Background

According to the American Psychiatric Association (APA), anxiety disorders are the most common type of psychiatric disorders.^[1]Many patients with anxiety disorders experience physical symptoms related to anxiety and subsequently visit their primary care providers. Despite the high prevalence rates of these anxiety disorders, they often are underrecognized and undertreated clinical problems.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR),^[2] anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances. These disorders include separation anxiety disorder, selective mutism, specific phobia, social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder, substance/medication-induced anxiety disorder, and anxiety disorder due to another medical condition. Obsessive-compulsive disorder (included in the obsessive-compulsive and related disorders), acute stress disorder, and posttraumatic stress disorder (included in the trauma and stress-related disorders) are no longer considered anxiety disorders as they were in the previous version of the DSM. However, these disorders are closely related to anxiety disorders and the sequential order of these chapters in the DSM-5-TR reflects this close relationship.

Anxiety disorders appear to be caused by an interaction of biopsychosocial factors, including genetic vulnerability, which interact with situations, stress, or trauma to produce clinically significant syndromes.

American Psychiatric Association. Available at https://www.psychiatry.org/patients-families/anxiety-disorders.
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. Washington, DC: American Psychiatric Association; 2022.
Williams LE, Oler JA, Fox AS, McFarlin DR, Rogers GM, Jesson MA, et al. Fear of the unknown: uncertain anticipation reveals amygdala alterations in childhood anxiety disorders. Neuropsychopharmacology. 2015 May. 40 (6):1428-35. [QxMD MEDLINE Link].
Martinez RC, Ribeiro de Oliveira A, Brandão ML. Serotonergic mechanisms in the basolateral amygdala differentially regulate the conditioned and unconditioned fear organized in the periaqueductal gray. Eur Neuropsychopharmacol. 2007 Nov. 17(11):717-24. [QxMD MEDLINE Link]. [Full Text].
Keeton CP, Kolos AC, Walkup JT. Pediatric generalized anxiety disorder: epidemiology, diagnosis, and management. Paediatr Drugs. 2009. 11(3):171-83. [QxMD MEDLINE Link].
Klumpp H, Fitzgerald JM. Neuroimaging Predictors and Mechanisms of Treatment Response in Social Anxiety Disorder: an Overview of the Amygdala. Curr Psychiatry Rep. 2018 Aug 28. 20 (10):89. [QxMD MEDLINE Link].
Tafet GE, Nemeroff CB. Pharmacological Treatment of Anxiety Disorders: The Role of the HPA Axis. Front Psychiatry. 2020. 11:443. [QxMD MEDLINE Link].
Freitas-Ferrari MC, Hallak JE, Trzesniak C, Filho AS, Machado-de-Sousa JP, Chagas MH. Neuroimaging in social anxiety disorder: a systematic review of the literature. Prog Neuropsychopharmacol Biol Psychiatry. 2010 May 30. 34(4):565-80. [QxMD MEDLINE Link].
Bomyea J, Ball TM, Simmons AN, Campbell-Sills L, Paulus MP, Stein MB. Change in neural response during emotion regulation is associated with symptom reduction in cognitive behavioral therapy for anxiety disorders. J Affect Disord. 2020 Jun 15. 271:207-214. [QxMD MEDLINE Link].
Katerndahl DA, Talamantes M. A comparison of persons with early-versus late-onset panic attacks. J Clin Psychiatry. 2000 Jun. 61(6):422-7. [QxMD MEDLINE Link].
Nikolaus S, Müller HW, Hautzel H. Different patterns of 5-HT receptor and transporter dysfunction in neuropsychiatric disorders--a comparative analysis of in vivo imaging findings. Rev Neurosci. 2016 Jan. 27 (1):27-59. [QxMD MEDLINE Link].
Vythilingam M, Anderson ER, Goddard A, Woods SW, Staib LH, Charney DS. Temporal lobe volume in panic disorder--a quantitative magnetic resonance imaging study. Psychiatry Res. 2000 Aug 28. 99(2):75-82. [QxMD MEDLINE Link].
Sobanski T, Wagner G, Peikert G, Gruhn U, Schluttig K, Sauer H, et al. Temporal and right frontal lobe alterations in panic disorder: a quantitative volumetric and voxel-based morphometric MRI study. Psychol Med. 2010 Nov. 40 (11):1879-86. [QxMD MEDLINE Link].
Johnson PL, Truitt W, Fitz SD, Minick PE, Dietrich A, Sanghani S. A key role for orexin in panic anxiety. Nat Med. 2010 Jan. 16(1):111-5. [QxMD MEDLINE Link]. [Full Text].
Poole JC, Dobson KS, Pusch D. Anxiety among adults with a history of childhood adversity: Psychological resilience moderates the indirect effect of emotion dysregulation. J Affect Disord. 2017 Aug 1. 217:144-152. [QxMD MEDLINE Link].
Tambs K, Czajkowsky N, Røysamb E, Neale MC, Reichborn-Kjennerud T, Aggen SH. Structure of genetic and environmental risk factors for dimensional representations of DSM-IV anxiety disorders. Br J Psychiatry. 2009 Oct. 195(4):301-7. [QxMD MEDLINE Link].
