Interactions between psychotherapy and drug therapy in generalized anxiety disorder

Given the availability of a wide range of proven pharmacological treatments for anxiety disorders and also the range of effective psychological interventions, the debate over drug therapy versus non-drug therapy, e.g. Cognitive Behavioural Therapy (CBT), has evolved into an appreciation of the importance of combining both approaches. The clinical trials of combination therapy in Generalized Anxiety Disorder (GAD) are still rare in comparison to those in Panic Disorder and OCD. A critical review of the few combination therapy studies in GAD revealed methodological limitations and variations in diagnostic criteria and in treatment–therapy combinations which gave inconsistent results, so rendering specific conclusions impossible, except that combination therapy may be of particular usefulness in severe cases of GAD. In general practice, not all patients require combination therapy and various criteria need to be addressed, e.g. What are the clinical indications, safety and efficacy of combined strategies? How does one adapt one treatment strategy to increase the efficacy of the other? Clinical findings have suggested that in particular anxiety states, drug therapy (especially the benzodiazepines) may inhibit the long term gains from psychotherapy. In order to show the differential long term effects of two anxiolytics (hydroxyzine and alprazolam) on ongoing psychosocial therapy in GAD, a controlled double-blind study was conducted concurrently in Mumbai and Paris.