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The German guidelines for the treatment of anxiety disorders

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Abstract

A consensus group consisting of 36 experts representing 20 leading German specialist societies and patient self-help organizations developed evidence-based recommendations for the treatment of anxiety disorders in Germany. These were based on a systematic review of randomized controlled trials on anxiety disorders (n = 403) and on preexisting German and international guidelines. According to the consensus committee, anxiety disorders should be treated with psychotherapy or pharmacological drugs or a combination of both. Cognitive behavioral therapy (CBT) was regarded as the psychological treatment with the highest level of evidence. Psychodynamic therapy (PDT) was recommended for cases in which CBT was not effective or not available or in which PDT was the informed patient’s preferred option. First-line drugs for anxiety disorders include selective serotonin reuptake inhibitors and serotonin–noradrenaline reuptake inhibitors. After remission, medications should be continued for 6–12 months. When either drug or psychotherapy was not effective, treatment should be switched to the other approach or to a combination of both. For patients non-responsive to standard treatments, alternative strategies are suggested. When developing a treatment plan, efficacy, side effects, costs and the preference of the patient should be considered. A large amount of data available from randomized controlled trials permit the formulation of robust evidence-based recommendations for the treatment of anxiety disorders. The recommendations were not only developed for the special situation in Germany, but may also be helpful for developing treatment plans in other countries.

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Abbreviations

CBT:

Cognitive behavioral therapy

DSM:

Diagnostic and Statistical Manual for Mental Disorders

GAD:

Generalized Anxiety Disorder

ITT:

Intention to treat

PDA:

Panic Disorder with or without Agoraphobia

PDT:

Psychodynamic therapy

RCT:

Randomized controlled trial

RIMA:

Reversible inhibitor of monoamine oxidase A

SAD:

Social Anxiety Disorder

SNRI:

Serotonin–noradrenaline reuptake inhibitor

SSRI:

Selective serotonin reuptake inhibitor

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Acknowledgments

The members of the guideline committee were as follows: Georg W. Alpers, Cord Benecke, Jürgen Deckert, Annegret Eckhardt-Henn, Christian Ehrig, Kerstin Engel, Peter Falkai, Franziska Geiser, Alexander L. Gerlach, Stephan Hau, Timo Harfst, Peter Joraschky, Michael Kellner, Volker Köllner, Gernot Langs, Heinz Liebeck, Jürgen Matzat, Markus Reitt, Heinrich Peter Rüddel, Gerhard Schick, Ulrich Schweiger, Regine Simon, Andreas Ströhle, Anne Springer, Hermann Staats, Walter Ströhm, Benedikt Waldherr, Birgit Watzke, Dirk Wedekind, Jörg Wiltink, Christian Zottl, and Peter Michael Zwanzger. The members of the steering committee were Borwin Bandelow, Manfred E. Beutel, Thomas Lichte, and Sebastian Rudolf. Moderation: Ina Kopp.

Conflict of interest

All participants in the guideline panel have declared their conflicts of interest (e.g., having received lecture honoraria from drug manufacturers or being a leading member of a group which advocates a particular form psychotherapy school). The guideline committee undertook every effort to base its recommendations exclusively on objective evaluation of the scientific evidence. Participants with a relevant conflict of interest abstained when recommendations on the treatment in question were put to a vote. Prof. Bandelow has served as a paid consultant to Lilly, Lundbeck, Otsuka, and Pfizer. He has received honoraria for lectures at scientific meetings and continuing medical education events from AstraZeneca, Glaxo, Janssen, Lilly, Lundbeck, Meiji-Seika, Otsuka, Pfizer, and Servier. Prof. Beutel has received payment from Pfizer, Servier, and Boehringer-Ingelheim for preparing scientific meetings and continuing medical education events. Dr. Rudolf, Prof. Lichte, and PD Wiltink declare that no conflict of interest exists.

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, University of Göttingen, von-Siebold-Str. 5, 37075, Göttingen, Germany

    Borwin Bandelow

  2. Institute of General Practice, Otto-von-Guericke University Magdeburg, Magdeburg, Germany

    Thomas Lichte

  3. Helios Clinic for Psychiatry and Psychosomatic Medicine, Schleswig, Germany

    Sebastian Rudolf

  4. Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany

    Jörg Wiltink & Manfred E. Beutel

Authors
  1. Borwin Bandelow
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  2. Thomas Lichte
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  4. Jörg Wiltink
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  5. Manfred E. Beutel
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Corresponding author

Correspondence to Borwin Bandelow.

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Bandelow, B., Lichte, T., Rudolf, S. et al. The German guidelines for the treatment of anxiety disorders. Eur Arch Psychiatry Clin Neurosci 265, 363–373 (2015). https://doi.org/10.1007/s00406-014-0563-z

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  • DOI: https://doi.org/10.1007/s00406-014-0563-z

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