What we’ve said about Generalized anxiety disorder

“I look for another cause of anxiety first that is more plausible. And if that's the cause, that's the diagnosis, not the GAD”

“I think that for GAD, we should only be making that diagnosis if we can identify a longer life course of anxiety. strong and severe neuroticism”

“It's related to MDD recurrent, non-manic depressive. Okay, so those are probably the more similar ones. And what is that really fundamentally most similar to? What construct, in my opinion? Trait neuroticism”

“the generalized anxiety disorder diagnosis is so loose in its criteria that almost anyone can fit into it. It's really a problem with the DSM rather than an issue with George, the character”

“I'm in the camp that GED is a terrible diagnosis, at least the way The Community Act. Acts with it. It's a very poor diagnosis. But I think there's some. Something real there”

“They say, if this patient has a generally high degree of anxiety, they have generalized anxiety disorder. Not true, folks, not true”

“anxiety is a non -specific. Non-specific state that every human being has and almost every single mental condition can produce or not produce”

“a GAD, an anxiety disorder that seems more primary, seems to just be an exaggeration of normal neurotic tendencies that you can see across almost all the population. And obsessionality that turns into OCD is sort of an exaggeration of a mental symptom or a phenomenon that in an isolated and specific way becomes extremely impairing”

“major depression plus PTSD with an agitated state, major depression plus generalized anxiety disorder with an anxious state, major depression with attention deficit disorder with irritable phases, major depression with borderline personality disorder with phases of variety of symptoms”

“stop the cycling first, primary target, and then you can see what's left over after that. Because in my experience, what looked like ADHD, well, it doesn't always go away, but it may diminish to the point where it doesn't need a further intervention”

“a patient will come and say, I have anxiety. They could be blatantly manic and it's like, oh, their problem is anxiety. To me, it's irresponsible To me, it's It's irresponsible to be treating someone without them knowing your diagnosis”

“This is an actual treatment. If you do this right, and don't get me wrong, there are a lot of ways to do this wrong, which is why often it helps to have a professional guide you through it”

“Usually, there's some sort of resistance and that their anxiety is serving some sort of purpose, like a subconscious belief that their anxiety is protecting them in some way”

“the medications don't solve your problems to make it easier for you to grow and change. And so even if you're going to use medications as a first-line treatment in a GAD phenotype”

“I see it kind of like OCD where it's a biological cause, but that the psychological solution is better. I'm more likely to use SSRIs, or second, third line agents for anxiety, high doses of SSRIs”

“I don't think they're going to be able to engage appropriately with the psychological and behavioral changes in their lives to treat that anxiety disorder if they're just not sleeping right”

“The Happiness Trap is a little bit lighter. It's acceptance and commitment therapy, which to me is like a lighter, easier, breezier form of CBT”

“It has few interactions. It is many There's many those types. Titrations and it works. And guess what? If you have OCD, you can even take it above 200 milligrams, but do so with caution”

“I'll start at 25 milligrams for a week and then move up to 50, stay there for a month, and then negotiate an effect. I usually will prescribe 30 of the 50 milligrams and say break the first four and a half”

“it doesn't cause agitation, as far as we can tell, Um, in people with bipolar. Bipolar disorders. It's effective for irritability, clinically speaking, in my experience”

“if they are a start and stop type of patient, then fluoxetine is great because it's long-acting. Right? They They can kind of get used to it, take it a few times a week, not as a PRN again, but just whenever they can remember”

“If you need someone that wants to gain weight or could use some weight or doesn't mind some weight gain and they have some sleep problems, mirtazapine, it's a good choice”

“I'll reach for duloxetine for comorbid pain or patients with fibromyalgia. Those are the patients that I find myself reaching for it”

“if someone's got a lot of allergies, if they're not sensitive to antihistamines, if they've got sleep problems, they have itching, go ahead, reach for the hydroxyzine. But to me, it's just not terribly good”

“studies needed much higher doses than what I see it be used at to show an effect on anxiety. I feel like all the time you see people on 100 milligrams, 300 milligrams of Gabapack”

“I achieve most. Most of what you want from low-dose quetiapine, Especially in a non - non-psychotic disorder, by using mirtazapine, Gabby Hinton. Gabapentin, Buspirone. Buspirone, Hydroxyzine, anything else”

“Think they tried to run studies for GAD and it did not perform well. So I'm going to put it in CF tier”

“The traditional algorithm goes SSRI SSRI and SNR. SNRI, and then you try your gabapentin and Lyrica, and then you try your TCA”

“if you're getting to the end of your list for the treatment of primary anxiety, you've done the re-diagnosis, they're in true therapy, they're doing mindfulness practice, and you're not really getting anywhere, Don't be afraid to do pregabalin”

“S through B tier stuff, You really need it. Doing more re-diagnosis And, uh, work. Working on formulation and lifestyle changes, et cetera, et cetera”

“99% of the time you're They're not really true. Treating the anxiety disorder when you use a benzodiazepine, a Z drug, or alcohol. Frankly, all about the same in terms of their use with different levels of tolerability for different people”

“Bupropion, in my opinion, worsens generalized anxiety disorder long term. It helps anxiety if the anxiety is This is a part of the depression. Depression. It doesn't help anxiety on its own, in my opinion”