Maron E, Hettema JM, Shlik J. Advances in molecular genetics of panic disorder. Mol Psychiatry. 2010 Jul. 15(7):681-701. [QxMD MEDLINE Link].
Zwanzger P, Eser D, Nothdurfter C, Baghai TC, Möller HJ, Padberg F, et al. Effects of the GABA-reuptake inhibitor tiagabine on panic and anxiety in patients with panic disorder. Pharmacopsychiatry. 2009 Nov. 42(6):266-9. [QxMD MEDLINE Link].
Wedekind D, Bandelow B, Broocks A, Hajak G, Rüther E. Salivary, total plasma and plasma free cortisol in panic disorder. J Neural Transm. 2000. 107(7):831-7. [QxMD MEDLINE Link].
Neumeister A, Bain E, Nugent AC, Carson RE, Bonne O, Luckenbaugh DA. Reduced serotonin type 1A receptor binding in panic disorder. J Neurosci. 2004 Jan 21. 24(3):589-91. [QxMD MEDLINE Link].
Esler M, Alvarenga M, Barton D, Jennings G, Kaye D, Guo L, et al. Measurement of Noradrenaline and Serotonin Metabolites With Internal Jugular Vein Sampling: An Indicator of Brain Monoamine Turnover in Depressive Illness and Panic Disorder. Front Psychiatry. 2022. 13:818012. [QxMD MEDLINE Link].
Lonsdorf TB, Rück C, Bergström J, Andersson G, Ohman A, Schalling M, et al. The symptomatic profile of panic disorder is shaped by the 5-HTTLPR polymorphism. Prog Neuropsychopharmacol Biol Psychiatry. 2009 Nov 13. 33(8):1479-83. [QxMD MEDLINE Link].
Strug LJ, Suresh R, Fyer AJ, Talati A, Adams PB, Li W, et al. Panic disorder is associated with the serotonin transporter gene (SLC6A4) but not the promoter region (5-HTTLPR). Mol Psychiatry. 2010 Feb. 15(2):166-76. [QxMD MEDLINE Link]. [Full Text].
Johnson MR, Lydiard RB, Ballenger JC. Panic disorder. Pathophysiology and drug treatment. Drugs. 1995 Mar. 49(3):328-44. [QxMD MEDLINE Link].
Greist JH, Jefferson JW, Kobak KA, Katzelnick DJ, Serlin RC. Efficacy and tolerability of serotonin transport inhibitors in obsessive-compulsive disorder. A meta-analysis. Arch Gen Psychiatry. 1995 Jan. 52(1):53-60. [QxMD MEDLINE Link].
Leibold NK, van den Hove DL, Esquivel G, De Cort K, Goossens L, Strackx E, et al. The brain acid-base homeostasis and serotonin: A perspective on the use of carbon dioxide as human and rodent experimental model of panic. Prog Neurobiol. 2015 Jun. 129:58-78. [QxMD MEDLINE Link].
Dannon PN, Lowengrub K, Amiaz R, Grunhaus L, Kotler M. Comorbid cannabis use and panic disorder: short term and long term follow-up study. Hum Psychopharmacol. 2004 Mar. 19(2):97-101. [QxMD MEDLINE Link].
Zacny JP, Chait LD. Breathhold duration and response to marijuana smoke. Pharmacol Biochem Behav. 1989 Jun. 33 (2):481-4. [QxMD MEDLINE Link].
Schifano F, Di Furia L, Forza G, et al. MDMA (‘‘ecstasy’’) consumption in the context of polydrug abuse: a report on 150 patients. Drug Alcohol Depend. Sep.
González-Berríos N. Sertraline-induced panic attack. Bol Asoc Med P R. 2009 Jan-Mar. 101(1):59-60. [QxMD MEDLINE Link].
Baldessarini RJ, Tondo L. Effects of Treatment Discontinuation in Clinical Psychopharmacology. Psychother Psychosom. 2019. 88 (2):65-70. [QxMD MEDLINE Link].
Molosh AI, Johnson PL, Fitz SD, Dimicco JA, Herman JP, Shekhar A. Changes in central sodium and not osmolarity or lactate induce panic-like responses in a model of panic disorder. Neuropsychopharmacology. 2010 May. 35(6):1333-47. [QxMD MEDLINE Link].
Dratcu L. Panic, hyperventilation and perpetuation of anxiety. Prog Neuropsychopharmacol Biol Psychiatry. 2000 Oct. 24(7):1069-89. [QxMD MEDLINE Link].
Esquivel G, Fernández-Torre O, Schruers KR, Wijnhoven LL, Griez EJ. The effects of opioid receptor blockade on experimental panic provocation with CO2. J Psychopharmacol. 2009 Nov. 23(8):975-8. [QxMD MEDLINE Link].
Knuts IJ, Cosci F, Esquivel G, Goossens L, van Duinen M, Bareman M, et al. Cigarette smoking and 35% CO(2) induced panic in panic disorder patients. J Affect Disord. 2010 Jul. 124(1-2):215-8. [QxMD MEDLINE Link].
Kendler KS, Karkowski LM, Prescott CA. Fears and phobias: reliability and heritability. Psychol Med. 1999 May. 29(3):539-53. [QxMD MEDLINE Link].
Fyer AJ, Mannuzza S, Chapman TF, Liebowitz MR, Klein DF. A direct interview family study of social phobia. Arch Gen Psychiatry. 1993 Apr. 50(4):286-93. [QxMD MEDLINE Link]. [Full Text].
Becker ES, Rinck M, Türke V, Kause P, Goodwin R, Neumer S, et al. Epidemiology of specific phobia subtypes: findings from the Dresden Mental Health Study. Eur Psychiatry. 2007 Mar. 22 (2):69-74. [QxMD MEDLINE Link].
Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994 Jan. 51(1):8-19. [QxMD MEDLINE Link].
Stein MB, Stein DJ. Social anxiety disorder. Lancet. 2008 Mar 29. 371(9618):1115-25. [QxMD MEDLINE Link].
