July 2019: Because of a risk of abuse and dependence, pregabalin is controlled under the Misuse of Drugs Act 1971 as a class C substance and scheduled under the Misuse of Drugs Regulations 2001 as schedule 3 (as of 1 April 2019). A footnote has been added by NICE to this guideline to reflect this change. Minor updates since publication July 2019: Recommendation 1.4.39 was amended to remove structured problem solving as a care and management option as this had originally been included in error. June 2018: Recommendation 1.2.13 was amended with advice on CBT. Recommendation 1.2.26 was updated with a link to the newest evidence on use of antipsychotics for treatment of GAD. Recommendation 1.4.7 was added to link to existing guidance on identifying treatment options for common mental health problems. Recommendation 1.4.10 on low-intensity interventions for mild to moderate panic disorder and 1.4.13 on treatment for moderate to severe panic disorder were added from the NICE guideline on common mental health disorders. Section 1.4 on stepped care for people with panic disorder was reordered.
This clinical guideline is an update of NICE’s previous guidance on generalised anxiety disorder. It was commissioned by NICE and developed by the National Collaborating Centre for Mental Health, and sets out clear evidence- and consensus-based recommendations for healthcare professionals on how to treat and manage generalised anxiety disorder in adults.
Around 4.4% of adults in England are affected by generalised anxiety disorder. It can become chronic if it is not treated, often co-occurs with other anxiety and depressive disorders and is associated with substantial disability. This guideline is an indispensable tool in enabling healthcare professionals to identify generalised anxiety disorder and provide the most effective treatments in a stepped-care framework.
This new guideline, which updates all the reviews of the previous guideline, presents and appraises the evidence for low- and high-intensity psychological interventions, drug treatment and other physical interventions, and also provides insight into the experience of care of people with generalised anxiety disorder. An important feature of the new guideline is the economic modelling that was undertaken in the areas of drug treatments and computerised cognitive behavioural therapy.
The guideline also partially updates the NICE Technology Appraisal 97, Computerised Cognitive Behaviour Therapy for Depression and Anxiety. This update focuses on CCBT for panic disorder only.
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