anxiety

Importance Anxiety disorders and symptoms are prevalent and burdensome, and patients are most likely to seek treatment in primary care settings. However, anxiety is underdetected and undertreated. This narrative review details behavioral and pharmacological treatment options that are feasible and effective in primary care.

Observations Screening for anxiety is recommended for primary care patients younger than 65 years. Given that anxiety often involves somatic symptoms, assessment should include patient-reported symptom measures, clinical interview, physical examination, and appropriate laboratory tests. For subthreshold symptoms (those that do not meet diagnostic criteria for anxiety disorders) and adjustment-related anxiety, starting with self-help and behavioral treatment is recommended. When deciding between behavioral, pharmacological, or combined treatment for anxiety disorders, consider the presentation, patient preferences, potential adverse effects, and treatment history, and engage in shared decision-making. Cognitive-behavioral therapy (CBT) is the first-line behavioral treatment for anxiety. Brief CBT in primary care delivered by embedded behavioral health clinicians is effective. First-line pharmacotherapy for anxiety disorders includes several selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, which tend to be well tolerated without considerable long-term adverse effects. The main decision for pharmacological treatment is between a daily medication and a short-acting medication taken as needed for intermittent symptoms or while awaiting the effect of a daily medication. Benzodiazepines are not recommended due to risk of adverse effects, especially with long-term use. The Collaborative Care Management model, which involves collaboration between primary care clinicians, consulting psychiatrists, and care managers who monitor patient progress and provide behavioral treatment, improves anxiety outcomes compared to usual primary care.

Conclusions and Relevance Clinicians should recognize common anxiety presentations and understand how to differentiate between anxiety and other psychiatric or medical conditions. Referring patients to behavioral health specialists for CBT and/or prescribing recommended pharmacotherapy with Collaborative Care Management can help to reduce patient morbidity and improve functioning.

Author/s:

Robyn L. Shepardson, Jeffrey S. Khan, Katherine A. Buckheit

I’m Concerned About Anxiety—What Do I Need to Know?

Megan George — Tue, 05 May 2026 13:36:49 +0000

Date Added:

May 5, 2026

Journal/Publication:

JAMA

Publication Date:

May 4, 2026

URL:

I’m Concerned About Anxiety—What Do I Need to Know?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jamainternmed.2026.0392

Keywords

PMID (1):

42081216

MeSH

Information for patients about the causes and management of anxiety. James W. Mold, MD, MPH

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What Is Anxiety?
Anxiety is a normal experience of worry or fear about something the body or mind interprets as threatening. Anxiety may show up in your thoughts, emotions, body sensations, or behaviors (like worrying, feeling nervous, sweaty palms, and avoiding certain situations).

Author/s:

Robyn L. Shepardson, Jeffrey S. Khan, Jennifer S. Funderburk

I’m Concerned About Anxiety—What Do I Need to Know?

Megan George — Tue, 05 May 2026 13:35:29 +0000

Date Added:

May 5, 2026

Journal/Publication:

JAMA

Publication Date:

May 4, 2026

URL:

I’m Concerned About Anxiety—What Do I Need to Know?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jamainternmed.2026.0392

Keywords

PMID (1):

42081216

MeSH

Information for patients about the causes and management of anxiety. James W. Mold, MD, MPH

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Author/s:

Robyn L. Shepardson, Jeffrey S. Khan, Jennifer S. Funderburk

Practical Recommendations for Minimizing Pain and Anxiety with IUD Insertion

Erin Blanchette — Mon, 24 Mar 2025 16:11:24 +0000

Date Added:

March 24, 2025

Journal/Publication:

Journal of the American Board of Family Medicine

Publisher:

American Board of Family Medicine

Publication Date:

November 1, 2024

Issue:

Volume:

Pages:

1150-1155

URL:

Practical Recommendations for Minimizing Pain and Anxiety with IUD Insertion

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.3122/jabfm.2024.240079R1

Keywords

PMID (1):

40118554

MeSH

Intrauterine Devices* / adverse effects

Intrauterine Devices

female

Contraceptive Agents, Female

Pain / prevention & control

pain management

Lidocaine

Prilocaine Drug Combination

An evidence-based review of methods for reducing pain during IUD insertion. Many of these would probably work as well for other painful procedures. James W. Mold, MD, MPH

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Background: Intrauterine devices (IUDs) are one of the most effective, long-lasting, and convenient contraceptive methods available in the United States. Unfortunately, the anticipated pain and anxiety associated with an IUD insertion procedure deter many people from using this contraceptive method.