Baxter AJ, Scott KM, Vos T, Whiteford HA. Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med. 2013 May. 43 (5):897-910. [QxMD MEDLINE Link].
Vanderminden J, Vanderminden E. Beyond symptoms: Race and gender predict anxiety disorder diagnosis. Society and Mental Health. 2018 Nov 14. 9:111-125. [Full Text].
Magee WJ, Eaton WW, Wittchen HU, McGonagle KA, Kessler RC. Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Arch Gen Psychiatry. 1996 Feb. 53(2):159-68. [QxMD MEDLINE Link].
Schneier FR, Heckelman LR, Garfinkel R, Campeas R, Fallon BA, Gitow A. Functional impairment in social phobia. J Clin Psychiatry. 1994 Aug. 55(8):322-31. [QxMD MEDLINE Link].
Lochner C, Mogotsi M, du Toit PL, Kaminer D, Niehaus DJ, Stein DJ. Quality of life in anxiety disorders: a comparison of obsessive-compulsive disorder, social anxiety disorder, and panic disorder. Psychopathology. 2003 Sep-Oct. 36(5):255-62. [QxMD MEDLINE Link].
Sareen J, Cox BJ, Afifi TO, de Graaf R, Asmundson GJ, ten Have M. Anxiety disorders and risk for suicidal ideation and suicide attempts: a population-based longitudinal study of adults. Arch Gen Psychiatry. 2005 Nov. 62(11):1249-57. [QxMD MEDLINE Link]. [Full Text].
Matza LS, Revicki DA, Davidson JR, Stewart JW. Depression with atypical features in the National Comorbidity Survey: classification, description, and consequences. Arch Gen Psychiatry. 2003 Aug. 60(8):817-26. [Full Text].
American Psychiatric Association. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association Press; 2000.
Lamers F, van Oppen P, Comijs HC, Smit JH, Spinhoven P, van Balkom AJ, et al. Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA). J Clin Psychiatry. 2011 Mar. 72 (3):341-8. [QxMD MEDLINE Link].
US Preventive Services Task Force, Barry MJ, Nicholson WK, Silverstein M, Coker TR, Davidson KW, et al. Screening for Anxiety Disorders in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2023 Jun 27. 329 (24):2163-2170. [QxMD MEDLINE Link].
Kanwar A, Malik S, Prokop LJ, Sim LA, Feldstein D, Wang Z, et al. The association between anxiety disorders and suicidal behaviors: a systematic review and meta-analysis. Depress Anxiety. 2013 Oct. 30 (10):917-29. [QxMD MEDLINE Link].
Culpepper L. Generalized anxiety disorder and medical illness. J Clin Psychiatry. 2009. 70 Suppl 2:20-4. [QxMD MEDLINE Link].
Rabatin J, Keltz LB. Generalized anxiety and panic disorder. West J Med. 2002 May. 176 (3):164-8. [QxMD MEDLINE Link].
Kluge M, Schüssler P, Steiger A. Persistent generalized anxiety after brief exposure to the dopamine antagonist metoclopramide. Psychiatry Clin Neurosci. 2007 Apr. 61(2):193-5. [QxMD MEDLINE Link].
Cha C, Nock M. Emotional intelligence is a protective factor for suicidal behavior. J Am Acad Child Adolesc Psychiatry. 2009 Apr. 48(4):422-30. [QxMD MEDLINE Link].
Nitschke JB, Sarinopoulos I, Oathes DJ, Johnstone T, Whalen PJ, Davidson RJ. Anticipatory activation in the amygdala and anterior cingulate in generalized anxiety disorder and prediction of treatment response. Am J Psychiatry. 2009 Mar. 166(3):302-10. [QxMD MEDLINE Link].
Siegmann E-M, Müller H, Luecke C, et al. Association of Depression and Anxiety Disorders With Autoimmune Thyroiditis: A Systematic Review and Meta-analysis. JAMA. May 2, 2018. [Full Text].
Baxter LR Jr, Schwartz JM, Bergman KS, Szuba MP, Guze BH, Mazziotta JC, et al. Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Arch Gen Psychiatry. 1992 Sep. 49(9):681-9. [QxMD MEDLINE Link].
de Beurs E, van Balkom AJ, Van Dyck R, Lange A. Long-term outcome of pharmacological and psychological treatment for panic disorder with agoraphobia: a 2-year naturalistic follow-up. Acta Psychiatr Scand. 1999 Jan. 99(1):59-67. [QxMD MEDLINE Link].
Shear MK, Beidel DC. Psychotherapy in the overall management strategy for social anxiety disorder. J Clin Psychiatry. 1998. 59 Suppl 17:39-46. [QxMD MEDLINE Link].
Loerinc AG, Meuret AE, Twohig MP, Rosenfield D, Bluett EJ, Craske MG. Response rates for CBT for anxiety disorders: Need for standardized criteria. Clin Psychol Rev. 2015 Dec. 42:72-82. [QxMD MEDLINE Link].
[Guideline] Mayor S. NICE advocates computerised CBT. BMJ. 2006 Mar 4. 332(7540):504. [QxMD MEDLINE Link].
Cuijpers P, Donker T, Weissman MM, Ravitz P, Cristea IA. Interpersonal Psychotherapy for Mental Health Problems: A Comprehensive Meta-Analysis. Am J Psychiatry. 2016 Apr 1. appiajp201515091141. [QxMD MEDLINE Link].
Barclay TH, Barclay RD. A clinical trial of cranial electrotherapy stimulation for anxiety and comorbid depression. J Affect Disord. 2014 Aug. 164:171-7. [QxMD MEDLINE Link].
Brooks M. FDA OKs Brain Stimulator for Insomnia, Anxiety, Depression. Medscape Medical News. Available at https://www.medscape.com/viewarticle/910999. March 27, 2019; Accessed: March 28, 2019.
