Psychiatric and Somatic Markers of Anxiety: Identification and Pharmacologic Treatment

Anxiety disorders are widely prevalent but insufficiently recognized and inadequately treated in primary care practice. The annual costs of morbidity and mortality of these disorders approach $50 billion, substantially more than costs for schizophrenia or all affective disorders combined. Somatization of anxiety contributes to the challenges of making an accurate diagnosis and to the indirect costs associated with delaying appropriate treatment. Pharmacologic interventions give clinicians the necessary tools to treat anxiety safely and effectively. Former therapeutic choices were limited to benzodiazepines, buspirone, and older antidepressants, but newer anxiolytic agents have become available. The selective serotonin reuptake inhibitors and agents with dual reuptake inhibition, such as venlafaxine XR, are optimizing therapy and yielding less risk for serious adverse events, greater safety in long-term therapy, and opportunity for improved patient compliance. These newer antidepressants provide substantial efficacy in patients with comorbid anxiety and depression, commonly seen in the primary care setting.