This guideline covers the care and treatment of people aged 18 and over with generalised anxiety disorder (chronic anxiety) or panic disorder (with or without agoraphobia or panic attacks). It aims to help people achieve complete relief of symptoms (remission), which is associated with better functioning and a lower likelihood of relapse.
In June 2020, we updated the information on the classes of antidepressants suitable for longer-term management of panic disorder and added links to MHRA advice on citalopram and selective serotonin reuptake inhibitors.
In July 2019, we updated footnotes and tables in this guideline to reflect a change in the law relating to pregabalin and gabapentin. As of 1 April 2019, because of a risk of abuse and dependence pregabalin and gabapentin are controlled under the Misuse of Drugs Act 1971 as class C substances and scheduled under the Misuse of Drugs Regulations 2001 as schedule 3.
MHRA advice on antiepileptic drugs in pregnancy: In July 2022, we linked to the MHRA safety advice on pregabalin risks during pregnancy in the recommendation on drug treatment for people with generalised anxiety disorder who cannot tolerate selective serotonin reuptake inhibitors or serotonin-noradrenaline reuptake inhibitors.
This guideline includes recommendations on:
- principles of care for people with generalised anxiety disorder
- stepped care for people with generalised anxiety disorder
- principles of care for people with panic disorder
- stepped care for people with panic disorder
Who is it for?
- Healthcare professionals
- Adults with a working diagnosis of generalised anxiety disorder or panic disorder (with or without agoraphobia), and their families and carers
Is this guideline up to date?
We checked this guideline in March 2020. We found no new evidence that affects the recommendations of this guideline but have updated information on medicines prescribed for anxiety.
Guideline development process
This guideline was previously called generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: management in primary, secondary and community care.
This guideline updates and replaces NICE guideline CG22 (December 2004) and evidence summary ESUOM12.
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.