GuidelinesOther guideline
Summary points
These are the approved guidelines published by the South African Society of Psychiatrists to provide an overview on treatment and management of commonly diagnosed psychiatric illnesses. The guidelines include consensus recommendations, based on peer contribution and using the international evidence based guidelines that are suitable for the local South African health service.
Please note that parts of this guideline may be out of date, an update will be published as soon as it is available.
- Both pharmacological therapies and CBT are considered first-line treatments for PD.
- Antidepressant agents have proven efficacy in the treatment of PD.
- Agents from within the SSRIs and SNRIs are the preferred options, namely the SSRIs citalopram, escitalopram, fluvoxamine, fluoxetine, paroxetine, sertraline and the SNRI venlafaxine.
- Adjunctive benzodiazepines have a role in treatment.
- For acute treatment, a combination of pharmacological treatment and CBT is likely to be more effective than either therapy alone.
- CBT and pharmacotherapy are not necessarily added concurrently– there is some evidence that adding CBT to patients previously treated with pharmacotherapy provides good benefits.
- Treatment with psychotherapy alone may be the preferred longer-term option.
- Acute treatment: Combination treatment (pharmacotherapy + psychotherapy or pharmacotherapy + pharmacotherapy (e.g. antidepressant plus benzodiazepine/sodium valproate).
- Maintenance treatment: Combination treatment or psychotherapy alone.
- In children and adolescents with PD, there are only non-randomised, controlled studies to support the utility of the SSRIs.
- CBT is a good alternative for women with PD who plan to become pregnant, and for pregnant women who need to discontinue medication.