Equally important is GAD ...

No less important is GAD in the practice of pulmonology: they suffer from 10-15% of patients with chronic obstructive pulmonary disease and subsyndromal anxiety detected in 13-51% of them. GAD affects lung function and quality of life for lung patients, as one of prognostic factors for hospitalization [15]. Finally, a chronic and clinically apparent GAD affects up to 30% of long-living cancer patients [84]. The treatment goal of treatment for GAD is to eliminate the main symptoms - chronic anxiety, muscle tension, autonomic hyperactivity and sleep disorders. Therapy should begin by explaining the patient the fact that available to him to somatic and mental symptoms are a manifestation of increased anxiety and that anxiety itself - is not a "natural reaction to stress, and disease state, which is successfully treatable. The main methods of treatment of GAD is psychotherapy (primarily cognitive-behavioral and relaxation techniques) and drug therapy. In terms of national health care system systematic skilled psychotherapy until malodostupna, so in the first place stands medication GAD and subsyndromal anxiety. Its basic principle is not in the correction of certain physical and mental symptoms (Fig. 2), and in the administration of these drugs with protivotrevozhnym (anxiolytic) effect. In accordance with international guidelines, using different preparations with protivotrevozhnym action, anxiolytics and antidepressants. Their effectiveness in GAD was proven in double-blind controlled studies. Given the chronic course of GAD, the need for long-term therapy, the frequent presence of concomitant somatic diseases and taking other drugs, a drug for the treatment of GAD should meet the following criteria: effectiveness, safety and good tolerability with long-term acceptance, minimal drug interactions, rapid onset of action, quick cancel without incurring "withdrawal syndrome". The frequency of stable remission of GAD usually reaches 50-60% [18]. Steady positive trend noted in the average after 8 weeks and the symptoms of GAD - after 3-6 months of therapy. However, to avoid the recurrence of drug therapy is desirable to carry out longer, sometimes for a year or more [21]. Nevertheless, studies on long-term treatment of GAD are very few [73]. Of the antidepressants in GAD, the effectiveness of certain selective serotonin reuptake inhibitors (SSRIs), especially paroxetine [19.83], serotonin reuptake inhibitors and norepinephrine - nefazodone [37] and venlafaxine [22] (in Russia are not yet available), and as tricyclic antidepressant - imipramine [38]. Relative disadvantage of SSRIs is a long latency period before clinical effect. During the early reception of SSRIs may exacerbate symptoms of anxiety such as sleep disturbances and irritability, and actually protivotrevozhny effect develops in 2-6 weeks.