Anxiety Disorder

Chronic, excessive, difficult-to-control worry across multiple domains, present more days than not for ≥6 months (DSM-5), with associated somatic/cognitive symptoms causing significant distress or functional impairment.

• Excessive worry (health, work, finances, relationships), restlessness/feeling on edge, fatigue, poor concentration, irritability, muscle tension, sleep disturbance.

• Somatic: palpitations, GI upset, headache, sweating, tremor.

• Avoidance behaviors, reassurance seeking behavior.

• Clinical, DSM-5/ICD-11 criteria; GAD-7 for screening/severity (≥10 = clinically significant, useful for monitoring).

• Exclude organic causes: TSH, FBC, glucose, ECG if palpitations prominent; review caffeine, stimulant, and alcohol use, and medications (bronchodilators, corticosteroids).

Differentials: hyperthyroidism, arrhythmia, pheochromocytoma, substance intoxication/withdrawal, other anxiety disorders (panic disorder, social anxiety, OCD, PTSD), depression (frequently comorbid).

• Psychoeducation, lifestyle: reduce caffeine/stimulants, regular exercise, sleep hygiene, alcohol moderation

• CBT: first-line psychological therapy, strongest evidence base

• SSRIs: first-line pharmacological: sertraline 50mg od (titrate), escitalopram 10mg od, start low (transient early worsening possible), effect over 2-4 weeks, full effect 6-8 weeks

• SNRIs: venlafaxine XR 75mg od, duloxetine 30-60mg od, alternative

• Avoid long-term benzodiazepines: reserve for short-term (2-4 weeks max) severe symptom relief while awaiting SSRI effect (diazepam 2-5mg bd-tds)

• Pregabalin: alternative, some abuse potential

• Beta-blockers (propranolol): adjunct for situational somatic symptoms only

• Continue effective pharmacotherapy minimum 6-12 months post-response before tapering

Referral: psychiatry for diagnostic complexity, treatment resistance, significant comorbidity, or suicidal ideation.