For GAD, benzodiazepines beat serotonergic antidepressants

  • Gomez AF & al.
  • Expert Opin Pharmacother
  • 28 May 2018

  • curated by Jim Kling
  • Clinical Essentials
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Takeaway

  • A meta-analysis in patients with generalized anxiety disorder (GAD) shows that benzodiazepines (BZs), selective serotonin reuptake inhibitors (SSRIs), and serotonin and norepinephrine reuptake inhibitors (SNRIs) all work better than placebo, but benzodiazepines had the largest effect on symptoms.

Why this matters

  • The authors suggest that BZs should be considered as a viable treatment option for GAD, especially in the initial treatment phase.
  • BZs can be addictive, but this risk varies considerably among individuals.
  • BZs should not be prescribed to patients with current or past substance abuse and should not be prescribed indefinitely.

Study design

  • Meta-analysis of 56 randomized, placebo-controlled studies including a total of 12,655 participants with GAD.
  • The participants received placebo (n=6191), SSRIs (16 trials; n=2712), SNRIs (17 trials; n=2603), or BZs (23 trials; n=1149).
  • Funding: None.

Key results

    • Significantly better improvement in GAD symptoms was noted with pharmacotherapy than placebo therapy (Hedges’ g, 0.37; P<.0001>
    • The largest effect was noted with BZs (Hedges’ g, 0.50; P<.0001 followed by snris g p and ssris>
    • There were no significant differences between SSRI and SNRI groups (P=.48).

    Limitations

    • Results to be interpreted with caution.
    • Variability in data.
    • Limited generalizability.

    Coauthored with Chitra Ravi, MPharm

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