2 November 2009

Up to one in five people presenting to GPs and pharmacists will experience symptoms of an anxiety disorder at some point during their life.

To help health professionals accurately diagnose and treat anxiety, the National Prescribing Service (NPS) has developed a new education program, Managing anxiety disorders.

“Anxiety disorders are characterised by combinations of key symptoms; excessive anxiety, fear, worry, avoidance and compulsive rituals that are associated with impaired function or significant distress,” NPS senior clinical adviser, Judith Mackson said.

“Anxiety symptoms may be primary or secondary to other physical or psychiatric disorders. To accurately diagnose anxiety disorders, health professionals need to characterise all the anxiety symptoms against criteria.”

The NPS Managing anxiety disorders program encourages health professionals to:

• Use key symptoms to differentiate between types of anxiety disorders and determine effective treatment
• Trial non-drug therapy including psychological therapy as first line
• Consider an antidepressant for those who do not respond adequately to psychological therapies, selecting on the basis of evidence of efficacy in the diagnosed anxiety disorder
• Reserve benzodiazepines for short-term use in selected circumstances

“Psychological therapies should be the first treatment choice in most anxiety disorders to control symptoms and improve function. This includes cognitive behavioural therapy and other non-drug strategies,” Ms Mackson said.

If psychological and other non-drug therapies do not provide sufficient benefit, an antidepressant may be considered. There is however no evidence that starting with combined therapy is more effective than either an antidepressant or psychological therapies alone.

“Health professionals also need to consider the adverse effect profile before prescribing an antidepressant. Not all antidepressants have been assessed for efficacy for all anxiety disorders, nor can efficacy be generalised across an antidepressant class,” Ms Mackson warned.

“In general, benzodiazepines should only be recommended for people who have not responded to at least two therapies, as they may cause dependence. This is particularly the case in those with a history of dependence on alcohol and/or other drugs,” Ms Mackson said.

As part of the therapeutic program, health professionals can utilise:

• Case study (60): Managing anxiety disorders
• Prescribing Practice Review (48): Managing anxiety disorders in primary care
• NPS News (65): Which treatment for what anxiety disorder?

For more information visit www.nps.org.au, phone (02) 8217 8700 or email info@nps.org.au.

ENDS

The National Prescribing Service Limited (NPS) is an independent, non-profit organisation for Quality Use of Medicines funded by the Australian Government Department of Health and Ageing.