Hunot V, Churchill R, Silva de Lima M, Teixeira V. Psychological therapies for generalised anxiety disorder. Cochrane Database Syst Rev. 2007. (1):CD001848. [QxMD MEDLINE Link].
Ipser JC, Carey P, Dhansay Y, Fakier N, Seedat S, Stein DJ. Pharmacotherapy augmentation strategies in treatment-resistant anxiety disorders. Cochrane Database Syst Rev. 2006 Oct 18. CD005473. [QxMD MEDLINE Link].
Walkup J, Labellarte M, Riddle MA, Pine DS, Greenhill L, Fairbanks J, et al. Treatment of pediatric anxiety disorders: an open-label extension of the research units on pediatric psychopharmacology anxiety study. J Child Adolesc Psychopharmacol. 2002 Fall. 12(3):175-88. [QxMD MEDLINE Link].
Toneatto T, Nguyen L. Does mindfulness meditation improve anxiety and mood symptoms? A review of the controlled research. Can J Psychiatry. 2007 Apr. 52(4):260-6. [QxMD MEDLINE Link].
[Guideline] American Psychiatric Association (APA). Practice guideline for the treatment of patients with panic disorder. 2nd ed. Washington (DC): American Psychiatric Association (APA); 2009 Jan. Available from the PsychiatryOnline website. Available at https://psychiatryonline.org/content.aspx?bookid=28&sectionid=1680635. Accessed: June 15, 2011.
Owen RP, Sangkuhl K, Klein TE, Altman RB. Cytochrome P450 2D6. Pharmacogenet Genomics. 2009 Jul. 19 (7):559-62. [QxMD MEDLINE Link].
Warner CH, Bobo W, Warner C, Reid S, Rachal J. Antidepressant discontinuation syndrome. Am Fam Physician. 2006 Aug 1. 74 (3):449-56. [QxMD MEDLINE Link].
Black K, Shea C, Dursun S, Kutcher S. Selective serotonin reuptake inhibitor discontinuation syndrome: proposed diagnostic criteria. J Psychiatry Neurosci. 2000 May. 25 (3):255-61. [QxMD MEDLINE Link].
Celexa (citalopram hydrobromide) [package insert]. St. Louis, Missouri: Forest Pharmaceuticals, Inc. August, 2011. Available at [Full Text].
US Food and Drug Administration. Celexa (citalopram hydrobromide): Drug safety communication – abnormal heart rhythms associated with high doses. [Full Text].
Croom KF, Perry CM, Plosker GL. Mirtazapine: a review of its use in major depression and other psychiatric disorders. CNS Drugs. 2009. 23(5):427-52. [QxMD MEDLINE Link].
Kim JE, Yoon SJ, Kim J, Jung JY, Jeong HS, Cho HB, et al. Efficacy and tolerability of mirtazapine in treating major depressive disorder with anxiety symptoms: an 8-week open-label randomised paroxetine-controlled trial. Int J Clin Pract. 2011 Mar. 65(3):323-9. [QxMD MEDLINE Link].
Sinclair LI, Christmas DM, Hood SD, Potokar JP, Robertson A, Isaac A. Antidepressant-induced jitteriness/anxiety syndrome: systematic review. Br J Psychiatry. 2009 Jun. 194(6):483-90. [QxMD MEDLINE Link].
Barlow JH, Ellard DR, Hainsworth JM, Jones FR, Fisher A. A review of self-management interventions for panic disorders, phobias and obsessive-compulsive disorders. Acta Psychiatr Scand. 2005 Apr. 111(4):272-85. [QxMD MEDLINE Link].
Lewis C, Pearce J, Bisson JI. Efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders: systematic review. Br J Psychiatry. 2012 Jan. 200:15-21. [QxMD MEDLINE Link].
Lydiard RB. The role of drug therapy in social phobia. J Affect Disord. 1998 Sep. 50 Suppl 1:S35-9. [QxMD MEDLINE Link].
Van Ameringen M, Allgulander C, Bandelow B, Greist JH, Hollander E, Montgomery SA, et al. WCA recommendations for the long-term treatment of social phobia. CNS Spectr. 2003 Aug. 8(8 Suppl 1):40-52. [QxMD MEDLINE Link].
Heimberg RG, Liebowitz MR, Hope DA, Schneier FR, Holt CS, Welkowitz LA, et al. Cognitive behavioral group therapy vs phenelzine therapy for social phobia: 12-week outcome. Arch Gen Psychiatry. 1998 Dec. 55(12):1133-41. [QxMD MEDLINE Link]. [Full Text].
Allgulander C. Paroxetine in social anxiety disorder: a randomized placebo-controlled study. Acta Psychiatr Scand. 1999 Sep. 100(3):193-8. [QxMD MEDLINE Link].
Stein MB, Fyer AJ, Davidson JR, Pollack MH, Wiita B. Fluvoxamine treatment of social phobia (social anxiety disorder): a double-blind, placebo-controlled study. Am J Psychiatry. 1999 May. 156(5):756-60. [QxMD MEDLINE Link].
Furukawa TA, Watanabe N, Churchill R. Psychotherapy plus antidepressant for panic disorder with or without agoraphobia: systematic review. Br J Psychiatry. 2006 Apr. 188:305-12. [QxMD MEDLINE Link].
Ayala ES, Meuret AE, Ritz T. Treatments for blood-injury-injection phobia: a critical review of current evidence. J Psychiatr Res. 2009 Oct. 43(15):1235-42. [QxMD MEDLINE Link].
Rothbaum BO, Anderson P, Zimand E, Hodges L, Lang D, Wilson J. Virtual reality exposure therapy and standard (in vivo) exposure therapy in the treatment of fear of flying. Behav Ther. 2006 Mar. 37(1):80-90. [QxMD MEDLINE Link]. [Full Text].
