Complications
Depression co-occurs in at least 50% of patients with GAD and increases the risk for suicidality, so caution is advised in prescribing tricyclic antidepressants and sedating medications. Patients with depression and GAD have a more severe and prolonged course.[214]
Treatment of comorbid depression with antidepressants could improve symptoms of both conditions and decrease the risk for suicidality.[215][216]
Hospitalization is warranted for serious suicidal risk.
Alcohol, sedative, hypnotic, or anxiolytic dependence or misuse may co-occur as patients may use these substances to reduce their anxiety. Alcohol misuse occurs in over one third of patients with GAD.[40]
Complications of this include secondary medical conditions (e.g., hepatotoxicity, gastrointestinal bleeding) and substance withdrawal.
Detoxification from alcohol or benzodiazepines is indicated if signs of substance withdrawal appear. Treatment in a specialized facility for chemical dependency should be considered. Recognition and treatment of underlying substance misuse is important to the overall treatment plan.
Anxiety in women during pregnancy and postpartum may be associated with long-term behavioral and mental health problems in offspring, with some evidence of alterations in the child's brain structure and function.[217][218][219] However, there are a number of genetic and environmental factors that may confound this association.[220]
Symptoms may cause the patient to consult their primary care physician for treatment.[1] If anxiety is unrecognized by the doctor, costly medical tests may be performed.[48]
Recognition of the pattern of subjective worry or anxiety with accompanying physical signs can help the physician avoid costly diagnostic tests yet still consider possible medical causes of anxiety.
Effective treatment with pharmacotherapy or cognitive behavioral therapy should reduce symptoms and health-care seeking.
Panic disorder, social phobia, or specific phobia often co-occur with GAD, and may contribute to distress and avoidance behaviors.[1]
Panic disorder and social phobia may respond to similar treatments (i.e., antidepressants and cognitive behavioral therapy). Behavioral treatments such as systematic desensitization may treat specific phobias, thus relieving distress.
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