Methods: A literature review was conducted on PubMed by searching the terms “IUD insertion”, “pain management”, “anxiety”, “gynecologic procedures”. The Cochrane database was also searched for reviews about pain management methods during IUD insertions. Findings were summarized using the American Academy of Family Physicians’ Strength of Recommendation Taxonomy (SORT) scale.

Results: Pharmacologic methods that can be used to reduce pain with IUD insertion include naproxen, tramadol, lidocaine paracervical blocks, 10% lidocaine spray, lidocaine-prilocaine cream, and EMLA cream. Non-pharmacologic methods for reducing pain or anxiety during gynecologic procedures include pre-insertion counseling, “verbal analgesia”, lavender aromatherapy, distraction with music or television, using Valsalva maneuver instead of tenaculum during IUD insertion, and use of heating pad during procedure.

Conclusion: Moderately effective pharmacologic and non-pharmacologic methods exist for reducing pain and anxiety with IUD insertion. These treatment methods should be offered to create a more comfortable experience for patients. Additional research is needed to determine the comparative efficacy of these methods.

Author/s:

Viktoriya Ovsepyan, Petra Kelsey, Ann E Evensen

Nonpharmacologic Treatments for Maternal Mental Health Conditions

Alex Haga — Tue, 20 Aug 2024 19:53:30 +0000

Date Added:

August 20, 2024

Journal/Publication:

Agency for Healthcare Research and Quality

Publication Date:

July 31, 2024

URL:

Nonpharmacologic Treatments for Maternal Mental Health Conditions

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

MeSH

Cognitive Behavioral Therapy

counseling

Postpartum period

An evidence-based review of non-pharmocologic treatments for maternal mental health conditions. James W. Mold, MD, MPH

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Objectives. This systematic review evaluates nonpharmacologic treatments for mental health conditions during the perinatal period (pregnancy and up to 12 months postpartum). We evaluated nonpharmacologic treatments for perinatal individuals with depressive disorders, anxiety disorders, bipolar disorder, post-traumatic stress disorder (PTSD), or obsessive-compulsive disorder (OCD).

Data sources and review methods. We searched MEDLINE®, PsycINFO®, Embase®, CINAHL®, the Cochrane Register of Clinical Trials, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov from January 1, 2000, to January 17, 2024, to identify relevant randomized controlled trials (RCTs). Nonpharmacologic interventions of interest included, among others, cognitive behavioral therapy (CBT), interpersonal therapy (IPT), exercise, non-directive counseling, behavioral activation, bright light therapy, eye movement desensitization and reprocessing (EMDR), and acupuncture. Outcomes of interest were improvement in scores on psychological assessment tools, cure or resolution of symptoms, suicide-related outcomes, and adherence to treatment. PROSPERO registration number: CRD42023440650.

