Drug Treatment of Generalized anxiety disorder-A Review

The researchers in order to document evidence of efficacy for GAD pharmacotherapy conducted a network meta-analysis of 89 randomized, controlled studies, published between 1998 and 2016, on 22 agents in 25,441 moderately anxious patients. A systematic review and network meta-analysis were performed on randomised trials in adult outpatients with generalised anxiety disorder identified from MEDLINE, Web of Science, Cochrane Library,ClinicalTrials.gov, Chinese National Knowledge Infrastructure (CNKI), Wanfang data, Drugs@FDA and commercial pharmaceutical registries. Placebo and active control trials were included. Data were extracted from all manuscripts and reports. Primary outcomes were efficacy (mean difference [MD] in a change in Hamilton Anxiety Scale Score) and acceptability (study discontinuations for any cause).

They estimated summary mean treatment differences and odds ratios using network meta-analyses with random effects. Most studies were placebo-controlled, and many used head-to-head comparisons; 18% of the studies were from China; few were conducted in seniors. Tolerability was measured by study dropout rates. The important findings are as follows-

• The strongest evidence, based on large samples, was for duloxetine, venlafaxine, escitalopram, and pregabalin.


• Based on somewhat smaller samples, mirtazapine, fluoxetine, sertraline, agomelatine, and buspirone were also effective.


• Quetiapine had the largest effect size but was less tolerated than placebo.


• Bupropion, studied in a few patients, showed efficacy.


• Paroxetine and the combined group of benzodiazepines were effective but had poor tolerability.


• Evidence of efficacy was poor for the new agents vilazodone and vortioxetine. Eliminating Chinese studies did not change the results.

Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are mainstays for GAD pharmacotherapy, but study generalizability is limited by the small proportion of older patients, who have a high GAD rate.