Management of unspecified anxiety disorder: Expert consensus

Aims: Treatment guidelines with respect to unspecified anxiety disorder have not been published. The aim of this study was to develop a consensus among field experts on the management of unspecified anxiety disorder. Methods: Experts were asked to evaluate treatment choices based on eight clinical questions concerning unspecified anxiety disorder using a nine -point Likert scale (1 = "disagree" to 9 = "agree"). According to the responses from 119 experts, the choices were categorized into first-, second-, and third -line recommendations. Results: Benzodiazepine anxiolytic use was not categorized as a first -line recommendation for the primary treatment of unspecified anxiety disorder, whereas multiple nonpharmacological treatment strategies, including coping strategies (7.9 +/- 1.4), psychoeducation for anxiety (7.9 +/- 1.4), lifestyle changes (7.8 +/- 1.5), and relaxation techniques (7.4 +/- 1.8), were categorized as first -line recommendations. Various treatment strategies were categorized as first -line recommendations when a benzodiazepine anxiolytic drug did not improve anxiety symptoms, that is, differential diagnosis (8.2 +/- 1.4), psychoeducation for anxiety (8.0 +/- 1.5), coping strategies (7.8 +/- 1.5), life-style changes (7.8 +/- 1.5), relaxation techniques (7.2 +/- 1.9), and switching to selective serotonin reuptake inhibitors (SSRIs) (7.0 +/- 1.8). These strategies were also highly endorsed when tapering the dosage of or discontinuing benzodiazepine anxiolytic drugs. There was no first- line recommendation regarding excusable reasons for continuing benzodiazepine anxiolytics. Conclusions: The field experts recommend that benzodiazepine anxiolytics should not be used as a first- line option for patients with unspecified anxiety disorder. Instead, several nonpharmacological interventions and switching to SSRIs were endorsed for the primary treatment of unspecified anxiety disorder and as alternatives to benzodiazepine anxiolytics.