eg, venlafaxine extended release) remain first-line pharmacotherapy for generalized anxiety disorder, social anxiety disorder, and panic disorder. Meta-analyses suggest that SSRIs and SNRIs are associated with small to medium effect sizes compared with placebo (eg, generalized anxiety disorder: standardized mean difference [SMD], −0.55 [95% CI, −0.64 to −0.46]; social anxiety disorder: SMD, −0.67 [95% CI, −0.76 to −0.58]; panic disorder: SMD, −0.30 [95% CI, −0.37 to −0.23]). Cognitive behavioral therapy is the psychotherapy with the most evidence of efficacy for anxiety disorders compared with psychological or pill placebo (eg, generalized anxiety disorder: Hedges g = 1.01 [large effect size] [95% CI, 0.44 to 1.57]; social anxiety disorder: Hedges g = 0.41 [small to medium effect] [95% CI, 0.25 to 0.57]; panic disorder: Hedges g = 0.39 [small to medium effect[ [95% CI, 0.12 to 0.65]), including in primary care. When selecting treatment, clinicians should consider patient preference, current and prior treatments, medical and psychiatric comorbid illnesses, age, sex, and reproductive planning, as well as cost and access to care.Conclusions and RelevanceAnxiety disorders affect approximately 34% of adults during their lifetime in the US and are associated with significant distress and impairment. First-line treatments for anxiety disorders include cognitive behavioral therapy, SSRIs such as sertraline, and SNRIs such as venlafaxine extended release.

A Review of Anxiety Disorders—Reply

“…Our Review included a recommended evidence-based PDT, panic-focused psychodynamic psychotherapy, and stated that "while access to first-line evidence-based psychotherapy, such as CBT for anxiety disorders, is often insufficient, clinicians should be aware of the varying levels of evidence for specific types of psychotherapy." 1 We also agree that given the chronicity of anxiety disorders and the current state of the literature, longer-term follow-up studies are important for both pharmacotherapies and psychotherapies. We specifically noted the lack of trials examining long-term efficacy of benzodiazepines, as well as several important considerations for pharmacotherapy interventions, including the higher rates of relapse with medication discontinuation and the recommendation to continue medication for at least 1 year to reduce relapse risk.…”

“…In Reply We thank Dr Boffa and colleagues for their insightful comments in response to our Editorial describing expanded opportunities for researchers to share data in compliance with funder mandates. 1 We agree with their concerns about the rights of research participants and patients to privacy and risks of reidentification from data sets considered anonymous. 2,3 JAMA and the JAMA Network journals offer investigators a set of defined questions regarding their plans to share data when submitting manuscripts reporting research, which include whether the data to be shared are "deidentified participant data" or "participant data with identifiers."…”

“…To the Editor We have several comments about the recent Review on anxiety disorders. 1 First, the authors stated that benefits from evidence-based psychotherapy are similar to those of pharmacotherapy in the treatment of anxiety. This is correct only if short-term effects are considered.…”

“…In Reply We thank Dr Leichsenring and colleagues for their comments and for drawing attention to their 3 published articles and another meta-analysis that were not included in our recent JAMA narrative Review of anxiety disorders. 1 sistent with the JAMA narrative Review requirements, our Review provided a brief overview of the presentation, assessment, diagnosis, and treatment of anxiety disorders, targeted for primary care clinicians, and considered available medical literature and treatment guidelines. In-depth analysis of the nuances of each anxiety disorder treatment approach and all existing trials and meta-analyses was not possible.…”

Amygdala AVPR1A mediates susceptibility to chronic social isolation in females

“…There is empirical support for the use of pharmacotherapies in patients with anxiety disorders, but many do not respond to treatment (Taylor et al, 2012). These drugs were developed for other disorders and act on a wide range of receptors that are broadly expressed in the central and peripheral nervous systems (e.g., serotonin, dopamine, adrenergic and GABA receptors) (Szuhany and Simon, 2022). Targeting AVPR1A circuits that respond to the removal of affiliative relationships in postpubertal female mice diminished anxiety-related adaptive behaviors.…”