Practice guideline for the treatment of patients with panic disorder. Work Group on Panic Disorder. American Psychiatric Association. Am J Psychiatry. 1998 May. 155(5 Suppl):1-34. [QxMD MEDLINE Link].
Pohl RB, Wolkow RM, Clary CM. Sertraline in the treatment of panic disorder: a double-blind multicenter trial. Am J Psychiatry. 1998 Sep. 155(9):1189-95. [QxMD MEDLINE Link]. [Full Text].
Michelson D, Lydiard RB, Pollack MH, Tamura RN, Hoog SL, Tepner R, et al. Outcome assessment and clinical improvement in panic disorder: evidence from a randomized controlled trial of fluoxetine and placebo. The Fluoxetine Panic Disorder Study Group. Am J Psychiatry. 1998 Nov. 155(11):1570-7. [QxMD MEDLINE Link].
Uhlenhuth EH, Balter MB, Ban TA, Yang K. International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: VI. Trends in recommendations for the pharmacotherapy of anxiety disorders, 1992-1997. Depress Anxiety. 1999. 9(3):107-16. [QxMD MEDLINE Link].
Herrera-Arellano A, Jiménez-Ferrer E, Zamilpa A, Morales-Valdéz M, García-Valencia CE, Tortoriello J. Efficacy and tolerability of a standardized herbal product from Galphimia glauca on generalized anxiety disorder. A randomized, double-blind clinical trial controlled with lorazepam. Planta Med. 2007 Jul. 73(8):713-7. [QxMD MEDLINE Link].
Blanck P, Perleth S, Heidenreich T, Kröger P, Ditzen B, Bents H, et al. Effects of mindfulness exercises as stand-alone intervention on symptoms of anxiety and depression: Systematic review and meta-analysis. Behav Res Ther. 2018 Mar. 102:25-35. [QxMD MEDLINE Link].
Fischer R, Bortolini T, Karl JA, Zilberberg M, Robinson K, Rabelo A, et al. Rapid Review and Meta-Meta-Analysis of Self-Guided Interventions to Address Anxiety, Depression, and Stress During COVID-19 Social Distancing. Front Psychol. 2020. 11:563876. [QxMD MEDLINE Link].
Saeed SA, Cunningham K, Bloch RM. Depression and Anxiety Disorders: Benefits of Exercise, Yoga, and Meditation. Am Fam Physician. 2019 May 15. 99 (10):620-627. [QxMD MEDLINE Link].
Stonerock GL, Hoffman BM, Smith PJ, Blumenthal JA. Exercise as Treatment for Anxiety: Systematic Review and Analysis. Ann Behav Med. 2015 Aug. 49 (4):542-56. [QxMD MEDLINE Link].
Koenig HG. Religion, spirituality, and health: the research and clinical implications. ISRN Psychiatry. 2012. 2012:278730. [QxMD MEDLINE Link].
Hu T, Xiao J, Peng J, Kuang X, He B. Relationship between resilience, social support as well as anxiety/depression of lung cancer patients: A cross-sectional observation study. J Cancer Res Ther. 2018 Jan. 14 (1):72-77. [QxMD MEDLINE Link].
Shillington KJ, Johnson AM, Mantler T, Irwin J. Kindness as an Intervention for Student Social Interaction Anxiety, Affect, and Mood: The KISS of Kindness Study. International Journal of Applied Positive Psychology. 2020 May 01. 6:23-44. [Full Text].
Miles A, Andiappan M, Upenieks L, Orfanidis C. Using prosocial behavior to safeguard mental health and foster emotional well-being during the COVID-19 pandemic: A registered report of a randomized trial. PLoS One. 2022. 17 (7):e0272152. [QxMD MEDLINE Link].
Komossa K, Depping AM, Meyer M, Kissling W, Leucht S. Second-generation antipsychotics for obsessive compulsive disorder. Cochrane Database Syst Rev. 2010 Dec 8. 12:CD008141. [QxMD MEDLINE Link].
Melaragno AJ. Pharmacotherapy for Anxiety Disorders: From First-Line Options to Treatment Resistance. Focus (Am Psychiatr Publ). 2021 Jun. 19 (2):145-160. [QxMD MEDLINE Link].
Brauer HR, Nowicki PW, Catalano G, Catalano MC. Panic attacks associated with citalopram. South Med J. 2002 Sep. 95 (9):1088-9. [QxMD MEDLINE Link].
Votaw VR, Geyer R, Rieselbach MM, McHugh RK. The epidemiology of benzodiazepine misuse: A systematic review. Drug Alcohol Depend. 2019 Jul 1. 200:95-114. [QxMD MEDLINE Link].
Bach DR, Korn CW, Vunder J, Bantel A. Effect of valproate and pregabalin on human anxiety-like behaviour in a randomised controlled trial. Transl Psychiatry. 2018 Aug 16. 8 (1):157. [QxMD MEDLINE Link].
Baldwin DS, Ajel K, Masdrakis VG, Nowak M, Rafiq R. Pregabalin for the treatment of generalized anxiety disorder: an update. Neuropsychiatr Dis Treat. 2013. 9:883-92. [QxMD MEDLINE Link].
Hong JSW, Atkinson LZ, Al-Juffali N, Awad A, Geddes JR, Tunbridge EM, et al. Gabapentin and pregabalin in bipolar disorder, anxiety states, and insomnia: Systematic review, meta-analysis, and rationale. Mol Psychiatry. 2022 Mar. 27 (3):1339-1349. [QxMD MEDLINE Link].
Advisory Committee FDA. SEROQUEL XR for the Treatment of Patients with either Major Depressive Disorder or Generalized Anxiety Disorder. FDA. Available at https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/PsychopharmacologicDrugsAdvisoryCommittee/UCM161963.pdf.
