Efficacy and tolerability of short-term duloxetine treatment in adults with generalized anxiety disorder: A meta-analysis

Li, Xinyuan; Zhu, Lijun; Zhou, Chunkui; Liu, Jing; Du, Heqian; Chen, Zhong; Fang, Shaokuan

doi:10.1371/journal.pone.0194501

Cited by 13 publications

(8 citation statements)

References 29 publications

(56 reference statements)

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“…In terms of response and overall acceptability, and also due to the relative scarcity of head-to-head comparisons with other antidepressants, duloxetine has not been recommended as a routine first-line acute treatment for major depression (53). Nevertheless, the drug has been proven safe and effective for improving core emotional symptoms and general functioning in MDD (54, 55) and psychic and somatic anxiety symptoms in GAD (56, 57); in prospective studies of efficacy, duloxetine has been evaluated employing the remission concept (getting the patient asymptomatic), rather than the response concept (getting the patient 50% better), and with a focus on recovery, which includes both clinical and functional remissions.…”

Section: Discussionmentioning

confidence: 99%

Duloxetine in Psychiatric Disorders: Expansions Beyond Major Depression and Generalized Anxiety Disorder

et al. 2019

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Background: Duloxetine hydrochloride (DUL) is an antidepressant included in the pharmacological class of serotonin–norepinephrine reuptake inhibitors approved for the treatment of major depressive disorder, generalized anxiety disorder, diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain. The aim of this review was to elucidate current evidences on the use of DUL in the treatment of a variety of psychiatric disorders.Methods: This systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed database was searched from January 1, 2003, to September 30, 2018, using 11 key terms related to psychiatric disorders (“persistent depressive disorder,” “dysthymic disorder,” “bipolar disorder,” “seasonal affective disorder,” “obsessive-compulsive disorder,” “social phobia,” “panic disorder,” “posttraumatic stress disorder,” “schizophrenia,” “eating disorders,” “sexual disorders,” “personality disorders”) and one key term related to duloxetine (“duloxetine hydrochloride”). Article titles and abstracts were scanned to determine relevance to the topic. For additional studies, the authors also examined the reference lists of several of the included papers.Results: Duloxetine may be an effective treatment for mood spectrum disorders, panic disorder, several symptom clusters of borderline personality, and as add-on drug in schizophrenia. Modest or conflicting results have been found for the efficacy of duloxetine in obsessive–compulsive disorder, posttraumatic stress disorder, eating, and sexual disorders.Conclusion: Major limitations of the reviewed studies were short trial duration, small sample sizes, and the lack of control groups. Defining the potential role of DUL in the treatment of psychiatric disorders other than major depressive disorder and generalized anxiety disorder needs further randomized, placebo-controlled studies.

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Section: Discussionmentioning

confidence: 99%

Duloxetine in Psychiatric Disorders: Expansions Beyond Major Depression and Generalized Anxiety Disorder

et al. 2019

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“…3 , 21 SNRIs also have some efficacy for the management of MDD with anxiety. 3 , 22 , 23 In addition, psychotherapy and CBT can be used to manage MDD, as well as the causes in which is rooted the anxiety, breaking the vicious circle of anxiety and MDD. 10 , 11 As complementary therapies, MECT and rTMS have been shown to be effective in MDD, but are not used alone for the management of MDD.…”

Section: Discussionmentioning

confidence: 99%

A Preliminary Study of Different Treatment Strategies for Anxious Depression

Wang¹,

Liu²,

Peng³

et al. 2022

NDT

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Background: Despite the best treatments, about 20% of patients with major depressive disorder (MDD) receiving drugs and psychological intervention show little or no improvement. There is no trial comparing different treatment methods in patients with anxiety/somatic subtype MDD. Aim: To compare the efficacy and safety of various treatments in patients with anxiety/ somatic subtype MDD. Methods: This was a preliminary multicenter randomized controlled trial at eight participating hospitals in China (09/2016-06/2019) (ClinicalTrials.gov #NCT03219008). The patients were randomized to mirtazapine/SNRIs, mirtazapine/SNRIs+cognitive behavioral therapy (CBT), mirtazapine+SNRIs, or mirtazapine+SNRIs+physical therapies (modified electroconvulsive treatment or repetitive transcranial magnetic stimulation). The primary endpoint was the 17-item Hamilton Depression Scale (HAMD-17). The Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) and Quality of Life (QOL)-6 were the secondary endpoints. The adverse events (AEs) were monitored. The patients were assessed at baseline (0 weeks), and at the end of the 2nd, 4th, 6th, 8th, and 12th week during treatment. Results: Finally, 107 patients were included: mirtazapine/SNRIs (n=36), mirtazapine/SNRIs +CBT (n=28), mirtazapine+SNRIs (n=29), and mirtazapine+SNRIs+physical therapies (n=14). The 17-HDRS and QIDS-SR scores decreased in all four groups, and the QOL-6 scores increased. There were no differences in the 17-HDRS (P=0.099), QIDS-SR (P=0.407), and QOL-6 (P=0.485) scores among the four groups. There were no differences in the occurrence of AEs among the four groups (P=0.942). Conclusion: This preliminary trial suggests that all four interventions (mirtazapine/SNRIs, mirtazapine/SNRIs+CBT, mirtazapine+SNRIs, or mirtazapine+SNRIs+physical therapies) achieved similar response and remission rates in patients with anxiety/somatic subtype MDD. The safety profile was manageable.

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“…However, there has been relatively little subsequent evidence to support the selective response of psychic and somatic symptoms to different pharmacotherapies. A range of medications that are efficacious for GAD improve both psychic and somatic symptoms [76][77][78][79] .…”

Section: Clinical Subtypesmentioning

confidence: 99%

The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management

et al. 2021

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The clinical construct of "anxiety neurosis" was broad and poorly defined, so that the delineation of specific anxiety disorders in the DSM-III was an important advance. However, anxiety and related disorders are not only frequently comorbid, but each is also quite heterogeneous; thus diagnostic manuals provide only a first step towards formulating a management plan, and the development of additional decision support tools for the treatment of anxiety conditions is needed. This paper aims to describe systematically important domains that are relevant to the personalization of management of anxiety and related disorders in adults. For each domain, we summarize the available research evidence and review the relevant assessment instruments, paying special attention to their suitability for use in routine clinical practice. We emphasize areas where the available evidence allows the clinician to personalize the management of anxiety conditions, and we point out key unmet needs. Overall, the evidence suggests that we are becoming able to move from simply recommending that anxiety and related disorders be treated with selective serotonin reuptake inhibitors, cognitive-behavioral therapy, or their combination, to a more complex approach which emphasizes that the clinician has a broadening array of management modalities available, and that the treatment of anxiety and related disorders can already be personalized in a number of important respects.

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Efficacy and tolerability of short-term duloxetine treatment in adults with generalized anxiety disorder: A meta-analysis

Cited by 13 publications

References 29 publications

Duloxetine in Psychiatric Disorders: Expansions Beyond Major Depression and Generalized Anxiety Disorder

Duloxetine in Psychiatric Disorders: Expansions Beyond Major Depression and Generalized Anxiety Disorder

A Preliminary Study of Different Treatment Strategies for Anxious Depression

The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management

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