Pharmacological treatment for generalized anxiety disorder in adults: an update

Reinhold, Jennifer A; Rickels, Karl

doi:10.1517/14656566.2015.1059424

Cited by 68 publications

(52 citation statements)

References 111 publications

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“…This meta-analysis provides evidence that BZs are more efficacious than ADs for reducing GAD symptoms. In light of this evidence and in accordance with other recent expert opinions [4], we recommend that BZs should be considered as a viable treatment option for adults with GAD, especially for the initial treatment phase.…”

Section: Discussionsupporting

confidence: 79%

“…Among these, SSRIs and SNRIs are considered the first-line medication options for GAD[3]. Randomized-controlled trials suggest that 60-75% of patients respond to SSRIs, compared to 40-60% of patients receiving placebo, with similar response rates for SNRIs and BZs[4]. Current prescribing guidelines recommend BZs for use only as a second-line or augmentative treatment option, although they are commonly prescribed by primary care physicians[5].…”

Section: Introductionmentioning

confidence: 99%

“…Currentprescribing guidelines only recommendBZs as augmentative agents, particularly to mitigate the adverse side effects during the initial weeks of therapy with an antidepressant[4]. However, some of the literature suggests that both drug classes may be associated with similar discontinuation effects[14].…”

Section: Introductionmentioning

confidence: 99%

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

Gómez

Barthel

Hofmann

2018

Expert Opinion on Pharmacotherapy

101

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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.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

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

Gómez

Barthel

Hofmann

2018

Expert Opinion on Pharmacotherapy

101

View full text Add to dashboard Cite

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“…Anxious depression tends to display a worse response to AD than other forms of depression [11], and AD are not more effective than placebo in the treatment of minor or subthreshold depression [62,63]. Nevertheless, AD, especially SSRI and SNRI, are considered to be a primary choice for treating anxious depression [2][3][4] as well as anxiety disorders, despite the fact that direct comparisons indicate that BZD are more effective and tolerable than AD for the latter [64][65][66]. Dosages of BZD used in trials concerned with depression were comparable to those employed in the treatment of anxiety [64][65][66].…”

Section: Discussionmentioning

confidence: 99%

Benzodiazepines as a Monotherapy in Depressive Disorders: A Systematic Review

Benasi¹,

Guidi²,

Offidani³

et al. 2018

Psychother Psychosom

Self Cite

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Background: The aim of this paper was to perform a systematic review and, when feasible, a meta-analysis of randomized controlled trials (RCT) which used benzodiazepines (BZD) as a monotherapy versus placebo, antidepressant drugs (AD), or both. Methods: Keyword searches were conducted for identifying RCT comparing BZD and AD, and/or placebo in the treatment of depression, using electronic databases from their inception up to April 2017. We selected reports of RCT in which BZD were compared to AD and/or placebo in the treatment of adult patients with a primary diagnosis of depressive disorder or anxious depression. When feasible, data were subjected to meta-analysis. Results: A total of 38 studies met the criteria for inclusion and were then included in the systematic review. Only 1 study concerned a newer AD, fluvoxamine. For the meta-analysis, we submitted data on response rate from 22 RCT, considering BZD versus placebo (8 comparisons) and BZD versus tricyclic antidepressants (TCA) (20 comparisons). There was a lack of significant differences as to response rate between BZD and placebo, as well as between BZD and TCA. Analysis of individual studies disclosed that, in more than half of the studies comparing BZD to TCA and/or placebo, BZD were significantly more effective than placebo and as effective as TCA. Conclusions: BZD are a therapeutic option in anxious depression and there are no indications that AD are preferable. There is a pressing need for RCT of adequate methodological quality and follow-up comparing BZD to second-generation AD and placebo in anxious depression.

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“…Vortioxetine, a novel medication that modulates serotonin receptors, has recently been approved for major depressive disorder and has not been tested in eating disorders. That drug has also been considered a potential treatment for generalized anxiety disorder [174]. Glutamatergic agents, corticotrophin releasing factor 1 antagonists, and angiotensin II receptor antagonists may also have anti-anxiety effects, but may not be available for clinical use for some time [175].…”

Section: New Approaches To Medication Intervention In Anmentioning

confidence: 99%

The Role of Psychotropic Medications in the Management of Anorexia Nervosa: Rationale, Evidence and Future Prospects

Frank

Shott

2016

CNS Drugs

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Anorexia nervosa is a severe psychiatric disorder without approved medication intervention. Every class of psychoactive medication has been tried to improve treatment outcome; however, randomized controlled trials have been ambiguous at best and across studies have not shown robust improvements in weight gain and recovery. Here we review the available literature on pharmacological interventions since anorexia nervosa came to greater public recognition in the 1960s. This will include a critical review of why those trials may not have been successful. We further provide a neurobiological background for the disorder and discuss how cognition, learning and emotion-regulating circuits could become treatment targets in the future. Making every effort to develop effective pharmacological treatment options for anorexia nervosa is imperative, as it continues to be a complex psychiatric disorder with high disease burden and mortality.

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Pharmacological treatment for generalized anxiety disorder in adults: an update

Cited by 68 publications

References 111 publications

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

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

Benzodiazepines as a Monotherapy in Depressive Disorders: A Systematic Review

The Role of Psychotropic Medications in the Management of Anorexia Nervosa: Rationale, Evidence and Future Prospects

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