J Korean Neuropsychiatr Assoc.
2010 Nov;49(6):553-563.
Korean Medication Algorithm Project for Generalized Anxiety Disorder 2009 (II) : Medication Algorithm & Long-Term Medication Treatment Strategy
- Affiliations
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- 1Department of Psychiatry, School of Medicine, CHA University, Seoul, Korea. freud@chol.com
- 2Department of Psychiatry, Inje University College of Medicine, Seoul, Korea.
- 3Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea.
- 4Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea.
- 5Department of Psychiatry, Sungkyunkwan University College of Medicine, Seoul, Korea.
Abstract
OBJECTIVES
This study was performed to investigate the consensus about medication algorithms, including long-term medication treatment strategies, in the treatment of generalized anxiety disorder (GAD).
METHODS
The executive committee of the Korean Medication Algorithm Project for GAD developed questionnaires about the psychopharmacologic treatment strategies for patients with GAD. Fifty-five (65%) of 84 experts of a reviewing committee answered the questionnaires. The consensus of expert opinion was classified into three categories, and the treatments of choice were selected by use of 95% confidence intervals and chi-square-tests.
RESULTS
The consensus on the first-line treatment strategy for GAD was as follows. Step 1 is the use of the one of a selective serotonin reuptake inhibitor (SSRI), a serotonin and noradrenaline reuptake inhibitor (SNRI) and buspirone for at least four to six weeks. Step 2 is to switch from a SSRI to a SNRI or buspirone or vice versa. Step 3 is to augment medication with an atypical antipsychotic or add a benzodiazepine or antihistamine. Step 4 is to switch to another combination, which includes a SSRI, a SNRI, mirtazapine or a tricyclic antidepressant Step 6 is to review the diagnosis, and 'benzodiazepines including clonazepam and alprazolam can be combined with another drug even from the initial period'. In terms of long-term medication treatment, the consensus first-line tr-eatment strategy involved the use of venlafaxine XR, escitalopram, fluoxetine, paroxetine CR, sertraline and buspirone.
CONCLUSION
This study provided information about the consensus among Korean experts regarding medication algorithms, including long-term medication treatment strategies, in the treatment of GAD.
Keyword
MeSH Terms
-
Alprazolam
Anxiety
Anxiety Disorders
Benzodiazepines
Buspirone
Citalopram
Clonazepam
Consensus
Cyclohexanols
Expert Testimony
Fluoxetine
Humans
Mianserin
Norepinephrine
Paroxetine
Psychopharmacology
Surveys and Questionnaires
Serotonin
Sertraline
Venlafaxine Hydrochloride
Alprazolam
Benzodiazepines
Buspirone
Citalopram
Clonazepam
Cyclohexanols
Fluoxetine
Mianserin
Norepinephrine
Paroxetine
Serotonin
Sertraline
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