The National Institute for Health and Clinical Excellence has issued a clinical guideline for the management of generalised anxiety disorder (GAD) and panic disorders in adults. This guideline replaces clinical guideline 22 which was published in 2004 and updated in 2007.

With respect to the pharmacological management of GAD, the following recommendations have been made (taken directly from source):

• Offer a selective serotonin reuptake inhibitor (SSRI). Consider offering sertraline first because it is the most cost-effective drug, but note that at the time of publication (January 2011) sertraline did not have UK marketing authorisation for this indication. Informed consent should be obtained and documented.

• If sertraline is ineffective, offer an alternative SSRI or a serotonin–noradrenaline reuptake inhibitor (SNRI), taking into account other factors, such as side-effect profiles and the potential for drug interactions, and other clinical factors etc

• If the person cannot tolerate SSRIs or SNRIs, consider offering pregabalin.

• Do not offer a benzodiazepine for the treatment of GAD in primary or secondary care except as a short-term measure during crises.

• Do not offer an antipsychotic for the treatment of GAD in primary care.

Please see link for full details and recommendations.

With respect to the management of panic disorder, the guideline makes the following recommendation:

• Antidepressants should be the only pharmacological intervention used in the longer term management of panic disorder. The two classes of antidepressants that have an evidence base for effectiveness are the SSRIs and tricyclic antidepressants.

Please see link for full details and recommendations.