Bandelow B, Sher L, Bunevicius R, Hollander E, Kasper S, Zohan J et al. Guidelines for the pharmacological treatment of anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder in primary care. Int J Psychiatry Clin Pract 16: 77-84

Department of Psychiatry and Psychotherapy, University of Göttingen, Göttingen, Germany.
International Journal of Psychiatry in Clinical Practice (Impact Factor: 1.39). 04/2012; 16(2):77-84. DOI: 10.3109/13651501.2012.667114
Source: PubMed


Anxiety disorders are frequently under-diagnosed conditions in primary care, although they can be managed effectively by general practitioners.
This paper is a short and practical summary of the World Federation of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety disorders, obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) for the treatment in primary care. The recommendations were developed by a task force of 30 international experts in the field and are based on randomized controlled studies.
First-line pharmacological treatments for these disorders are selective serotonin reuptake inhibitors (for all disorders), serotonin-norepinephrine reuptake inhibitors (for some) and pregabalin (for generalized anxiety disorder only). A combination of medication and cognitive behavior/exposure therapy was shown to be a clinically desired treatment strategy.
This short version of an evidence-based guideline may improve treatment of anxiety disorders, OCD, and PTSD in primary care.

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Available from: Borwin Bandelow, Feb 14, 2014
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    • "Available pharmacological and psychotherapeutic treatments (Bandelow et al., 2007) which aim to reduce fear and anxiety are associated with decreased symptom severity, but up to 40% of anxiety patients show only partial long-term benefit, and a majority of them fail to achieve complete remission (Hoffman & Mathew, 2008; Stein et al., 2009; Bandelow et al., 2012) clearly underlining the need for further improvement. Current pharmacological approaches either induce rapid anxiolytic effects (e.g. "
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    ABSTRACT: Pathological fear and anxiety are highly debilitating and, despite considerable advances in psychotherapy and pharmacotherapy they remain insufficiently treated in many patients with PTSD, phobias, panic and other anxiety disorders. Increasing preclinical and clinical evidence indicates that pharmacological treatments including cognitive enhancers, when given as adjuncts to psychotherapeutic approaches [cognitive behavioral therapy including extinction-based exposure therapy] enhance treatment efficacy, while using anxiolytics such as benzodiazepines as adjuncts can undermine long-term treatment success. The purpose of this review is to outline the literature showing how pharmacological interventions targeting neurotransmitter systems including serotonin, dopamine, noradrenaline, histamine, glutamate, GABA, cannabinoids, neuropeptides (oxytocin, neuropeptides Y and S, opioids) and other targets (neurotrophins BDNF and FGF2, glucocorticoids, L-type-calcium channels, epigenetic modifications) as well as their downstream signaling pathways, can augment fear extinction and strengthen extinction memory persistently in preclinical models. Particularly promising approaches are discussed in regard to their effects on specific aspects of fear extinction namely, acquisition, consolidation and retrieval, including long-term protection from return of fear (relapse) phenomena like spontaneous recovery, reinstatement and renewal of fear. We also highlight the promising translational value of the preclinial research and the clinical potential of targeting certain neurochemical systems with, for example D-cycloserine, yohimbine, cortisol, and L-DOPA. The current body of research reveals important new insights into the neurobiology and neurochemistry of fear extinction and holds significant promise for pharmacologically-augmented psychotherapy as an improved approach to treat trauma and anxiety-related disorders in a more efficient and persistent way promoting enhanced symptom remission and recovery.
    Full-text · Article · Dec 2014 · Pharmacology [?] Therapeutics
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    • "Considering the neurobiology of GAD, pharmacological guidelines recommend treatment with selective serotonin reuptake inhibitors, selective serotonin– norepinephrine reuptake inhibitors, or pregablin (Montgomery et al., 2006; Hoffman and Mathew, 2008; Baldwin et al., 2012; Bandelow et al., 2012). Approved selective serotonin reuptake inhibitors for GAD include escitalopram (Davidson et al., 2004; Allgulander et al., 2006; Lenze et al., 2009) and paroxetine (Pollack et al., 2001; Rickels et al., 2003; Stocchi et al., 2003). "
