The main types of anxiety disorder are: 

• Generalised anxiety disorder

This is characterised by excessive and inappropriate worrying that is persistent and not restricted to particular circumstances. NICE recommends education about anxiety and active monitoring in the first place, followed, if there is no improvement, by individual self-help or psycho-educational groups. 

If these measures do not help or there is marked functional impairment, NICE recommends high-intensity psychological intervention (cognitive behavioural therapy or applied relaxation) or drug therapy (sertraline or, if ineffective, another SSRI or venlafaxine. If these cannot be tolerated, then pregabalin). Escitalopram, paroxetine, duloxetine, venlafaxine and pregabalin are licensed for the treatment of patients with generalised anxiety disorder; sertraline is unlicensed for this indication.

• Panic disorder

Panic disorder is characterised by recurrent or unexpected surges of anxiety (panic attacks). Most patients develop a fear of having future panic attacks. 

Psychological therapy, antidepressant drug therapy (a SSRI or a tricyclic) or self-help is recommended by NICE. Citalopram, escitalopram, paroxetine, sertraline and venlafaxine are licensed for the treatment of panic disorder.

• Social anxiety disorder 

Previously known as social phobia, this is a disproportionate and persistent fear of, or anxiety about, social or performance situations. It is one of the most prevalent anxiety disorders. There are strong associations between social anxiety disorder and alcohol or cannabis misuse. 

Treatment with individual cognitive behavioural therapy (CBT) that has been specifically developed to treat social anxiety disorder, or CBT-supported self-help is the NICE recommendation. If CBT is unavailable or ineffective, or the patient prefers drug therapy, NICE recommends a SSRI (escitalopram or sertraline). Fluvoxamine, paroxetine or venlafaxine are alternatives if escitalopram or sertraline are not tolerated or ineffective.