Correspondence

Generalized Anxiety Disorder

N Engl J Med 2004; 351:2239November 18, 2004

Article

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.2-4 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

5 References

1. 1

   Fricchione G. Generalized anxiety disorder. N Engl J Med 2004;351:675-682
   Full Text | Web of Science | Medline

2. 2

   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
   Web of Science | Medline

3. 3

   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
   CrossRef | Web of Science | Medline

4. 4

   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
   CrossRef | Web of Science | Medline

5. 5

   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
   CrossRef | Web of Science | Medline

Author/Editor Response

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

3 References

1. 1

   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
   CrossRef | Web of Science | Medline

2. 2

   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
   CrossRef | Web of Science | Medline

3. 3

   Craft LL, Perna FM. The benefits of exercise for the clinically depressed. Prim Care Companion J Clin Psychiatry 2004;6:104-111
   CrossRef | Medline