The German Guidelines for the treatment of anxiety disorders: first revision

Borwin Bandelow,Jörg Wiltink,Sebastian Rudolf,Manfred E. Beutel,Antonia M. Werner,Ina Kopp

doi:10.1007/s00406-021-01324-1

Abstract

Starting in 2019, the 2014 German Guidelines for Anxiety Disorders (Bandelow et al. Eur Arch Psychiatry Clin Neurosci 265:363–373, 2015) have been revised by a consensus group consisting of 35 experts representing the 29 leading German specialist societies and patient self-help organizations. While the first version of the guideline was based on 403 randomized controlled studies (RCTs), 92 additional RCTs have been included in this revision. According to the consensus committee, anxiety disorders should be treated with psychotherapy, pharmacological drugs, or their combination. Cognitive behavioral therapy (CBT) was regarded as the psychological treatment with the highest level of evidence. Psychodynamic therapy (PDT) was recommended when CBT was not effective or unavailable or when PDT was preferred by the patient informed about more effective alternatives. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) are recommended as first-line drugs for anxiety disorders. Medications should be continued for 6–12 months after remission. When either medications or psychotherapy were not effective, treatment should be switched to the other approach or to their combination. For patients non-responsive to standard treatments, a number of alternative strategies have been suggested. An individual treatment plan should consider efficacy, side effects, costs and the preference of the patient. Changes in the revision include recommendations regarding virtual reality exposure therapy, Internet interventions and systemic therapy. The recommendations are not only applicable for Germany but may also be helpful for developing treatment plans in all other countries.

Highlights

Anxiety disorders (Table 1) are the most prevalent psychiatric disorders and are associated with a high burden of illness [8]
Treatment is indicated when a patient fulfills criteria for an anxiety disorder as defined by ICD or DSM, shows marked distress or suffers from the sequelae resulting from the disorder
When pregnant women suffer from an anxiety disorder, the risk of an untreated anxiety disorder must be weighed against the risk of damage to the unborn child as a result of drug treatment

Summary

Introduction

Anxiety disorders (Table 1) are the most prevalent psychiatric disorders and are associated with a high burden of illness [8]. With a 12-month prevalence of 10.3%, specific phobias are the most common anxiety disorders [18], individuals suffering from isolated phobias rarely seek treatment. The second most common type is panic disorder with or without agoraphobia (PDA; 6.0%), followed by social anxiety disorder (SAD) (2.7%) and generalized anxiety disorder (GAD; 2.2%). There is no evidence that anxiety disorders have occurred more frequently in recent years or decades [21, 22]. These disorders often co-occur with other anxiety disorders, depression, somatoform, personality, and substance abuse disorders [19]

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