International study of expert judgement on therapeutic use of benzodiazepines and other psychotherapeutic medications: II. Pharmacotherapy of anxiety disorders

• Published in: Journal of affective disorders 1995-12, Vol.35 (4), p.153-162
• Main Authors: Uhlenhuth, E.H., Balter, Mitchell B., Ban, Thomas A., Yang, Kenneth
• Format: Article
• Language: English
• Subjects: Anti-Anxiety Agents - adverse effects; Anti-Anxiety Agents - therapeutic use; Antidepressive Agents - adverse effects; Antidepressive Agents - therapeutic use; Anxiety disorder, Drug treatment; Anxiety Disorders - drug therapy; Anxiety Disorders - psychology; Benzodiazepine; Benzodiazepines; Biological and medical sciences; Cross-Cultural Comparison; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Humans; Medical sciences; Neuropharmacology; Panic Disorder - drug therapy; Panic Disorder - psychology; Patient Care Team; Pharmacology. Drug treatments; Phobic Disorders - drug therapy; Phobic Disorders - psychology; Product Surveillance, Postmarketing; Psycholeptics: tranquillizer, neuroleptic; Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Psychotherapy
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/0165-0327(95)00064-X

Objective: To assemble expert clinical experience and judgement in the treatment of anxiety and related disorders in a systematic, quantitative manner. Methods: A panel of internationally recognized Experts in treating anxiety and depression was constituted by multistage peer nomination. 90% completed a questionnaire. This report focuses on case vignettes of 7 anxiety disorders followed by questions about relevant therapeutic options. Results: Panelists usually recommended both psychological and pharmacological interventions. Most favored antidepressants, usually tricyclic, for agoraphobia, panic and OCD; beta-blockers for specific social phobia; and benzodiazepines for GAD and adjustment disorder. Some Experts favored polypharmacy, usually an antidepressant and a benzodiazepine. The majority usually advocated pharmacotherapy for 6 months or more. They recommended the same duration of treatment with benzodiazepines and other medications, except for GAD. Conclusions: The responses of the Expert Panel imply that: 1. (1) most anxiety disorders are serious and merit vigorous, prolonged pharmacotherapy; 2. (2) antidepressants and benzodiazepines are effective and safe for long-term treatment of these conditions. This outcome contrasts with the widespread apprehension about long-term pharmacotherapy, especially with benzodiazepines, and some regulatory views.