Tired and anxious

• Published in: BMJ 2008-10, Vol.337 (oct01 2), p.a1241-a1241
• Main Authors: Gale, Chris, Davidson, Oliver
• Format: Article
• Language: English
• Subjects: Alcohol-Related Disorders - psychology; Antidepressants; Anxiety; Depressive Disorder - psychology; Fatigue - etiology; Fear & phobias; Humans; Male; Mental depression; Middle Aged; Phobic Disorders - etiology; Psychiatry
• ISSN: 0959-8138; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.a1241

Some guidelines suggest that men can drink up to 21 standard drinks a week, 6 and up to eight drinks in a session, 7 but some people have difficulty keeping below these limits. 8 The CAGE questionnaire can help ascertain whether or not he is dependent on alcohol. 9 Questions include, "have you felt the need to cut down alcohol?" "have you been abstinent for a period?" "how guilty do you feel about your alcohol use?," and "do you need a drink in the morning to get going?" Check also for other consequences of his drinking including marital discord, financial difficulties, legal problems (especially driving), and problems at work to see how invasive his drinking has become. 3. 10 The second review (search date 2004) identified 15 controlled trials-paroxetine 20-60 mg/day, fluvoxamine 100-300 mg/day, escitalopram 10-20 mg/day, fluoxetine 10-60 mg/day, and sertraline 50-200 mg/day were all efficacious when compared with placebo. 11 Large effects sizes have been reported for the use of cognitive behavioural therapy in anxiety-meta-analyses suggest that it is highly effective in adults with a range of disorders, including generalised anxiety disorder and social phobias. 12 Evidence exists for its long term effectiveness in anxiety disorders. 13 The benefit of combining cognitive behavioural therapy with drug treatment is unclear because few well controlled trials have looked at single versus combined treatment for social phobia and generalised anxiety disorder.