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| |  DG DISPATCH - ECNP: Generalized Anxiety Disorder Has Worst Impact On Quality Of Life By Cameron Johnston Special to DG News LONDON, UK -- September 23, 1999 -- While generalized anxiety disorder might not be taken seriously as a medical condition by many people - even doctors don’t put it high on their list of priorities - it is, in fact, one of the more debilitating mental disorders, with one of the least favorable outcomes.
At the annual meeting of the European College of Neuropsychopharmacology (ECNP), being held in London, UK, this week, doctors from the US and Europe presented data indicating just how serious generalized anxiety disorder (GAD) might be, and why the condition presents such a perplexing clinical challenge for physicians. "If we were to ask many of our colleagues to come up with a pecking order of mental and psychiatric illnesses, anxiety disorder, and particularly generalized anxiety disorder would probably come in last," said Dr. David Sheehan, a professor of psychiatry at the University of South Florida College of Medicine, in Tampa. In his study, Dr. Sheehan and his colleagues noted that among patients whose GAD was accompanied by major depression, 14 percent had attempted suicide at least once, while among those who did not have depression, 11 percent had attempted suicide. Patients with GAD are also more than twice as likely to relapse after six months of treatment than patient with major depressive disorder, said Dr. Martin Keller, chief of psychiatry at Brown University School of Medicine, in Providence, R.I. Moreover, their chances of recovery from the disorder are only seven percent at four months, 25 percent at two years, and a scant 38 percent after having the illness for five years. By comparison, patients with uncomplicated panic disorder, meaning they do not have a clinically defined phobia, have a 25 percent chance of recovery after four months with the illness, 55 percent at two year, and 63 percent at five years. What’s curious about the ways in which GAD is treated, Dr. Keller added, was that the percentages of patients being treated primarily with benzodiazapines, tricyclic antidepressants, anxiolytics and SSRIs has not changed markedly since 1989. It’s even more unfortunate, he said, that patients are more often than not being treated with sub-clinical doses of whatever medication their physician happens to be prescribing for them. The fact is, he added, the likelihood of patients with GAD getting effective psychotherapy has not changed since the late 80s. Almost 40 percent of them are still being treated with behavioral modification and other forms of therapy that are known to be completely ineffective. "If we measure impairment of social functioning, people with GAD are significantly worse off than people with any other chronic medical illnesses," he said. "When we look at physical functioning, people with GAD are doing worse than those with diabetes, hypertension and arthritis. Only those with coronary artery disease have more impairment in physical function than individuals suffering from GAD," he added. Indeed the list of treatments still in favor with some doctors does a disservice to the patients with GAD. According to Dr.Malcolm Lader, a professor at the Institute of Psychiatry, which is part of the Maudsley Hospital in London, UK, benzodiazapines "have not fulfilled their promise, although they are a great improvement over barbituates." Patients who try to treat their GAD with benzodiazapines experience a short-term rebound disorder when they try to lower their daily doses, and as many as 25-30 percent of them experience severe withdrawal symptoms when they try to discontinue the drug altogether. Those withdrawal symptoms, he said are worse than the symptoms of GAD itself in 5-10 percent of the cases.
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