Psychoanalysis and barbiturates were the primary treatment modalities until the mid-20th century. Psychoanalysis, although not empirically shown to be efficacious for the anxiety disorders, helps one to understand the roots of anxiety [18]. Pharmacologically, the barbiturates were widely used to treat anxiety. However, they have the potential for physical dependence and risk of misuse, including being dangerous in overdose. The benzodiazepines, which are partial agonists for the GABA-A receptors, were discovered in the 1960s. They are widely used to treat anxiety disorders. Researchers in the 1960s also found that the tricyclic antidepressant imipramine (Tofranil) reduced panic attack frequency [18, 19]. Since the 1980s, selective serotonin reuptake inhibitors (SSRIs), starting with fluoxetine (Prozac), have been utilized for the treatment of anxiety disorders. Regarding the psychological therapies, cognitive-behavioral therapy has been empirically validated for anxiety disorders [18]. The overall efficacy of medications for the anxiety disorders is similar to the best psychological therapies, but there appears to be a longer-lasting therapeutic benefit with the psychological therapies [18]. For many patients, a combination of pharmacotherapy and psychotherapy seems to work best.

In the comprehensive evaluation, a primary care practitioner must always think about the categories of anxiety disorders, including patients with chronic general medical problems. The practitioner must also consider coexisting psychiatric disorders including depression, bipolar disorder, eating disorders, adult attention deficit hyperactivity disorder, and alcohol and other substance abuse. There is no substitute for spending a little extra time with the patient and listening carefully. Close observation and involvement of the patient in the discussion is very important in the evaluation of anxiety disorders. Education is vital to helping the patient understand and deal with the various ramifications of anxiety disorder symptoms. It is also not uncommon for anxious patients to question their diagnosis and demonstrate ambivalence and apprehension about their treatment. Patience and persistence is required of both the practitioner and the patient.

Anxiety becomes a clinical diagnosis when the symptoms become distressing and interferes with a patient’s functioning. Anxiety disorders are commonly encountered in the primary care setting. Most patients with anxiety disorders have at least one serious general medical problem and a significantly higher probability for physical illness than those who do not suffer from anxiety disorders [20]. Anxiety disorders can affect all bodily systems including the gastrointestinal, respiratory, cardiovascular, endocrine, neurologic, and rheumatologic. Individuals with anxiety disorders also suffer from higher rates of allergies [20]. Many clinicians consider anxiety disorders as conditions that are brief and benign, but they can be truly chronic, serious, at times disabling conditions.

It is important to remember that diagnosing anxiety disorders is based on the direct clinical interview and the observation of objective manifestations of anxiety [21]. Self-report and clinician-administered checklists can be extremely valuable adjuncts in the assessment and follow-up of anxiety symptoms as well.