In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, World J Biol Psychiatry
3:171), recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD)
and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a
substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse
prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed
by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of
Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders, a consensus panel of 30 international experts, are
now based on 510 published randomized, placebo- or comparator-controlled clinical studies (RCTs) and 130 open
studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs),
serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic
antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/
SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance
abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this
overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive
behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled
studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in
combination with the above medicines.