Kuehn BM. FDA panel issues mixed decision on quetiapine in depression and anxiety. JAMA. 2009 May 27. 301 (20):2081-2. [QxMD MEDLINE Link].
Karno M, Golding JM, Sorenson SB, Burnam MA. The epidemiology of obsessive-compulsive disorder in five US communities. Arch Gen Psychiatry. 1988 Dec. 45(12):1094-9. [QxMD MEDLINE Link].
Wittchen HU, Fehm L. Epidemiology, patterns of comorbidity, and associated disabilities of social phobia. Psychiatr Clin North Am. 2001 Dec. 24(4):617-41. [QxMD MEDLINE Link].
Kobak KA, Greist JH, Jefferson JW, Katzelnick DJ, Henk HJ. Behavioral versus pharmacological treatments of obsessive compulsive disorder: a meta-analysis. Psychopharmacology (Berl). 1998 Apr. 136(3):205-16. [QxMD MEDLINE Link].
Bloch MH, Landeros-Weisenberger A, Kelmendi B, Coric V, Bracken MB, Leckman JF. A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder. Mol Psychiatry. 2006 Jul. 11(7):622-32. [QxMD MEDLINE Link].
Pittenger C, Krystal JH, Coric V. Glutamate-modulating drugs as novel pharmacotherapeutic agents in the treatment of obsessive-compulsive disorder. NeuroRx. 2006 Jan. 3(1):69-81. [QxMD MEDLINE Link].
van Grootheest DS, Cath DC, Beekman AT, Boomsma DI. Twin studies on obsessive-compulsive disorder: a review. Twin Res Hum Genet. 2005 Oct. 8(5):450-8. [QxMD MEDLINE Link].
Carey G, Gottesman I. Twin and family studies of anxiety, phobic, and obsessive disorders. In: Klein DF, Rabkin JG. Anxiety: New Research and Changing Concepts. New York: Raven Press; 2000.
Lochner C, Mogotsi M, du Toit PL, Kaminer D, Niehaus DJ, Stein DJ. Quality of life in anxiety disorders: a comparison of obsessive-compulsive disorder, social anxiety disorder, and panic disorder. Psychopathology. 2003 Sep-Oct. 36(5):255-62. [QxMD MEDLINE Link].
Arnold PD, Sicard T, Burroughs E, Richter MA, Kennedy JL. Glutamate transporter gene SLC1A1 associated with obsessive-compulsive disorder. Arch Gen Psychiatry. 2006 Jul. 63(7):769-76. [QxMD MEDLINE Link].
Denys D, Van Nieuwerburgh F, Deforce D, Westenberg H. Association between the dopamine D2 receptor TaqI A2 allele and low activity COMT allele with obsessive-compulsive disorder in males. Eur Neuropsychopharmacol. 2006 Aug. 16(6):446-50. [QxMD MEDLINE Link].
Dickel DE, Veenstra-VanderWeele J, Cox NJ, Wu X, Fischer DJ, Van Etten-Lee M. Association testing of the positional and functional candidate gene SLC1A1/EAAC1 in early-onset obsessive-compulsive disorder. Arch Gen Psychiatry. 2006 Jul. 63(7):778-85. [QxMD MEDLINE Link].
Lin PY. Meta-analysis of the association of serotonin transporter gene polymorphism with obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2007 Apr 13. 31(3):683-9. [QxMD MEDLINE Link].
Deykin EY. Posttraumatic Stress Disorder in Childhood and Adolescence: A Review. Medscape Mental Health [online]. 1999. [Full Text].
Marshall RD, Pierce D. Implications of recent findings in posttraumatic stress disorder and the role of pharmacotherapy. Harv Rev Psychiatry. 2000 Jan-Feb. 7(5):247-56. [QxMD MEDLINE Link].
Milad MR, Orr SP, Lasko NB, Chang Y, Rauch SL, Pitman RK. Presence and acquired origin of reduced recall for fear extinction in PTSD: results of a twin study. J Psychiatr Res. 2008 Jun. 42(7):515-20. [QxMD MEDLINE Link].
Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, et al. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry. 1989 Nov. 46(11):1006-11. [QxMD MEDLINE Link].
First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV-TR Axis I Disorders. Patient Edition (SCID-I/P, 11/2002 revision). New York: Biometrics Research Department, New York State Psychiatric Institute; November 2002.
Helping Children and Adolescents Cope with Violence and Disasters. National Institute of Mental Health. NIH Publication No. 01-3518. Bethesda, Md: National Institute of Mental Health; 2001.
Dickie EW, Brunet A, Akerib V, Armony JL. An fMRI investigation of memory encoding in PTSD: influence of symptom severity. Neuropsychologia. 2008 Apr. 46(5):1522-31. [QxMD MEDLINE Link].
Germain A, Shear MK, Hall M, Buysse DJ. Effects of a brief behavioral treatment for PTSD-related sleep disturbances: a pilot study. Behav Res Ther. 2007 Mar. 45(3):627-32. [QxMD MEDLINE Link].
Raskind MA, Peskind ER, Hoff DJ, Hart KL, Holmes HA, Warren D. A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder. Biol Psychiatry. 2007 Apr 15. 61(8):928-34. [QxMD MEDLINE Link].
Rodriguez BF, Weisberg RB, Pagano ME, Machan JT, Culpepper L, Keller MB. Mental health treatment received by primary care patients with posttraumatic stress disorder. J Clin Psychiatry. 2003 Oct. 64(10):1230-6. [QxMD MEDLINE Link].
