World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders – Version 3. Part I: Anxiety disorders

Abstract

This is the third version of the guideline of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Posttraumatic Stress Disorders which was published in 2002 and revised in 2008. A consensus panel of 33 international experts representing 22 countries developed recommendations based on efficacy and acceptability of available treatments. Since the publication of the last version of this guideline, a substantial number of new randomised controlled trials (RCTs) have been published. In this version, not only medications but also psychotherapies and other non-pharmacological interventions were evaluated, applying the same rigorous methods that are standard for the assessment of medication treatments. A systematic search for published trials for the treatment of these disorders in adults, adolescents, and children was performed, resulting in 1007 evaluable RCTs. The present paper (Part I) contains recommendations for the treatment of panic disorder/agoraphobia (PDA), generalised anxiety disorder (GAD), social anxiety disorder (SAD), specific phobias, mixed anxiety disorders in children and adolescents, separation anxiety and selective mutism. Selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first-line medications for anxiety disorders. Cognitive behavioural therapy (CBT) is the is the first-line psychotherapy for for anxiety disorders. The expert panel also made recommendations for patients who do not respond to standard treatments and recommendations against certain interventions which failed to provide sufficient evidence.It is the goal of this initiative to provide treatment guidance for these disorders that has validity throughout the world.

Management of unspecified anxiety disorder: Expert consensus

“…Anxiety disorders are frequent and persistent illnesses that is regarded as the ninth most health‐related cause of disability 1 . Treatment guidelines based on solid evidence that mainly stems from randomized controlled trials are available in some anxiety disorders including generalized anxiety disorder, panic disorder, and social anxiety disorder 2–5 . Unspecified anxiety disorder is a diagnosis that is characterized as significant anxiety or phobias without the exact criteria for any other anxiety disorders.…”

Anxiety disorders in general medical practice – clinical picture, diagnosis, optimized approaches to therapy

“…Анализ современных клинических рекомендаций, опубликованных как в нашей стране, так и за рубежном указывает на то, что тревожные расстройства эффективно поддаются как психофармакотерапии, так и психотерапии 2 [27,28]. Кроме того, было убедительно доказано, что комбинирование психофармакотерапии и психотерапии способствует существенному улучшению прогноза у пациентов с основными формами тревожных расстройств [29].…”

“…Исторически СИОЗС описываются как одна из групп антидепрессантов, однако прогресс нейронаук и клинических исследований за последние десятилетия свидетельствует в пользу наличия у препаратов этого класса выраженного противотревожного действия, которое реализуется вне зависимости от наличия у пациента депрессии [15]. Современные клинические рекомендации подтверждают, что все доступные в настоящее время СИОЗС эффективны при всех основных формах тревожных расстройств 3 [28] и в целом их эффективность сопоставима. Однако некоторые из СИОЗС в отдельных странах могут быть не зарегистрированы по некоторым показаниям.…”

Selenium and Its Compounds in the Treatment of Anxiety and Related Disorders: A Scoping Review of Translational and Clinical Research

“…The pathophysiology of these disorders is complex, involving structural and functional alterations of specific cortical and subcortical brain structures [10][11][12], dysfunction of specific neurotransmitter systems [13,14], immuneinflammatory pathways [15], oxidative stress [16,17], and impaired neural plasticity [18]. In contemporary guidelines for the pharmacological management of anxiety and related disorders, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the recommended first-line treatments [19,20]. Though these groups of drugs are superior to placebos, their effectiveness is often modest [21][22][23], and only about 40-60% of patients show a clinically significant response to them in short-to medium-term clinical trials [24][25][26].…”