Anxiety disorders: under-diagnosed and insufficiently treated.

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.