Primary Care Approaches to Anxiety: CBT and SSRIs/SNRIs Lead Effective Treatment

Anxiety disorders are common yet often underrecognized in primary care, but a review shows that cognitive-behavioral therapy (CBT), selective serotonin and serotonin-norepinephrine reuptake inhibitors (SSRIs/SNRIs), and collaborative care models can substantially improve outcomes. Current recommendations support anxiety screening for adults younger than 65 years, with assessment including symptom questionnaires, clinical interviews, physical examination, and laboratory testing because anxiety frequently presents with physical symptoms. For mild or subthreshold anxiety, self-help strategies and behavioral interventions are recommended as first-line approaches. For diagnosed anxiety disorders, treatment decisions should be individualized based on symptom severity, patient preferences, treatment history, and potential adverse effects. CBT remains the preferred behavioral therapy, including brief CBT delivered within primary care settings. First-line medications include SSRIs and SNRIs, which are generally well tolerated and suitable for long-term use, whereas benzodiazepines are discouraged because of adverse-effect risks. Collaborative Care Management—integrating primary care clinicians, psychiatrists, and care managers—has also been shown to improve anxiety outcomes and patient functioning. Source: https://jamanetwork.com/