Generalized Anxiety Disorder
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《新英格兰医药杂志》
To the Editor: Fricchione (Aug. 12 issue)1 discusses generalized anxiety disorder and its treatment with pharmacologic agents and psychotherapy. We are surprised, however, that there is no mention of exercise as an additional means of treating anxiety. Cardiologists are interested in this disorder, because anxiety is a risk factor for major cardiovascular events,2 particularly sudden death from cardiac causes, a fact that suggests that malignant arrhythmias due to an increase in sympathetic stimulation or impaired vagal tone may be involved in such deaths.2,3,4 Exercise is known to exert salutary effects on certain emotions,3,4 including anxiety,5 and we have shown that cardiac rehabilitation and exercise training have a beneficial effect on measures of autonomic function.3 Exercise training has been shown to lead to reductions of more than 50 percent in the prevalence of the symptoms of anxiety.5 This supports exercise training as an additional method to reduce chronic anxiety.
Carl J. Lavie, M.D.
Richard V. Milani, M.D.
Ochsner Clinic Foundation
New Orleans, LA 70121
clavie@ochsner.org
References
Fricchione G. Generalized anxiety disorder. N Engl J Med 2004;351:675-682.
Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999;99:2192-2217.
Lucini D, Milani RV, Costantino G, Lavie CJ, Porta A, Pagani M. Effects of cardiac rehabilitation and exercise training on autonomic regulation in patients with coronary artery disease. Am Heart J 2002;143:977-983.
Lavie CJ, Milani RV. Effects of cardiac rehabilitation and exercise training programs on coronary patients with high levels of hostility. Mayo Clin Proc 1999;74:959-966.
Lavie CJ, Milani RV. Prevalence of anxiety in coronary patients with improvement following cardiac rehabilitation and exercise training. Am J Cardiol 2004;93:336-339.
Dr. Fricchione replies: Drs. Lavie and Milani raise the prospect that exercise may be an effective additional treatment for generalized anxiety disorder. They cite their studies showing a reduction in anxiety in the cardiac-rehabilitation population with exercise, which is important, given the cardiac risk associated with anxious mood.1 The reduction of anxiety as a result of exercise has also been shown in other medically ill populations in which anxiety was measured as a state or trait.2 My review was focused on generalized anxiety disorder, and space did not permit a full discussion of anxiety in relation to medical conditions. Nevertheless, the promising results of exercise in medically ill populations should encourage more rigorous study of its usefulness in the treatment of patients who have received a diagnosis of criteria-based generalized anxiety disorder. The fact that exercise appears to confer a benefit on those with clinical depression is also encouraging.3
Gregory Fricchione, M.D.
Massachusetts General Hospital
Boston, MA 02114
gfricchione@partners.org
References
Januzzi JL Jr, Stern TA, Pasternak RC, DeSanctis RW. The influence of anxiety and depression on outcomes of patients with coronary artery disease. Arch Intern Med 2000;160:1913-1921.
Suh MR, Jung HH, Kim SB, Park JS, Yang WS. Effects of regular exercise on anxiety, depression, and quality of life in maintenance hemodialysis patients. Ren Fail 2002;24:337-345.
Craft LL, Perna FM. The benefits of exercise for the clinically depressed. Prim Care Companion J Clin Psychiatry 2004;6:104-11.
Carl J. Lavie, M.D.
Richard V. Milani, M.D.
Ochsner Clinic Foundation
New Orleans, LA 70121
clavie@ochsner.org
References
Fricchione G. Generalized anxiety disorder. N Engl J Med 2004;351:675-682.
Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999;99:2192-2217.
Lucini D, Milani RV, Costantino G, Lavie CJ, Porta A, Pagani M. Effects of cardiac rehabilitation and exercise training on autonomic regulation in patients with coronary artery disease. Am Heart J 2002;143:977-983.
Lavie CJ, Milani RV. Effects of cardiac rehabilitation and exercise training programs on coronary patients with high levels of hostility. Mayo Clin Proc 1999;74:959-966.
Lavie CJ, Milani RV. Prevalence of anxiety in coronary patients with improvement following cardiac rehabilitation and exercise training. Am J Cardiol 2004;93:336-339.
Dr. Fricchione replies: Drs. Lavie and Milani raise the prospect that exercise may be an effective additional treatment for generalized anxiety disorder. They cite their studies showing a reduction in anxiety in the cardiac-rehabilitation population with exercise, which is important, given the cardiac risk associated with anxious mood.1 The reduction of anxiety as a result of exercise has also been shown in other medically ill populations in which anxiety was measured as a state or trait.2 My review was focused on generalized anxiety disorder, and space did not permit a full discussion of anxiety in relation to medical conditions. Nevertheless, the promising results of exercise in medically ill populations should encourage more rigorous study of its usefulness in the treatment of patients who have received a diagnosis of criteria-based generalized anxiety disorder. The fact that exercise appears to confer a benefit on those with clinical depression is also encouraging.3
Gregory Fricchione, M.D.
Massachusetts General Hospital
Boston, MA 02114
gfricchione@partners.org
References
Januzzi JL Jr, Stern TA, Pasternak RC, DeSanctis RW. The influence of anxiety and depression on outcomes of patients with coronary artery disease. Arch Intern Med 2000;160:1913-1921.
Suh MR, Jung HH, Kim SB, Park JS, Yang WS. Effects of regular exercise on anxiety, depression, and quality of life in maintenance hemodialysis patients. Ren Fail 2002;24:337-345.
Craft LL, Perna FM. The benefits of exercise for the clinically depressed. Prim Care Companion J Clin Psychiatry 2004;6:104-11.