Prognosis

Pharmacotherapy should be given for at least 12 weeks at a therapeutic dose to determine efficacy, and, in the author's clinical experience (supported by one systematic review and meta-analysis of 28 studies), should be continued for at least 12 months if effective.[48]​​​​​[50][73][170]​​​​ The patient and prescriber may agree to attempt to taper the medication after this period, with monitoring for the recurrence of symptoms. If there is agreement to reduce and stop the antidepressant, do so slowly, and carefully monitor for the recurrence of symptoms. As a general guide based on expert opinion, discontinue the drug by no more than one-quarter of the dose each month, but note that some patients may require more gradual rates of withdrawal.[22]

Psychotherapy should be given for at least 6-8 sessions. Gains with psychotherapy have been shown to be maintained for up to 24 months.[81]

With proper treatment, a decrease in symptoms, improved psychosocial functioning, and a reduction in the need for medical care can be achieved. Remission (which may be defined as no longer meeting diagnostic criteria for the anxiety disorder combined with a lack of current impairment in functioning) occurs in approximately 51% of people with GAD following treatment.[212]

GAD may recur under physical or emotional stress. If relapse occurs during or after discontinuation, clinical practice is to re-introduce treatment, although the evidence base to support this is lacking. 'Booster' sessions of CBT may be considered if patients experience a relapse after a successful course of CBT.​[87][132]

Depression co-occurs in at least 50% of patients with GAD and increases the risk for suicidality. Patients with depression and GAD have a more severe and prolonged course.[213]

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