Anxiety disorders have a high prevalence, particularly
specific phobia,
social anxiety disorder (SAD),
post-traumatic stress disorder (
PTSD) and generalized
anxiety disorder (GAD). The lifetime prevalence for any
anxiety disorder is almost 30%. Also, many
anxiety disorders have a high rate of comorbid depression, which is generally secondary to the anxiety. Despite high prevalence,
anxiety disorders are under-diagnosed, misdiagnosed and inappropriately treated. There is a hierarchy in the lifetime probability of treatment contact, with panic and GAD being diagnosed and treated earlier - possibly as a result of these disorders being the most "visible", unlike SAD, which is characteristically discreet. Under-diagnosis is linked with under-treatment: less than one in five patients with an
anxiety disorder receive appropriate medication, which improves to almost one in three for subjects with comorbid depression. For the majority of people with undiagnosed or untreated
anxiety disorder, there are many negative consequences, for both the individual and society. These include disability, reduced ability to work leading to loss of productivity, and a high risk of suicide. All of these factors contribute to a reduced quality of life. The economic costs associated with
anxiety disorders are large - €48 billion over 28 European countries - and similar to those for
dementia. Almost half of the costs are indirect, due to loss of productivity and earnings; the remainder being direct medical and non-medical costs. Current first-line
therapies are the antidepressive
selective serotonin reuptake inhibitors (
SSRIs), with cognitive behavioural
therapy a first- or second-line treatment. However,
benzodiazepines continue to be prescribed more often than
antidepressants. Recent studies have shown that a new type of SSRI,
escitalopram (the S-enantiomer of the racemic
citalopram), with a unique mode of action, is effective and offers potential as a new treatment for
anxiety disorders.