Efficacy of drug treatments for anxiety disorder

Hi All,

These were recent published results from a meta-analysis on meds that deal with anxiety. These sorts of analyses combine lots of randomised controlled trials and tease out the overall effects. While we all respond differntly to meds it might be worth looking at what they found across a large population when deciding on an SSRI for example.

British Medical Journal, 2011

OBJECTIVE: To appraise the evidence for comparative efficacy and tolerability of drug treatments in patients with generalised anxiety disorder.

DESIGN: Systematic review of randomised controlled trials. Primary Bayesian probabilistic mixed treatment meta-analyses allowed pharmacological treatments to be ranked for effectiveness for each outcome measure, given as percentage probability of being the most effective treatment.

MAIN OUTCOME MEASURES: Proportion of participants experiencing ≥50% reduction from baseline score on Hamilton anxiety scale (HAM-A).

RESULTS: The review identified 3249 citations, and 46 randomised controlled trials met inclusion criteria; 27 trials contained sufficient or appropriate data for inclusion in the analysis. Analyses **compared nine drugs **(duloxetine, escitalopram, fluoxetine, lorazepam, paroxetine, pregabalin, sertraline, tiagabine, and venlafaxine). In the primary probabilistic mixed treatment meta-analyses, fluoxetine was ranked first for response and remission (probability of 62.9% and 60.6%, respectively) and sertraline was ranked first for tolerability (49.3%). In a subanalysis ranking treatments for generalised anxiety disorder currently licensed in the United Kingdom, duloxetine was ranked first for response (third across all treatments; 2.7%), escitalopram was ranked first for remission (second across all treatments; 26.7%), and pregabalin was ranked first for tolerability (second across all treatments; 7.7%).

CONCLUSIONS: Though the frequentist analysis was inconclusive because of a high level of uncertainty in effect sizes (based on the relatively small number of comparative trials), the probabilistic analysis, which did not rely on significant outcomes, showed that fluoxetine (in terms of response and remission) and sertraline (in terms of tolerability) seem to have some advantages over other treatments. Among five UK licensed treatments, duloxetine, escitalopram, and pregabalin might offer some advantages over venlafaxine and paroxetine.

I wish I could keep straight which generics were which name-brand were which type of drug!I had to look these all up.

duloxetine = Cymbalta = SNRI
escitalopram = Lexapro = SSRI
fluoxetine = Prozac = SSRI
lorazepam = Ativan = benzodiazipine
paroxetine = Paxil = SSRI
pregabalin = Lyrica = anticonvulsant
sertraline = Zoloft = SSRI
tiagabine = Gabitril = antconvulsant
venlafaxine = Effexor = SNRI

So it sounds like the study results show that SSRIs are a good place to start with anxiety treatment.