Comparing the efficacy of benzodiazepines and serotonergic anti-depressants for adults with generalized anxiety disorder: a meta-analytic review

Abstract

Introduction: Generalized anxiety disorder (GAD) is a common form of anxiety disorder. Selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines (BZs) are the most commonly prescribed medications for GAD, but little is known about the relative efficacy of these pharmacological treatments. Areas Covered: This study provides a meta-analytic review of the efficacy of these medications in the treatment of adults with GAD.A comprehensive literature search yielded 54 articles reporting 56 unique studies with 12,655 participants treated with either pill placebo (6,191 participants), SSRIs (16 trials, 2,712 participants), SNRIs (17 trials, 2,603 participants), or BZs (23 trials, 1,149 participants). The overall combined effect size was modest to moderate (Hedges’ g = 0.37, p< 0.0001). Effect sizes decreased significantly over time. SSRIs (Hedges’ g = 0.33) and SNRIs (Hedges’ g = 0.36) demonstrated significantly lower effect sizes than BZs (Hedges’ g = 0.50). Expert opinion: These findings were not due to differences in treatment length or publication year. The results of this study suggest that the most common forms of pharmacotherapy for adult GAD are moderately effective, with BZs being the most effective drug.

Trends in Antidepressant Use and Expenditure in Six Major Cities in China From 2013 to 2018

“…The clinical guidelines for treating depression suggest SSRIs (mostly escitalopram, paroxetine, and sertraline) as the preferred pharmacological treatment in adults (29,30); however, the antidepressant efficacy of SSRIs is not superior to that of TCAs (31). SSRIs are also used to treat anxiety disorders, but the efficacy of SSRIs in this application is not superior to that of benzodiazepines (32). The reported overall adverse event rates of SSRIs and TCAs are comparable, but SSRIs are reported to have a lower incidence rate of cardiovascular effects and higher rates of neurogenic adverse effects (33).…”

Incidence of and Characteristics Associated With Long-term Benzodiazepine Use in Finland

“… 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 Some authors also suggest that BZDR benefits may persist, at least in specific patient groups, 14 , 15 , 16 , 17 and that the risk-benefit ratio of long-term use (eg, in anxiety disorders) has not been properly studied in comparison with alternative pharmacotherapeutic approaches such as the administration of selective serotonin reuptake inhibitors. 18 , 19 …”

Chronic activation of the relaxin‐3 receptor on GABA neurons in rat ventral hippocampus promotes anxiety and social avoidance

“…Despite their prevalence and socioeconomic impact, the neural circuits and synaptic mechanisms underlying anxiety disorders remain quite poorly understood. Current treatment options are limited, and generally comprise agents originally used for treating depression, such as benzodiazepines and selective serotonin reuptake inhibitors, which are associated with major side‐effects (Gomez, Barthel, & Hofmann, ). Thus, new insights into the nature of anxiety‐related circuits and their regulation by transmitter and neuromodulatory systems are key to developing better treatments; and research to identify and explore novel structural and molecular therapeutic targets is essential.…”