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    ABSTRACT: This was a flexible-dosed study to evaluate the efficacy and safety of duloxetine 30-120 mg once daily in the treatment of generalized anxiety disorder (GAD) in older adult patients. Patients with GAD, who were at least 65 years of age, were randomly assigned to double-blind treatment with either duloxetine (N = 151) or placebo (N = 140). The primary efficacy measure was the Hamilton Anxiety Rating Scale (HAM-A) total score, and the primary endpoint was at week 10. Global functioning was assessed by the Sheehan Disability Scale (SDS). Safety and tolerability was assessed by the occurrence of treatment-emergent adverse events, serious adverse events, laboratory analyses, and vital signs. Analyses were conducted on an intent-to-treat basis. The overall baseline mean HAM-A total score was 24, and SDS global score was 14. Completion rates were 75% for placebo and 76% for duloxetine. At week 10, duloxetine was superior to placebo on mean changes from baseline in HAM-A total scores (-15.9 vs. -11.7, p < 0.001) and in SDS global scores (-8.6 vs. -5.4, p < 0.001). Treatment-emergent adverse events occurred in ≥5% of duloxetine-treated patients and twice the rate than with placebo including constipation (9% vs. 4%, p = 0.06), dry mouth (7% vs. 1%, p = 0.02), and somnolence (6% vs. 2%, p = 0.14). Duloxetine treatment was efficacious in the improvement of anxiety and functioning in older adult patients with GAD, and the safety profile was consistent with previous GAD studies. © 2014 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd.
    Full-text · Article · Sep 2014 · International Journal of Geriatric Psychiatry
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    • "Most pharmacological guidelines suggest that first-line pharmacotherapy should include selective serotonin reuptake inhibitors (SSRIs) and, more recently, venlafaxine extended-release, a serotonin norepinephrine reuptake inhibitor (SNRI), has also been identified as a promising agent for the treatment of PTSD (American Psychiatric Association, 2004; Baldwin et al., 2005; Bandelow et al., 2012; Canadian Psychiatric Association, 2006; Schaffer et al., 2012). However, the current pharmacotherapy options for PTSD often do not result in satisfactory clinical outcomes, as evidenced by several controlled or open-label clinical trials and a handful of metaanalyses that used various selection criteria (Ipser and Stein, 2012; Pae et al., 2008a; Watts et al., 2013). "
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    ABSTRACT: Despite the fact that the majority of currently available treatment guidelines propose antidepressants as the first-line pharmacological therapy for posttraumatic stress disorder (PTSD), a substantial portion of patients fail to show an adequate response following this type of treatment. In this context, a number of small, open-label studies and randomized controlled clinical trials (RCTs) have found atypical antipsychotics (AAs) to be a beneficial treatment for patients with PTSD. Thus, the present meta-analysis was conducted to enhance the sample size power and further the current understanding of the role of AAs for the treatment of PTSD. An extensive search of several databases identified 12 appropriate RCTs and available data from 9 of these (n = 497) were included in the final meta-analysis. AAs may have potential benefits for the treatment of PTSD as indicated by changes from baseline of the total score on the Clinician Administered PTSD Scale (CAPS; standardized mean difference [SMD] = -0.289, 95% confidence intervals [CIs] = -0.471, -0.106), P = 0.002). Additionally, AAs were found to be significantly more effective (P < 0.0001) than a placebo in terms of change from baseline for the intrusion sub-score on the CAPS (SMD = -0.373, 95% CIs = -0.568, -0.178) but there were no significant reductions for the avoidance and hyperarousal sub-symptoms. The responder rate and rate of improvement of depressive symptoms were also significantly higher in the AA group than the placebo group (P = 0.004 and P < 0.0001, respectively). However, the present results should be interpreted carefully and be translated into clinical practice only with due consideration of the limited quality and quantity of existing RCTs included in this analysis.
    Full-text · Article · May 2014 · Journal of Psychiatric Research
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