Results. We identified 103 RCTs. Nonpharmacologic treatments were compared to control or each other in 101 RCTs and to pharmacologic treatments in 2 RCTs. The risk of bias was moderate for the majority of included studies, mostly related to lack of blinding. For perinatal individuals with depressive disorders, CBT was more effective than treatment as usual (TAU) to reduce depressive and anxiety symptoms (both moderate strength of evidence [SoE]); IPT was more effective than TAU to treat depressive symptoms (moderate SoE) and anxiety symptoms (low SoE); and both behavioral activation (a CBT technique, with low SoE) and exercise interventions (moderate SoE) were more effective than TAU to reduce depressive symptoms. Remission rates for depressive symptoms were higher with CBT and IPT compared to TAU (both low SoE) and higher with specific acupuncture than nonspecific or sham acupuncture (low SoE). There were no differences between CBT and non-directive counseling (an active patient-led intervention), between counseling and TAU, and between bright light and placebo light therapy (all low SoE). CBT was more effective than TAU to reduce anxiety and depressive symptoms for individuals with combined depressive and anxiety disorders (low SoE). Few (or no) eligible studies evaluated individuals with anxiety disorder, PTSD, OCD, or bipolar disorders, precluding conclusions for these conditions. There was also insufficient evidence for suicide-related outcomes, potential harms of treatment, and adherence to treatment, and for comparisons of nonpharmacologic with pharmacologic treatments.

Conclusion. Several nonpharmacologic treatments are more effective than TAU for perinatal mental health conditions, with the strongest evidence for CBT and IPT to reduce depressive symptoms among perinatal individuals with depressive disorders or combined depressive and anxiety disorders. Future research is needed to evaluate the comparative effectiveness of lesser studied nonpharmacologic interventions and lesser studied perinatal mental health conditions.

A GUIDE to help patients and families better understand serious illnesses: Mnemonic device provides way to teach learners about advance care planning

Erin Blanchette — Sun, 04 Feb 2024 22:49:57 +0000

Date Added:

February 4, 2024

Journal/Publication:

Canadian Family Physician

Publisher:

College of Family Physicians of Canada

Publication Date:

January 1, 2024

Issue:

Volume:

Pages:

68-70

URL:

A GUIDE to help patients and families better understand serious illnesses: Mnemonic device provides way to teach learners about advance care planning

Type:

Clinical Decision Aids, Best Local Practices

Format:

Article

DOI (1):

10.46747/cfp.700168

Keywords

advance care planning

PMID (1):

38262750

MeSH

Advance Care Planning

patients

terminal care

Cardiopulmonary Resuscitation

life expectancy

anxiety

Explanation of how to use illness trajectory graphs to guide advance care planning in people with serious illnesses. James W. Mold, MD, MPH

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Advance care planning (ACP) was identified as a priority in the 2006 final report of the Public Information and Awareness Working Group of the Canadian Strategy on Palliative and End-of-Life Care.1 An important component of ACP is patients’ understanding of their prognoses, which might include expectations related to future function, symptoms, and life expectancy.2-4 Without realistic prognostic information, patients are at risk of not engaging in ACP that would otherwise help them gain control over their illnesses, reduce anxiety, and avoid unwanted treatments.2,3,5 Moreover, lack of that information might lead to challenging downstream goals-of-care conversations. In guidance published in 2023 regarding a physician’s duty to discuss a patient’s medical condition and prognosis during a goals-of-care discussion when the physician deems cardiopulmonary resuscitation not to be indicated, the College of Physicians and Surgeons of Ontario highlighted the importance of physicians being able to communicate prognoses skillfully.6

Author/s:

Helen James, Warren Harris Lewin

Screening for Anxiety Disorders in Adults: US Preventive Services Task Force Recommendation Statement

Aubrey Delammermore — Sat, 24 Jun 2023 22:55:19 +0000

Date Added:

June 24, 2023

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

June 20, 2023

URL:

Screening for Anxiety Disorders in Adults: US Preventive Services Task Force Recommendation Statement

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2023.9301

Keywords

PMID (1):

37338866

MeSH

The USPSTF recommends screening all adults under 65 for anxiety disorders. James W. Mold, MD, MPH

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Importance: Anxiety disorders are commonly occurring mental health conditions. They are often unrecognized in primary care settings and substantial delays in treatment initiation occur.

Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for anxiety disorders in asymptomatic adults.

Population: Asymptomatic adults 19 years or older, including pregnant and postpartum persons. Older adults are defined as those 65 years or older.

Evidence assessment: The USPSTF concludes with moderate certainty that screening for anxiety disorders in adults, including pregnant and postpartum persons, has a moderate net benefit. The USPSTF concludes that the evidence is insufficient on screening for anxiety disorders in older adults.

