Anxiety disorders: does one treatment fit all?

Anxiety disorders are relatively common; almost 30% of the population suffer from some form of anxiety disorder at some point during their life. Anxiety and depressive symptoms often co-exist, and for physicians in primary care the boundaries between depression and anxiety disorders (e.g. generalised anxiety disorder [GAD], social anxiety disorder [SAD], and panic disorder) are often fairly fluid. Differences in treatment tend to occur in patients diagnosed with a pure anxiety disorder and those with comorbid anxiety and depression. For example, the proportion of patients with pure GAD who seek help and get treated for anxiety is much lower than those patients with GAD and comorbid depression. The selective serotonin reuptake inhibitor (SSRI) escitalopram is effective in panic disorder, reducing panic attack frequency and anticipatory anxiety compared with placebo. Furthermore, escitalopram has shown efficacy in patients with SAD and GAD. Antidepressants have potential in treating anxiety disorders, and further novel drug treatments and development of treatment guidelines will be required to effectively manage those patients.