The Dec 16, 2006 Lancet podcast on Generalized Anxiety Disorder addresses the question: how should our medical system detect and treat anxiety?

GAD is defined by exclusion.   It is not a panic disorder—which is a sudden, severe, episode or attack, of anxiety.   GAD is not post traumatic stress disorder—which also has clearly defined source.  GAD, Professor Peter Tyrer says, effects 10 to 12% of the population at any one time.   It is chronic.  It persists.  It is described as free floating.  Everything a person does or thinks is tinged with anxiety.   Psychological symptoms include: tension, worry, inability to concentrate. The physical symptoms are a consequence of continuous autonomic arousal: palpitations, trouble breathing, chest pains, tingling, and feelings of unreality, depersonalization.

Depression and anxiety often overlap—in fact that combination is the most common mental illness a primary care physician would see.   And it isn’t that a primary care physical would be blind to anxiety—it is so common that they know it when they see it—but what is more rare is the decision to treat it, because they, like the general public, see it as a symptom and they look past it, wanting to get to the underlying problem.

But GAD treatment exists.   Not only are there drugs (sedatives, tranquilizers, anti-depressants) but also cognitive behavioral therapies that help the patient identify their distorted cognitions and conclusions they have about their symptoms.

Since anxiety is such a common ailment, economic and social concerns demand it be dealt with in primary care.  The big challenge facing the UK national health service is to:

… make the psychological treatments available, because these are the ones that are wanted by patients, and the evidence base suggests, because of the dependence problems with drug treatments, and these occur with all types of psychiatric drugs for treatment of anxieties, nothing really which is effective in treating anxiety has no problems at all when you stop taking it, but this doesn’t apply to the psychological treatments …

The psychological treatments are successful and their effects persist.   The drugs stop being effective when the patient stops taking them.