Högberg G, Pagani M, Sundin O, Soares J, Aberg-Wistedt A, Tärnell B. Treatment of post-traumatic stress disorder with eye movement desensitization and reprocessing: outcome is stable in 35-month follow-up. Psychiatry Res. 2008 May 30. 159(1-2):101-8. [QxMD MEDLINE Link].
Ponniah K, Hollon SD. Empirically supported psychological treatments for adult acute stress disorder and posttraumatic stress disorder: a review. Depress Anxiety. 2009. 26(12):1086-109. [QxMD MEDLINE Link].
Litz BT, Engel CC, Bryant RA, Papa A. A randomized, controlled proof-of-concept trial of an Internet-based, therapist-assisted self-management treatment for posttraumatic stress disorder. Am J Psychiatry. 2007 Nov. 164(11):1676-83. [QxMD MEDLINE Link].
Foa EB, Wilson R. Stop Obsessing!: How to Overcome Your Obsessions and Compulsions. Revis ed. New York: Bantam Dell; 2001.
Coric V, Taskiran S, Pittenger C, Wasylink S, Mathalon DH, Valentine G, et al. Riluzole augmentation in treatment-resistant obsessive-compulsive disorder: an open-label trial. Biol Psychiatry. 2005 Sep 1. 58(5):424-8. [QxMD MEDLINE Link].
Greenberg WM, Benedict MM, Doerfer J, Perrin M, Panek L, Cleveland WL. Adjunctive glycine in the treatment of obsessive-compulsive disorder in adults. J Psychiatr Res. 2009 Mar. 43(6):664-70. [QxMD MEDLINE Link].
Grayson J. Freedom From Obsessive Compulsive Disorder: A Personalized Recovery Program for Living With Uncertainty. New York: Berkley Publishing Group; 2004.
Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry. 2007 Jul. 164(7 Suppl):5-53. [QxMD MEDLINE Link]. [Full Text].
Jung HH, Kim CH, Chang JH, Park YG, Chung SS, Chang JW. Bilateral anterior cingulotomy for refractory obsessive-compulsive disorder: Long-term follow-up results. Stereotact Funct Neurosurg. 2006. 84(4):184-9. [QxMD MEDLINE Link].
Greenberg BD, Malone DA, Friehs GM, Rezai AR, Kubu CS, Malloy PF. Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder. Neuropsychopharmacology. 2006 Nov. 31(11):2384-93. [QxMD MEDLINE Link].
Mallet L, Polosan M, Jaafari N, Baup N, Welter ML, Fontaine D, et al. Subthalamic nucleus stimulation in severe obsessive-compulsive disorder. N Engl J Med. 2008 Nov 13. 359(20):2121-34. [QxMD MEDLINE Link].
Montgomery SA, Mansuy L, Ruth A, Bose A, Li H, Li D. Efficacy and safety of levomilnacipran sustained release in moderate to severe major depressive disorder: a randomized, double-blind, placebo-controlled, proof-of-concept study. J Clin Psychiatry. 2013 Apr. 74 (4):363-9. [QxMD MEDLINE Link].
Roman MW, Wilkinson SM. Vortioxetine (Brintellix®) and levomilnacipran (Fetzima®): the two newest additions to the antidepressant formulary. Issues Ment Health Nurs. 2014 Dec. 35 (12):972-4. [QxMD MEDLINE Link].
De Diego-Adeliño J, Crespo JM, Mora F, Neyra A, Iborra P, Gutiérrez-Rojas L, et al. Vortioxetine in major depressive disorder: from mechanisms of action to clinical studies. An updated review. Expert Opin Drug Saf. 2022 May. 21 (5):673-690. [QxMD MEDLINE Link].
Sanchez C, Asin KE, Artigas F. Vortioxetine, a novel antidepressant with multimodal activity: review of preclinical and clinical data. Pharmacol Ther. 2015 Jan. 145:43-57. [QxMD MEDLINE Link].
Wang SM, Han C, Lee SJ, Patkar AA, Masand PS, Pae CU. Vilazodone for the treatment of major depressive disorder: focusing on its clinical studies and mechanism of action. Psychiatry Investig. 2015 Apr. 12 (2):155-63. [QxMD MEDLINE Link].
Thase ME, Chen D, Edwards J, Ruth A. Efficacy of vilazodone on anxiety symptoms in patients with major depressive disorder. Int Clin Psychopharmacol. 2014 Nov. 29 (6):351-6. [QxMD MEDLINE Link].
Stuivenga M, Giltay EJ, Cools O, Roosens L, Neels H, Sabbe B. Evaluation of vilazodone for the treatment of depressive and anxiety disorders. Expert Opin Pharmacother. 2019 Feb. 20 (3):251-260. [QxMD MEDLINE Link].
Murphy GE, Simons AD, Wetzel RD. Plasma nortriptyline and clinical response in depression. J Affect Disord. 1985 Mar-Apr. 8 (2):123-9. [QxMD MEDLINE Link].
Aaltonen L, Syvälahti E, Iisalo E, Peltomäki T. Anticholinergic activity in the serum of patients receiving maintenance amitriptyline or doxepin therapy. Acta Pharmacol Toxicol (Copenh). 1985 Jan. 56 (1):75-80. [QxMD MEDLINE Link].
Lechin F, van der Dijs B, Jara H, Orozco B, Baez S, Benaim M, et al. Effects of buspirone on plasma neurotransmitters in healthy subjects. J Neural Transm (Vienna). 1998. 105 (6-7):561-73. [QxMD MEDLINE Link].
Smith BH, Higgins C, Baldacchino A, Kidd B, Bannister J. Substance misuse of gabapentin. Br J Gen Pract. 2012 Aug. 62 (601):406-7. [QxMD MEDLINE Link].
Aliyev NA, Aliyev ZN. Valproate (depakine-chrono) in the acute treatment of outpatients with generalized anxiety disorder without psychiatric comorbidity: randomized, double-blind placebo-controlled study. Eur Psychiatry. 2008 Mar. 23 (2):109-14. [QxMD MEDLINE Link].

