ABSTRACT
OBJECTIVES: This study investigated the consensus about treatment strategies for the initial treatment of generalized anxiety disorder (GAD). This issue represents one of the subjects addressed by the Korean Medication Algorithm Project for GAD in Korea. METHODS: The executive committee of the Korean Medication Algorithm Project for GAD, supported by The Korean Association of Anxiety Disorders, developed questionnaires about treatment strategies for patients with GAD, based on guidelines or algorithms and clinical trial studies previously published in foreign countries, especially by the International Psychopharmacology Algorithm Project, the National Institute for Clinical Excellence, and the Canadian Psychiatric Association. Fifty-five (64%) of 86 experts on a committee reviewing GAD in Korea responded to the questionnaires. We classified the consensus of expert opinions into three categories (first-line, second-line, and third-line treatment strategies) and identified the treatment of choice according using a Chi-square test and a 95% confidence interval. RESULTS: For the initial treatment of GAD, antidepressant monotherapy and the combination of antidepressants and benzodiazepines as anxiolytics were recommended as the first line strategies. Escitalopram, paroxetine CR and venlafaxine XR were selected as first-line antidepressant treatments, and alprazolam, clonazepam and lorazepam were the preferred benzodiazepines. The mean starting doses and mean maximum doses of the drugs were 7.55+/-3.09 mg and 24.91+/-8.14 mg for escitalopram, 12.57+/-2.83 mg and 44.76+/-15.00 mg for paroxetine CR, and 46.81+/-16.74 mg and 223.32+/-60.64 mg for venlafaxine XR. CONCLUSION: These results, which reflect recent studies and clinical experiences, may provide guidelines for the initial.