Challenges in the treatment of anxiety disorders: beyond guidelines

Anxiety disorders are highly prevalent, come in many forms and are often chronic, with many patients requiring long-term maintenance therapy. Anxiety and depression may also be comorbid in up to 50% of patients, leading to problems during diagnosis and treatment. Despite their frequency, the recognition and treatment of anxiety disorders is frequently suboptimal, with as few as 15% of patients obtaining treatment consistent with evidence-based care recommendations. Current treatment guidelines for anxiety disorders include a range of pharmacological and non-pharmacological approaches. However, the use of these guidelines alone may not be sufficient to improve patient outcomes. Optimal treatments for anxiety should be based on chronic disease management and balance efficacy with long-term tolerability. Current first-line therapies should include broad-spectrum agents that have proven efficacy in treating both anxiety and depression and are effective across all treatment phases. The allosteric serotonin reuptake inhibitor (ASRI), escitalopram, is a particularly effective treatment, offering high rates of remission combined with relatively low rates of discontinuation due to adverse events. Combination therapy involving medication and psychological approaches, e.g., cognitive behavioral therapy, may also be helpful. Novel approaches to delivering psychotherapy and self-management via the Internet may address accessibility issues for evidence-based psychological treatments.