¹Suh Yonsei Psychiatry Clinic, Psychiatry, Seoul, Korea, Republic of, ²Yonsei University Wonju College of Medicine, Psychiatry, Wonju, Korea, Republic of, ³School of Medicine, CHA University, Ilsan Medical Center, Psychiatry, Ilsan, Korea, Republic of, ⁴Yonsei University College of Medicine, Psychiatry, Seoul, Korea, Republic of

Background: The Korean Association of Anxiety Disorders developed Korean guidelines for the treatment of generalized anxiety disorder (GAD) 2024. In this paper, we discussed the consensus among psychiatrists specializing in anxiety disorders, regarding treatment strategies for pharmacological treatment of GAD in Korea.

Aims & Objectives: This study aimed to establish expert consensus on treatment strategies for generalized anxiety disorder when treatment response is insufficient and when comorbid conditions are present, as part of developing the 2024 Korean guidelines for the treatment of generalized anxiety disorder.

Method: The executive committee developed a questionnaire based on existing international and Korean treatment guidelines and academic literature. Sixty-five experts participated in the survey. Responses were analyzed using the 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 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.

Discussion & Conclusions: This expert consensus reflects current clinical practices and experiences in Korea, providing valuable insights for clinicians treating generalized anxiety disorder patients who have insufficient treatment responses or comorbidities. The findings emphasize the importance of a multimodal treatment approach, including both pharmacotherapy and psychotherapy, and offer specific recommendations for adjusting treatment strategies in these complex cases.