Overview
Generalised Anxiety Disorder
1. Clinical Overview
Summary
Generalised anxiety disorder (GAD) is characterised by excessive, uncontrollable worry about multiple areas of life, present more days than not for at least 6 months. Associated symptoms include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance. NICE recommends stepped care: education and active monitoring, low-intensity psychological interventions, high-intensity psychological therapy (CBT), and pharmacotherapy (SSRI first-line).
Key Facts
- Definition: Excessive worry for 6+ months + 3 associated symptoms
- Prevalence: 5-7% lifetime
- First-line treatment: CBT and/or SSRI (sertraline)
2. Diagnosis
- Persistent worry (multiple domains) for 6+ months
- Associated symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, sleep problems
- GAD-7 screening tool
3. Management
Stepped Care (NICE)
- Step 1: Education, active monitoring
- Step 2: Low-intensity psychological interventions (guided self-help, psychoeducational groups)
- Step 3: CBT or applied relaxation; OR drug treatment
- Step 4: Specialist services
Pharmacotherapy
| Drug | Notes |
|---|---|
| Sertraline (SSRI) | First-line |
| Duloxetine (SNRI) | If SSRI fails |
| Pregabalin | If above fail or not tolerated |
| Benzodiazepines | SHORT-TERM only (2-4 weeks), adjunct for crises |
4. References
- NICE Guideline CG113. Generalised anxiety disorder and panic disorder. 2011 (updated 2019).
Last Reviewed: 2026-01-01 | MedVellum Editorial Team