Recommendation: The USPSTF recommends screening for anxiety disorders in adults, including pregnant and postpartum persons. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety disorders in older adults. (I statement).

Author/s:

US Preventive Services Task Force, Barry, M. J., Nicholson, W. K., Silverstein, M., Coker, T. R., Davidson, K. W., Davis, E. M., Donahue, K. E., Jaén, C. R., Li, L., Ogedegbe, G., Pbert, L., Roa, G., Ruiz, J. M., Stevermer, J., Tsevat, J., Underwood, S. M., Wong, J. B.

Bedbugs

Aubrey Delammermore — Sat, 27 May 2023 05:00:00 +0000

Date Added:

May 27, 2023

Journal/Publication:

CMAJ

Publisher:

CMA Impact

Publication Date:

May 23, 2023

Issue:

Volume:

195

Pages:

E709

URL:

Bedbugs

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

37220928

Keywords

bedbugs

insecticide resistance

bedbug bites

antihistamines

anxiety

PMID (1):

10.1503/cmaj.221454

MeSH

Bedbugs

Insecticide Resistance

sleep initiation and maintenance disorders

Bedding and Linens

Ectoparasitic Infestations

A concise review of what clinicians need to know about bedbugs. James W. Mold, MD, MPH

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A resurgence in bedbugs is a result of increased travel and insecticide resistance
Many bedbug populations are resistant to pyrethroid, a chemical contained in most currently used insecticides.1 Bedbugs multiply exponentially, with thousands of bugs per infestation after 2–3 months.

Author/s:

Freedman, A., McDougall, L., Lamy, P.

Anxiety in Children and Adolescents: Screening

Rowan Hutchins — Sun, 16 Oct 2022 05:00:00 +0000

Date Added:

October 16, 2022

Journal/Publication:

JAMA

Publisher:

US Preventitive Services Task Force

Publication Date:

October 11, 2022

Issue:

Volume:

328

Pages:

1438-1444

URL:

Anxiety in Children and Adolescents: Screening

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2022.18184

Keywords

anxiety

Anxiety disorders

adolescent

adolescent psychiatry

preventative care

USPSTF

PMID (1):

36219419

MeSH

adolescent

Anxiety / diagnosis

Anxiety Disorders / diagnosis

preventitive health services

child

USPSTF recommends screening older children and adolescents (age 8 – 18) for anxiety. James W. Mold, MD, MPH

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Anxiety disorder, a common mental health condition in the US, comprises a group of related conditions characterized by excessive fear or worry that present as emotional and physical symptoms. The 2018-2019 National Survey of Children’s Health (NSCH) found that 7.8% of children and adolescents aged 3 to 17 years had a current anxiety disorder. Anxiety disorders in childhood and adolescence are associated with an increased likelihood of a future anxiety disorder or depression.

Author/s:

Carol M. Mangione, MD, MSPH

Post COVID-19 Syndrome (Long Haul Syndrome): Description of a Multidisciplinary Clinic at the Mayo Clinic and Characteristics of the Initial Patient Cohort

Saige Blanchard — Tue, 18 May 2021 05:00:00 +0000

Date Added:

May 18, 2021

Journal/Publication:

Mayo Clinic Proceedings

Publisher:

Mayo Foundation for Medical Education and Research

Publication Date:

April 30, 2021

URL:

Post COVID-19 Syndrome (Long Haul Syndrome): Description of a Multidisciplinary Clinic at the Mayo Clinic and Characteristics of the Initial Patient Cohort

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://doi.org/10.1016/j.mayocp.2021.04.024

Keywords

MeSH

preexisting condition coverage

A description of adult patients with COVID-19 “long-haul syndrome” being seen at the Mayo Clinic.

James W. Mold, MD, MPH

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Objective

To describe characteristics of a series of patients reporting prolonged symptoms after an infection with COVID-19.

