药物治疗应给予至少 6至8周, 以确定疗效,以作者的临床经验来看,如果有效应继续用药至少 12个月。[30]Fricchione G. Generalized anxiety disorder. N Engl J Med. 2004 Aug 12;351(7):675-82.http://www.ncbi.nlm.nih.gov/pubmed/15306669?tool=bestpractice.com[81]Batelaan NM, Bosman RC, Muntingh A, et al. Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials. BMJ. 2017 Sep 13;358:j3927.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5596392/http://www.ncbi.nlm.nih.gov/pubmed/28903922?tool=bestpractice.com 患者和处方医生可能达成一致,在此时期后尝试逐渐减少药物,并监测患者症状的复发。如治疗得当,随着症状的减少,社会心理功能会逐步恢复,医疗照顾消耗减少。GAD 可能会在躯体或情绪压力下复发。
30%~60%的患者并存抑郁,且自杀风险增加。抑郁障碍合并 GAD 患者有一个更为严重,时间更长的病程。[106]Kessler RC, DuPont RL, Berglund P, et al. Impairment in pure and comorbid generalized anxiety disorder and major depression at 12 months in two national surveys. Am J Psychiatry. 1999 Dec;156(12):1915-23.http://www.ncbi.nlm.nih.gov/pubmed/10588405?tool=bestpractice.com