Patient with persistent anxiety and worry. Action: confirm the criteria for generalised anxiety disorder (GAD), explain the anxiety cycle, start with non-pharmacological interventions and avoid long-term benzodiazepines; refer if suicide risk or comorbidity.
Suicidal ideation, panic attacks with cardiovascular symptoms, psychotic symptoms, alcohol or substance use, severe functional impairment → priority referral.
Excessive worry and anxiety on most days for ≥6 months, with ≥3 somatic symptoms (muscle tension, irritability, insomnia, fatigue, difficulty concentrating).
Explain the anxiety cycle, sleep hygiene, reducing caffeine and alcohol, regular exercise and breathing techniques. Involve the support network.
Cognitive behavioural therapy (CBT) as first line. In moderate-to-severe symptoms, SSRIs (e.g. sertraline) by medical prescription, with slow titration and warning of initial effects.
Review every 2–4 weeks. Benzodiazepines only short term (≤4 weeks) with gradual tapering; avoid in older people. Reassess SSRI response at 4–6 weeks.
Benzodiazepines only short term (≤4 weeks) and by medical prescription, with gradual discontinuation. Avoid in older people (risk of falls and confusion). SSRIs require slow titration and a warning about transient worsening at the start.