ISSN 2586-0151 (Print) | ISSN 2586-0046 (Online)
대한불안의학회지 (20권2호 72-81)
Korean Guidelines for the Treatment of Generalized Anxiety Disorder 2024 Part III: Strategies for Insufficient Treatment Response and Comorbidities
2024 한국형 범불안장애 치료지침 III: 치료 반응이 불충분한 경우 및 공존질환이 존재하는 경우 치료 전략
June-ho Seo1 , Chun Il Park2 , Min-Kyoung Kim3 , Eunsoo Moon4 , Myung Hee Ahn5 , Hyeon-Ah Lee6 , Yoon Young Chang7 , Won Kim7 , Kyoung-Uk Lee8 , and Ho-Suk Suh9
1 Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, 2 Department of Psychiatry, Yonsei University College of Medicine, Seoul, 3 Department of Psychiatry, CHA Ilsan Medical Center, CHA University, Ilsan, 4 Department of Psychiatry, Pusan National University School of Medicine, Busan, 5 Division of Psychiatry, Health Screening and Promotion Center, Asan Medical Center, Seoul, 6 Department of Psychiatry, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, 7 Department of Psychiatry, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, 8 Department of Psychiatry, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, College of Medicine, Uijeongbu, 9 Suh Hosuk Yonsei Psychiatry Clinic for Healthy Mind, Seoul, Korea
Objectives : This study aimed to establish expert consensus on treatment strategies for generalized anxiety
disorder (GAD) when treatment response is insufficient and when comorbid conditions are present as part of
developing the 2024 Korean guidelines for the treatment of GAD.
Methods : The executive committee developed a questionnaire based on existing international and Korean
treatment guidelines and academic literature. Sixty-five experts participated in a survey. Responses were analyzed using chi-squared test and 95% confidence intervals to determine the level of consensus. Treatment
strategies were categorized into first-line, second-line, and third-line choices.
Results : For patients with an insufficient treatment response, combining pharmacotherapy and psychotherapy was the most preferred first-line strategy. Experts recommended switching to or augmenting with a
different class of antidepressants, adding benzodiazepines or azapirones, and augmenting with atypical antipsychotics as first-line pharmacotherapy adjustments. Suitable psychotherapies included cognitive behavioral
therapy (CBT), mindfulness-based cognitive therapy (MBCT), acceptance and commitment therapy (ACT),
and applied relaxation. For patients with comorbid conditions such as depression, other anxiety disorders, or
alcohol and substance use disorders, a combination of pharmacotherapy and psychotherapy was also the most
preferred first-line treatment. In these cases, the use of antidepressants alone or in combination with benzodiazepines, azapirones, or atypical antipsychotics was recommended.
Conclusions : This expert consensus reflects current clinical practices and experiences in Korea, providing
valuable insights for clinicians treating GAD patients who have insufficient treatment responses or comorbidities. Findings of this study emphasize the importance of a multimodal treatment approach, including both
pharmacotherapy and psychotherapy. They also offer specific recommendations for adjusting treatment strategies in these complex cases. (Anxiety and Mood 2024;20(2):72-81)
Generalized anxiety disorder; Treatment guidelines; Insufficient treatment response; Comorbidities; Expert consensus.
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