Pharmacotherapy of anxiety disorders: which substances are declared as first choice treatment options by Polish psychiatrists?

Introduction:
Drugs belonging to the group labeled as antidepressants are indicated by standards, guidelines and recommendations as the first choice pharmacological treatment for numerous mental disorders, including depression and anxiety disorders. Therefore, the question arises whether they are used taking into account the specificity of the action of a particular substance in a specific disorder and the current registration in specific diagnosis, or whether they are used interchangeably, as a uniform group of drugs that would be effective in the entire range of diagnoses of anxiety disorders.

Material and methods:
A survey was conducted among the participants of the session on psychopharmacotherapy of the 27^th International Conference in Poland in 2022. The aim of the survey was to obtain data on the first line choices of pharmacotherapy by polish psychiatrists in three anxiety disorders: generalized anxiety disorder, social phobia, anxiety disorder with panic attacks.

Results:
Psychiatrists choose drugs from the SSRI group (selective serotonin reuptake inhibitor) as a first line treatment of anxiety disorders. Escitalopram was indicated as the drug of first choice in more than 80% of cases. Participants under 40 were more likely to prescribe SSRIs and SNRIs (SNRI serotonin norepinephrin reuptake inhibitor) as their first choice, while participants above this median age also chose drugs other than SSRIs and SNRIs. Substances with over 50% indications in the treatment of generalized anxiety disorder, panic attacks and social phobia are escitalopram (81%), sertraline (62%), pregabalin (55%) and paroxetine (52%). Three of four most frequently indicated drugs belong to the SSRI group. SNRIs were also chosen frequently: venlafaxine (43%) and duloxetine (26%). With the exception of pregabalin, drugs indicated by at least 10% of survey participants are only SSRIs and SNRIs. Among the SSRI drugs, only fluvoxamine was not taken into account. Sertraline, which was indicated as the second most commonly used drug, is not registered in Poland for the treatment of generalized anxiety disorder.

Conclusions:
SSRIs and then SNRIs are indicated as drugs of first choice in the treatment of anxiety disorders. This also applies to a substance that has not been formally registered in the treatment of a generalized drug, i.e. sertraline. This special position of drugs may result, apart from the clinical features of their action, from approach to this group of drugs as homogeneous (with the exception of fluvoxamine) with efficacy in each disorder in a given category, e.g. all anxiety disorders.