123 - Summary of NICE guidelines for the treatment

Summary of NICE guidelines for the treatment of GAD, panic disorder and OCD

Depression and anxiety disorders CHAPTER 3 References

1. Nash JR, et al. Pharmacotherapy of anxiety. HandbExp Pharmacol 2005; (169):469–501.
2. Munkholm K, et al. Minor tranquillizers for short-­term treatment of newly onset symptoms of anxiety and distress: a systematic review with network meta-­analysis of randomized trials. Eur Arch Psychiatry Clin Neurosci 2024; 274:475–486.
3. Benitez CI, et al. Use of benzodiazepines and selective serotonin reuptake inhibitors in middle-­aged and older adults with anxiety disorders: a longitudinal and prospective study. Am J Geriatr Psychiatry 2008; 16:5–13.
4. Demyttenaere K, et al. Clinical factors influencing the prescription of antidepressants and benzodiazepines: results from the European study of the epidemiology of mental disorders (ESEMeD). J Affect Disord 2008; 110:84–93.
5. Hirschtritt ME, et al. Balancing the risks and benefits of benzodiazepines. JAMA 2021; 325:347–348.
6. National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management. Clinical guideline [CG113]. 2011 (last updated June 2020, reviewed May 2024, last checked November 2024); https://www.nice.org.uk/guidance/cg113.
7. Davidson JR. Use of benzodiazepines in social anxiety disorder, generalized anxiety disorder, and posttraumatic stress disorder. J Clin Psychiatry 2004; 65 Suppl 5:29–33.
8. Scott A, et al. Antidepressant drugs in the treatment of anxiety disorders. Adv Psychiatr Treat 2001; 7:275–282.
9. Ballenger JC. Remission rates in patients with anxiety disorders treated with paroxetine. J Clin Psychiatry 2004; 65:1696–1707.
10. Davidson JR, et  al. A psychopharmacological treatment algorithm for generalised anxiety disorder (GAD). J Psychopharmacol 2010; 24:3–26.
11. Baldwin DS, et  al. 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. J Psychopharmacol 2014; 28:403–439.
12. Baldwin D, et al. Efficacy of drug treatments for generalised anxiety disorder: systematic review and meta-­analysis. BMJ 2011; 342:d1199.
13. Slee A, et al. Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-­analysis. Lancet 2019; 393:768–777.
14. Kong W, et al. Comparative remission rates and tolerability of drugs for generalised anxiety disorder: a systematic review and network meta-­ analysis of double-­blind randomized controlled trials. Front Pharmacol 2020; 11:580858.
15. Caillard V, et al. Comparative effects of low and high doses of clomipramine and placebo in panic disorder: a double-­blind controlled study. French University Antidepressant Group. Acta Psychiatr Scand 1999; 99:51–58.
16. Wade AG, et al. The effect of citalopram in panic disorder. Br J Psychiatry 1997; 170:549–553.
17. Londborg PD, et al. Sertraline in the treatment of panic disorder: a multi-­site, double-­blind, placebo-­controlled, fixed-­dose investigation. Br J Psychiatry 1998; 173:54–60.
18. Pollack MH, et al. Combined paroxetine and clonazepam treatment strategies compared to paroxetine monotherapy for panic disorder. J Psychopharmacol 2003; 17:276–282. Drug Comments Levetiracetam 300–3000mg/day in divided doses156 Moclobemide 600mg/day in divided doses Initiate at 300mg/day in divided doses. Has a UK licence for social phobia. Recommended by NICE.148 Phenelzine 15–90mg/day157 Avoidance of tyramine-­rich food important. Recommended by NICE.148 Pregabalin 150–600mg/day153 600mg/day superior to placebo153 Experimental Ketamine 0.5mg/kg IV One good RCT,158 one post hoc analysis159 Topiramate 25–400mg/day160 Small open-label study of 23 patients suggests efficacy but poorly tolerated Valproate 500–2500mg/day161 Small open-label study of 17 patients suggests efficacy