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GPs should not offer benzodiazepines or antipsychotics to patients presenting with generalised anxiety disorder (GAD), according to updated guidance from NICE.

GAD is a common condition that can be recognised by chronic, excessive worry about a number of different events associated with heightened tension. It can vary in its severity and complexity for each person, and for this reason it is very important to consider how each patient should be treated individually.

Patients should be educated about their condition and actively monitored. If symptoms do not improve, the patient should be offered low-intensity psychological interventions such as individual non-facilitated self-help; individual guided self-help or the chance to join psychoeducational groups.

Patients with GAD that does not respond to this should then be considered for either a high-intensity psychological intervention, such as cognitive behavioural therapy (CBT) or applied relaxation, or drug treatment, as part of a new stepped-care approach to managing GAD.

People with GAD who are at risk of self-harming should be offered a specialist assessment of their needs and risks, including the impact on their relationships with families and carers.

NICE recommends that combination treatments should only be undertaken by practitioners with expertise in the psychological and drug treatment of complex, treatment-refractory anxiety disorders and after full discussion with the person about the likely advantages and disadvantages of the treatments suggested.

This partial update builds on the original 2004 guideline and introduces a number of new recommendations, many of which are aimed at improving the diagnosis and management of GAD in adults.

GP rates of diagnosis and treatment of anxiety disorders are much lower than expected due to difficulties in recognising anxiety disorders and a reluctance among patients to discuss their symptoms with their GP.

Additionally, many patients present with other physical or somatic symptoms associated with their anxiety that they consider to be more legitimate or more troubling.

Christine Carson, Programme Director for the Centre for Clinical Practice at NICE, said: “The new recommendations include health professionals considering a diagnosis of GAD in patients presenting with anxiety or significant worry, and in those frequently attending primary care who have a chronic physical health problem, or do not have a physical health problem but are seeking re-assurance about somatic symptoms or are repeatedly worrying about a range of different issues.”

Dr Tim Kendall, Director of the National Collaborating Centre for Mental Health and Consultant Psychiatrist at Sheffield Health and Social Care NHS Foundation Trust said: “It is with real pride that we are now announcing the release of new, better and fully updated guidance on the treatment and management of GAD in primary and secondary care.

“It has been produced through probably the most rigorous evidence analysis worldwide and the recommendations are, as a result, really robust. People with GAD will be able to choose from a range of self help interventions, including two psychological treatments and some antidepressants.

“The guideline emphasises choice and patient preference, and is much clearer that there are some old treatments that just don't work. This is a really excellent and new piece of work produced with some of our top national clinical experts and really committed service users,” he added.