Methods

This study describes the multidisciplinary COVID-19 Activity Rehabilitation Program (CARP), established at Mayo Clinic to evaluate and treat post-COVID-19 syndrome (PCS) patients, and reports the clinical characteristics of the first 100 patients receiving evaluation and management during the timeframe of June 1, 2020 and December 31, 2020.

Results

The cohort consisted of 100 patients (mean age 45 years, 68% women, BMI 30.2, presenting a mean of 93 days after infection). Common pre-existing conditions were respiratory (23%) and mental health, including depression and/or anxiety (34%.) The majority (75%) had not been hospitalized for COVID-19. Common presenting symptoms ware fatigue (80%), respiratory complaints (59%), and neurologic complaints (59%) followed by subjective cognitive impairment, sleep disturbance, and mental health symptoms. More than one-third of the patients (34%) reported difficulties with performing basic activities of daily living. Only 1 in 3 patients had returned to unrestricted work duty at the time of the analysis. For most patients, laboratory and imaging studies were normal or non-diagnostic despite debilitating symptoms. Most patients required physical therapy, occupational therapy, or brain rehabilitation. Face-to-face and virtual care delivery modalities were feasible.

Conclusion

Many of the patients did not experience COVID-19-related symptoms that were severe enough to require hospitalization, were younger than 65 years of age, more likely to be female, and most had no pre-existing comorbidities prior to SARS-CoV-2 infection. Symptoms including mood disorders, fatigue, and perceived cognitive impairment resulted in severe negative impacts on resumption of functional and occupational activities in patients experiencing prolonged effects.

Author/s:

Vanichkachorn, G., Newcomb, R., Cowl, C. T., Trenary, M., Higgins, S., Neveau, D., Murad, M. H., Breeher, L., Miller, S.

Screening for Anxiety in Adolescent and Adult Women: A Recommendation From the Women's Preventive Services Initiative

Brian Desmarais — Fri, 12 Jun 2020 19:58:10 +0000

Date Added:

June 12, 2020

Journal/Publication:

Annals of Internal Medicine

Publication Date:

June 9, 2020

URL:

Screening for Anxiety in Adolescent and Adult Women: A Recommendation From the Women's Preventive Services Initiative

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/M20-0580

Keywords

Health services administration and management

The Women’s Preventive Services Initiative (WPSI) recommends screening for anxiety in women and adolescent girls aged 13 years or older who are not currently diagnosed with anxiety disorders, including pregnant and postpartum women. Optimal screening intervals are unknown, and clinical judgment should be used to determine frequency. When screening suggests the presence of anxiety, further evaluation is necessary to establish the diagnosis and determine appropriate treatment and follow-up. James W. Mold, MD, MPH

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Abstract

Description: The Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient representatives, developed a recommendation on screening for anxiety in adolescent and adult women to improve detection; achieve earlier diagnosis and treatment; and improve health, function, and well-being. The WPSI's recommendations are intended to guide clinical practice and coverage of services for the Health Resources and Services Administration and other stakeholders. The target audience for this recommendation includes all clinicians providing preventive health care to women, particularly in primary care settings. This recommendation applies to women and adolescent girls aged 13 years or older who are not currently diagnosed with anxiety disorders, including pregnant and postpartum women.

Methods: The WPSI developed this recommendation after evaluating results of a systematic review of the effectiveness of screening, accuracy of screening instruments, and benefits and harms of treatments in adolescent girls and adult women. No studies directly evaluated the overall effectiveness or harms of screening for anxiety. Twenty-seven screening instruments and their variations were moderately to highly accurate in identifying anxiety (33 individual studies and 2 systematic reviews; 171 studies total). Symptoms improved and relapse rates decreased with psychological therapies (246 randomized controlled trials [RCTs] in 5 systematic reviews) and with selective serotonin reuptake inhibitors or selective serotonin and norepinephrine reuptake inhibitors (126 RCTs in 3 systematic reviews). The WPSI also considered the effect of screening on symptom progression and identification of associated and underlying conditions, as well as implementation factors.

