Practitioner 2011; 255 (1739): 7-14

Selecting the best treatment for generalised anxiety disorder

20 Apr 2011Pais-up subscribers

A multiple treatments meta-analysis has found that sertraline is the best tolerated therapy for generalised anxiety disorder (GAD). There were 27 randomised controlled trials which were suitable for inclusion in the analysis. Response was defined as a reduction of 50% or more from the baseline Hamilton anxiety scale (HAM-A) score, remission as a final HAM-A score ≤7 and tolerability as the withdrawal rate due to adverse events. For each outcome measure, drugs were ranked according to the probability of their being the most effective/well tolerated treatment.Nine drugs (duloxetine, escitalopram, fluoxetine, lorazepam, paroxetine, pregabalin, sertraline, tiagabine, and venlafaxine) were compared with one another. Fluoxetine was ranked first for response (probability 62.9%) and remission (60.6%) whereas sertraline was ranked first for tolerability (49.3%). Of those drugs which are licensed in the UK for the treatment of GAD, duloxetine was ranked first for response (probability 2.7%), escitalopram was ranked first for remission (26.7%) and pregabalin was ranked first for tolerability (7.7%). 'These findings need to be treated with caution. All studies were sponsored by drug companies, unpublished studies were not specifically looked for, and publication bias is therefore likely. The absence of tricyclics from the list of drugs included in the analysis does not mean that SSRIs are superior to tricyclics in the treatment of GAD. It simply reflects the fact that most clinical trials of tricylics were carried out before GAD became a recognised diagnosis.'

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