Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology

Abstract

This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees.

The pharmacological management of psychiatric comorbidities in patients with epilepsy

“…Positive interactions represent additive or synergistic treatment effects and this can be potentially postulated for depression, anxiety, pain and migraine prophylaxis, but evidence-based data are limited. For example, pregabalin (PGB) is currently licensed for the treatment of generalised anxiety disorder and a recent study suggested a synergistic effects between antidepressants and PGB (37). Evidence-based data on augmentation strategies in neuropathic pain or migraine are limited although it is reasonable to hypothesise that the combined AED-antidepressant treatment could be favourable.…”

Management of panic disorder in primary care

“…Once the diagnosis has been explained to the patient, it is often reasonable to give a hopeful prognosis, outline the available treatments and negotiate a treatment package. Table 2) have been shown to be effective against the symptoms of panic disorder 13,14 and clinical studies have demonstrated high rates of efficacy -up to 80 per cent in some trials using drugs originally developed for depression (antidepressants). Among antidepressants, citalopram, escitalopram, paroxetine, sertraline and certain formulations of venlafaxine are licensed specifically for panic disorder.…”

“…Numerous double-blind randomised trials have demonstrated significantly higher rates of response or remission on active drug compared with placebo, despite panic disorder being typically associated with relatively high rates of placebo response. These trials, which will be discussed in the following paragraphs, are summarised in the British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder 13 and described in greater detail in the Canadian clinical practice guidelines for the management of anxiety, post-traumatic stress and obsessive-compulsive disorders. 14 The main classes with evidence of efficacy are drugs that augment the function of serotonin (and sometimes noradrenaline) through reuptake blockade and drugs acting as positive allosteric modulators at GABA A receptor (benzodiazepines).…”

Use of pregabalin for therapy of patients with generalised anxiety disorder - pilot investigation: Review of case studies

“…Zbog toge postoji preporuka je da se pacijentima sa generalizovanim anksioznim poremećajem za početak lečenja odredi terapija koja je pokazala efikasnost, a nema neželjena dejstva koja mogu da kompromituju tretman [5,6]. Pored toga, treba da se obrati pažnja na eventualno postojanje komorbidih oboljenja (pre svega depresije), ali i na praktične aspekte -kao što su iskustva sa terapijom, dostupnost terapije i lekara za buduće kontrole, ekonomske mogućnosti pacijenta, preference samog pacijenta i slično.…”

“…Što se tiče farmakoterapije, na osnovu kliničkog iskustva i na osnovu rezultata kliničkih studija, a na bazi potvrđene efikasnosti i najbenignijeg profila neže-ljenih dejstava, preporuka je da se pacijenti sa generalizovanim anksioznim poremećajem tretiraju nekim lekom iz grupe SSRI antidepresiva (citalopram, escitalopram, fluoksetin, paroksetin, sertralin), nekim lekom iz grupe iz grupe SNRI antidepresiva (duloksetin ili venlafaksin) ili pregabalinom, ukoliko ne postoje simptomi komorbidne depresije [5,6,7].…”