Recommendation: The WPSI recommends screening for anxiety in women and adolescent girls aged 13 years or older who are not currently diagnosed with anxiety disorders, including pregnant and postpartum women. Optimal screening intervals are unknown, and clinical judgment should be used to determine frequency. When screening suggests the presence of anxiety, further evaluation is necessary to establish the diagnosis and determine appropriate treatment and follow-up.

Keywords: Adolescents; Anxiety; Anxiety disorders; Forecasting; Health services administration and management; Quality of life; Questionnaires; Reuptake inhibitors; Serotonin; Systematic reviews.

Author/s:

Gregory, K.D., Chelmow, C., Nelson, H.D., Sayres Van Niel, M., Conry, J.A., Garcia, F., Kendig, S.M., O'Reilly, N., Qaseem, A., Ramos, D., Salganicoff , A., Son, S., Wood, J.K, Zahn, C.

Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-analysis

Jeffrey Wilson — Sun, 24 Feb 2019 19:56:30 +0000

Date Added:

February 24, 2019

Journal/Publication:

The Lancet

Publisher:

Elsevier

Publication Date:

January 31, 2019

Issue:

10173

Volume:

393

Pages:

768-777

URL:

Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/S0140-6736(18)31793-8

Keywords

anxiety

global anxiety disorder

PMID (1):

30712879

MeSH

This is a systematic review of the evidence available on treatment of global anxiety disorder.

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BACKGROUND:

Generalised anxiety disorder is a disease that can be associated with substantial dysfunction. Pharmacological treatment is often the first choice for clinicians because of the cost and resource constraints of psychological alternatives, but there is a paucity of comparative information for the multiple available drug choices.

METHODS:

A systematic review and network meta-analysis was performed on randomised trials in adult outpatients with generalised anxiety disorder identified from MEDLINE, Web of Science, Cochrane Library, ClinicalTrials.gov, Chinese National Knowledge Infrastructure (CNKI), Wanfang data, Drugs@FDA and commercial pharmaceutical registries. Placebo and active control trials were included. Data were extracted from all manuscripts and reports. Primary outcomes were efficacy (mean difference [MD] in change in Hamilton Anxiety Scale Score) and acceptability (study discontinuations for any cause). We estimated summary mean treatment differences and odds ratios using network meta-analyses with random effects. This study is registered with PROSPERO, number CRD42018087106.

FINDINGS:

Studies were published between Jan 1, 1994 and Aug 1, 2017, in which 1992 potential studies were screened for inclusion. This analysis is based on 89 trials, which included 25 441 patients randomly assigned to 22 different active drugs or placebo. Duloxetine (MD -3·13, 95% credible interval [CrI] -4·13 to -2·13), pregabalin (MD -2·79, 95% CrI -3·69 to -1·91), venlafaxine (MD -2·69, 95% CrI -3·50 to -1·89), and escitalopram (MD -2·45, 95% CrI -3·27 to -1·63) were more efficacious than placebo with relatively good acceptability. Mirtazapine, sertraline, fluoxetine, buspirone, and agomelatine were also found to be efficacious and well tolerated but these findings were limited by small sample sizes. Quetiapine (MD -3·60 95% CrI -4·83 to -2·39) had the largest effect on HAM-A but it was poorly tolerated (odds ratio 1·44, 95% CrI 1·16-1·80) when compared with placebo. Likewise, paroxetine and benzodiazepines were effective but also poorly tolerated when compared with placebo. Risk of reporting bias was considered low, and when possible all completed studies were included to avoid publication bias.

INTERPRETATION:

To our knowledge, this is the largest contemporary review of pharmacological agents for the treatment of generalised anxiety disorder by use of networkanalysis. There are several effective treatment choices for generalised anxiety disorder across classes of medication. The failure of initial pharmacological therapy might not be a reason to abandon a pharmacological treatment strategy.

Author/s:

Slee, April, Nazareth, Irwin, Bondaronek, Paulina, Liu, Yifeng, Cheng, Zhihang, Freemantle, Nick