Media Gallery

Anxiety. Chart showing the female-to-male sex ratio for anxiety disorders. Adapted from Kessler et al, 1994.
Anxiety. Age of onset for anxiety disorders based on specific anxiety disorder type.
Brain structures involved in dealing with fear and stress.

of 3

#author-disclosures{display:block}#author-disclosures.modal-layer{position:relative}#author-disclosures .modal-content{max-height:none}#author-disclosures .close-modal{display:none}

Author

Nita V Bhatt, FAPA, MD, MPH Associate Professor, Associate Director of Medical Student Education (Psychiatry), Department of Psychiatry, Wright State University, Boonshoft School of Medicine; Staff Psychiatrist, Twin Valley Behavioral Healthcare; Clinical Assistant Professor, Ohio State University College of Medicine; Clinical Assistant Professor, Ohio University Heritage College of Osteopathic Medicine

Nita V Bhatt, FAPA, MD, MPH is a member of the following medical societies: American Medical Association, American Psychiatric Association, Ohio Psychiatric Physicians Association

Disclosure: Nothing to disclose.

Coauthor(s)

Andrew B Correll, BS MD Candidate, Wright State University, Boonshoft School of Medicine

Andrew B Correll, BS is a member of the following medical societies: Aerospace Medical Association, American Psychiatric Association, Ohio Psychiatric Physicians Association

Disclosure: Nothing to disclose.

Vina B Jain, MD Staff Psychiatrist, Department of Psychiatry and Behavioral Medicine, GHS University Medical Group, Greenville Health System

Vina B Jain, MD is a member of the following medical societies: American Association of Physicians of Indian Origin, American Psychiatric Association, Association of Women Psychiatrists, South Carolina Psychiatric Association

Disclosure: Nothing to disclose.

Matthew J Baker, DO Assistant Professor, Department of Psychiatry, Wright State University, Boonshoft School of Medicine

Matthew J Baker, DO is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Psychiatric Association, Ohio Psychiatric Physicians Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

David Bienenfeld, MD Professor, Departments of Psychiatry and Geriatric Medicine, Wright State University, Boonshoft School of Medicine

David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, Association for Academic Psychiatry

Disclosure: Nothing to disclose.

Additional Contributors

William R Yates, MD, MS Research Psychiatrist, Laureate Institute for Brain Research; Professor of Research, Department of Psychiatry, University of Oklahoma College of Medicine at Tulsa

William R Yates, MD, MS is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Acknowledgements

Edward Bessman, MD Chairman, Department of Emergency Medicine, John Hopkins Bayview Medical Center; Assistant Professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine

Edward Bessman, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine