Anxiety and anxiety disorders are addressed in the practice guideline of the Dutch College of General Practitioners (NHG).
It is important to distinguish anxiety and anxiety disorders because of differences in prognosis and treatment.
Several visits may be needed before the diagnosis is established.
Treatment is based on a stepped-care model. For anxiety, psychoeducation and follow-up visits are often sufficient. For anxiety disorders with relatively low levels of distress or social dysfunctioning, self-help with supervision in addition to psychoeducation is helpful. If this is not effective or if there is severe distress or social dysfunctioning, cognitive behavioural therapy is the first choice treatment. An antidepressant could be started after or in addition to cognitive behavioural therapy.
If an antidepressant is prescribed, SSRIs are preferred above tricyclic antidepressants because of the lesser risk of severe adverse effects.
Conflict of interest: H.W.J. van Marwijk received compensation from Pfizer for lecturing. L.J.A. Hassink-Franke received fee attendance money from the NHG. B. Terluin and his institution of employment received compensation from the NHG for attending work-group meetings; also from various facilities for activities related to continuing education. He has also received royalties from Datec BV Publishing Company for the commercial use of 4DKL. M. van Avendonk received remuneration from Sanofi-Aventis for attending a conference and has received royalties for the book ‘Leven met Diabetes’ (Living with Diabetes). Financial support for this article: none declared.