An international survey of reported prescribing practice in the treatment of patients with generalised anxiety disorder

Abstract

Objective. To gain insight into the experience and practice of psychiatrists in the pharmacological management of patients with generalized anxiety disorder (GAD). Methods. Multiple-choice questionnaire completed by 501 psychiatrists (representing a 45% response rate) from 18 countries, selected by pharmaceutical company representatives to attend a scientific meeting, through having an interest in anxiety disorders. Results. Use of screening tools, routine structured diagnostic interviews, and practice guidelines was infrequent. Over one-third of patients did not receive their initial psychiatric consultation within a month after referral. A total of 45% of patients had symptoms for 2 years or longer before being diagnosed and treated. Most patients had been treated with benzodiazepines before referral. 80% of respondents always or often prescribed selective serotonin reuptake inhibitors (SSRIs), 43% serotonin–norepinephrine reuptake inhibitors (SNRIs), or pregabalin (35%) as first-line treatments. The most frequently recommended second-line treatments were SNRIs (41%) and pregabalin (36%). Concentration difficulties, fatigue, excessive worrying and pain were reported as the symptoms most difficult to manage. Conclusions. Patients with GAD have frequently been treated with benzodiazepines before referral to a psychiatrist. SSRIs were the preferred first-line treatment, and SNRIs and pregabalin preferred second-line treatments. Reported practice in this sample appears largely consistent with recent evidence-based treatment guidelines.

Key words::

• Generalized anxiety disorder
• GAD
• survey
• psychiatrist
• clinical practice

Acknowledgements

The authors wish to thank all psychiatrists who completed the survey and Ms Janet Bray MRPharmS, who provided assistance with data collection, analysis, and editorial support.

Statement of Interest

The Managing Anxiety in Practice (MAP™) programme was organized by Intramed Europe International Business Centre and funded by Pfizer Ltd. The programme content, including the content of the questionnaire, was developed by the Steering Committee. Authors were compensated for their role in the MAP™ Steering Committee but were not compensated for their development of this manuscript. Janet Bray was compensated by Pfizer Ltd.

David Baldwin has acted as a consultant to a number of companies with an interest in anxiety disorders (AstraZeneca, Eli Lilly, Lundbeck, Pierre Fabre, Pfizer, Roche, Servier, Wyeth). He has held research grants (on behalf of his employer) from a number of companies with an interest in affective disorders (Lundbeck, Wyeth), and has accepted paid speaking engagements in industry supported symposia (Astra Zeneca, Lundbeck, Pfizer, Servier) at international and national meetings. He is a medical patron of the self-help organisation charity, Anxiety UK. Christer Allgulander has acted as a speaker for Lilly, Pfizer and AstraZeneca, and been a member of the advisory board for Pfizer. In the last five years and in the near future, Borwin Bandelow has been/will be on the Speakers board for: AstraZeneca, Bristol-Myers-Squibb, Dainippon Sumitomo, Janssen-Cilag, Lilly, Lundbeck, Pfizer, Solvay, Wyeth, Xian-Janssen and on the Consultant/advisory board for: AstraZeneca, Cephalon, Lilly, Lundbeck, Pfizer, Roche, Wyeth. Francisco Ferre has acted as a speaker for Pfizer in industry supported satellite symposia at international and national meetings. He is the coordinator and the scientific advisor of a study sponsored by Pfizer. He has accepted paid speaking engagements in from Bristol Myers, Eli Lilly, GSK, and Wyeth. Stefano Pallanti has acted as a speaker for Pfizer, Abbot, Eli Lilly, been a member of an advisory board for AstraZeneca, acted as a consultant to Transcept Pharmaceutical.