2024 한국형 범불안장애 치료지침: 초기 및 유지 약물치료 전략
Korean Guidelines for the Treatment of Generalized Anxiety Disorder 2024: Initial and Maintenance Treatment Strategies for the Pharmacological Treatment of Generalized Anxiety Disorder
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Objective : The Korean Association of Anxiety Disorders developed Korean guidelines for the treatment of generalized anxiety disorder (GAD) 2024. In this paper, we discussed the consensus among psychiatrists specializing in anxiety disorders, regarding initial and maintenance treatment strategies for pharmacological treatment of GAD in Korea. Methods : The executive committee developed questionnaires on treatment strategies for patients with GAD, based on previous treatment guidelines and academic articles published internationally and in Korea. Sixty-two experts responded to the questionnaires. The consensus of expert opinions was classified into three categories (first-line, second-line, and third-line choices) using the chi-square test and 95% confidence intervals. Results : Combination of antidepressants and anxiolytics was recommended as treatments of choice (ToC), and antidepressant single pharmacotherapy as first-line strategies for initial treatment of GAD. Several SSRI, SNRI, and mirtazapine were preferred from among many antidepressants, and, among anti-anxiety drugs, clonazepam, alprazolam, buspirone, and lorazepam were first preferred. In the case of maintenance treatment of GAD, antidepressant single pharmacotherapy was selected as ToC and first-line strategies. In addition, it was reported that the preference for atypical antipsychotics was high not only in the initial but also in the maintenance treatment stage as antidepressants and atypical antipsychotics combination treatment maintained the top second-line strategies. Patients were typically examined every four weeks during treatment, to review effectiveness and side effects of the drug. Pharmacotherapy was generally continued for one year or more. Conclusion : This study is based on the clinical experience of Korean experts regarding pharmacological treatment strategies for patients with GAD, and and it is expected to be helpful in presenting the basis and plan for GAD treatment in clinical practice. (Anxiety and Mood 2024;20(2):54-64)
Abstract
Objective : The Korean Association of Anxiety Disorders developed Korean guidelines for the treatment of generalized anxiety disorder (GAD) 2024. In this paper, we discussed the consensus among psychiatrists specializing in anxiety disorders, regarding initial and maintenance treatment strategies for pharmacological treatment of GAD in Korea. Methods : The executive committee developed questionnaires on treatment strategies for patients with GAD, based on previous treatment guidelines and academic articles published internationally and in Korea. Sixty-two experts responded to the questionnaires. The consensus of expert opinions was classified into three categories (first-line, second-line, and third-line choices) using the chi-square test and 95% confidence intervals. Results : Combination of antidepressants and anxiolytics was recommended as treatments of choice (ToC), and antidepressant single pharmacotherapy as first-line strategies for initial treatment of GAD. Several SSRI, SNRI, and mirtazapine were preferred from among many antidepressants, and, among anti-anxiety drugs, clonazepam, alprazolam, buspirone, and lorazepam were first preferred. In the case of maintenance treatment of GAD, antidepressant single pharmacotherapy was selected as ToC and first-line strategies. In addition, it was reported that the preference for atypical antipsychotics was high not only in the initial but also in the maintenance treatment stage as antidepressants and atypical antipsychotics combination treatment maintained the top second-line strategies. Patients were typically examined every four weeks during treatment, to review effectiveness and side effects of the drug. Pharmacotherapy was generally continued for one year or more. Conclusion : This study is based on the clinical experience of Korean experts regarding pharmacological treatment strategies for patients with GAD, and and it is expected to be helpful in presenting the basis and plan for GAD treatment in clinical practice. (Anxiety and Mood 2024;20(2):54-64)
참고문헌 (16)
- Ruscio AM, "Cross-sectional comparison of the epidemiology of DSM-5 generalized anxiety disorder across the globe", JAMA Psychiatry, 74, pp.465~475 (2017)
- Wittchen HU, "Generalized anxiety disorder : prevalence, burden, and cost to society", Depress Anxiety, 16, pp.162~171 (2002)
- Lee JY, "Korean medication algorithm project for generalized anxiety disorder 2009(II) : medication algorithm & long-term medication treatment strategy", J Korean Neuropsychiatr Assoc, 49, pp.553~563 (2010)
- Bandelow B, "World Federation of Societies of Biological Psychiatry(WFSBP)guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders-Version 3. Part II : OCD and PTSD", World J Biol Psychiatry, 24, pp.118~134 (2023)
- Buszewicz M, "Pilot of a randomised controlled trial of the selective serotonin reuptake inhibitor sertraline versus cognitive behavioural therapy for anxiety symptoms in people with generalised anxiety disorder who have failed to respond to low-intensity psychological treatments as defined by the National Institute for Health and Care Excellence guidelines", Health Technol Assess, 21, pp.1~138 (2017)
- Katzman MA, "Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders", BMC Psychiatry, 14(Suppl 1), pp.S1~ (2014)
- Zimmerman N, "Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders : major depression summary", Med J Aust, 209, pp.43~ (2018)
- Albert U, "Role and clinical implications of atypical antipsychotics in anxiety disorders, obsessive-compulsive disorder, trauma-related, and somatic symptom disorders : a systematized review", Int Clin Psychopharmacol, 31, pp.249~258 (2016)
- Lorenz RA, "Adjunctive use of atypical antipsychotics for treatment-resistant generalized anxiety disorder", Pharmacotherapy, 30, pp.942~951 (2010)
- Gao K, "Atypical antipsychotics in primary generalized anxiety disorder or comorbid with mood disorders", Expert Rev Neurother, 9, pp.1147~1158 (2009)
- Hoge EA, "Aripiprazole as augmentation treatment of refractory generalized anxiety disorder and panic disorder", CNS Spectr, 13, pp.522~527 (2008)
- Szeleszczuk L, "Propranolol versus other selected drugs in the treatment of various types of anxiety or stress, with particular reference to stage fright and post-traumatic stress disorder", Int J Mol Sci, 23, pp.17~ (2022)
- De Salas-Cansado M, "Pregabalin versus SSRIs and SNRIs in benzodiazepine-refractory outpatients with generalized anxiety disorder : a post hoc cost-effectiveness analysis in usual medical practice in Spain", Clinicoecon Outcomes Res, 4, pp.157~168 (2012)
- Baldwin DS, "Pregabalin for the treatment of generalized anxiety disorder : an update", Neuropsychiatr Dis Treat, 9, pp.883~892 (2013)
- Sicras-Mainar A, "Comparative effectiveness and costs of generic and brand-name gabapentin and venlafaxine in patients with neuropathic pain or generalized anxiety disorder in Spain", Clinicoecon Outcomes Res, 7, pp.299~312 (2015)
- Hong JSW, "Gabapentin and pregabalin in bipolar disorder, anxiety states, and insomnia : Systematic review, meta-analysis, and rationale", Mol Psychiatry, 27, pp.1339~1349 (2022)