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

Aim

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 (published in 2002, revised in 2008).

Method

A consensus panel of 33 international experts representing 22 countries developed recommendations based on efficacy and acceptability of available treatments. In total, 1007 RCTs for the treatment of these disorders in adults, adolescents, and children with medications, psychotherapy and other non-pharmacological interventions were evaluated, applying the same rigorous methods that are standard for the assessment of medications.

Result

This 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. Cognitive behavioural therapy (CBT) is the first-line psychotherapy for anxiety disorders. The expert panel also made recommendations for patients not responding to standard treatments and recommendations against interventions with insufficient evidence.

Conclusion

It is the goal of this initiative to provide treatment guidance for these disorders that has validity throughout the world.

Keywords:

• Anxiety disorders
• treatment
• guideline
• adolescents
• children

Acknowledgements

B. Bandelow, C. Allgulander, D. Baldwin, K. Domschke, E. Erikson, V. Masdrakis, N. Fineberg, S. Pallanti, and J. Zohar are members of the Anxiety Disorders Network (ADRN) of the European College of Neuropsychopharmacology (ECNP).

Disclosure statement

The authors have worked to ensure that all information, concerning drug dosages, schedules, routes of administration and licencing in this guideline is accurate and consistent with general psychiatric and medical standards at the time of publication. However, due to changing government regulations, continuing research, and changing information concerning drug therapy and reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage, or for added precautions. Moreover, specific situations may require a specific therapeutic response not included in this guideline. For these reasons and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of physicians directly involved in their care or the care of a member of their family. The authors and publisher disclaim any responsibility for any consequences which may follow from the use of information presented in this guideline.

The preparation of these guidelines has not been financially supported by any commercial organisation. This practice guidelines have mainly been developed by psychiatrists and psychotherapists who are in active clinical practice. In addition, some contributors are primarily involved in research or other academic endeavours. It is possible that through such activities some contributors have received income related to medicines discussed in this guideline. A number of mechanisms are in place to minimise the potential for producing biased recommendations due to conflicts of interest.

The following conflicts of interest were reported for the past 36 months.

The following authors report there are no competing interests to declare:

Table

Note

These principles of practice are considered guidelines only. Adherence to them will not ensure a successful outcome in every case. The individual treatment of a patient should be planned by in the light of clinical features presented by the patient and the diagnostic and treatment options available.

Some of the medications recommended in this guideline may not (or not yet) have received approval for the treatment of anxiety disorders in every country. As the approval by national regulatory authorities is dependent on a variety of factors, this guideline is exclusively based on the available evidence.