Long-term Management of Generalized Anxiety Disorder
mentioned, GAD is a chronic, continuous condition in the ma-jority of patients.
Frequently beginning in adolescence or early adulthood, the course of GAD can
persist for decades, with rela-tively low remission rates. The HARP data
indicate that among the 164 GAD patients followed, only 15% had a full
remission for 2 months or longer at any time during the first follow-up year,
25% had a full remission during the 2-year follow-up, and only 35% had a full
remission after 5 years (Yonkers et al., 1996). In a 5-year follow-up study of 64 GAD
patients, only 18% of GAD subjects achieved a full remission compared with 45%
of panic disorder subjects (Woodman et al., 1999).
these findings, less research has been conducted to assess the efficacy of
chronic long-term anxiolytic therapy. To our knowledge, only three
double-blind, controlled studies eval-uating the long-term pharmacological
treatment of GAD have been conducted. The first, a 1-year follow-up of patients
who par-ticipated in a 6-month diazepam maintenance study, found that
two-thirds of all patients relapsed within a 1-year period after di-azepam
discontinuation. In the second study, GAD patients were treated for 6 months
with buspirone or clorazepate, and reevalu-ated them after discontinuation at 6
and 40 months. The authors found that the improvement achieved in both
treatment groups was sustained during the 6-month maintenance phase, with no
need for an increase in medication intake, and no evidence of tolerance or
abuse. At follow-up, approximately 60% of patients treated initially with
clorazepate compared with 30% of patients treated initially with buspirone were
experiencing at least mod-erate anxiety symptoms. Finally, in a recent study,
Stocchi and colleagues (2001) found that many patients with GAD are not able to
remain symptom-free for long periods without treatment. Therefore, a long-term
therapy may be needed in many patients.
Generally, the current recommendation for GAD treatment sug-gests a treatment
period of approximately 1 year after response has been established prior to
considering treatment discontinua-tion. Stress management and problem-solving
techniques, along with specific psychotherapeutic approaches such as cognitive–
behavioral therapy, should be attempted in addition to medica-tion treatment.