The new guidelines from the British Association for Psychopharmacology for anxiety disorders

Anxiety disorders, which often commence in childhood, are among the most common psychological disorders encountered in primary care practice, with 1 year and lifetime prevalence (excluding post-traumatic stress disorder) of 12.0 and 21.1%, respectively. Because of their wide range of clinical presentation and comorbidity with other disorders such as depression, they are frequently under-recognized. These factors, coupled with lack of physician confidence in their ability to treat these conditions, leads to under-treatment. Treatment of anxiety disorders is further complicated by a significant lag time between first onset and initial contact with a treatment provider. Even for those anxiety disorders characterized by relatively early treatment contact (i.e. panic disorder and generalized anxiety disorder), <50% of patients are treated at first onset of symptoms. Following treatment, approximately 50% of patients significantly improve over 6-16 months, but complete recovery is uncommon. To help remedy this situation, the British Association for Pharmacology (BAP) has issued comprehensive evidence-based guidelines (developed from a consensus meeting 20-21 May 2004 involving clinical experts and representatives of user groups) to aid clinicians in diagnosing and treating anxiety disorders. The guidelines focus on pharmacological interventions for all primary anxiety disorders in adults (18-65 years), and are intended for doctors in primary care, as well as specialist practice. Importantly, the guidelines cover the difficult topic of treatment non-response. The BAP guidelines link treatment recommendations with quality of evidence, allowing clinicians to judge the confidence they might place in particular recommendations.