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Review
. 2018 Jun;19(8):883-894.
doi: 10.1080/14656566.2018.1472767. Epub 2018 May 28.

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

Angelina F Gomez  1 , Abigail L Barthel  1 , Stefan G Hofmann  1
Affiliations
Review

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

Angelina F Gomez et al. Expert Opin Pharmacother. 2018 Jun.

Abstract

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). These findings were not due to differences in treatment length or publication year. Expert opinion: 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.

Keywords: GAD; Generalized anxiety disorder; SNRI; SSRI; benzodiazepines; medication; meta-analysis; pharmacotherapy.

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Figures

Figure 1
Figure 1
Flowchart of study selection.
Figure 2
Figure 2
Funnel plot with imputed studies.
Figure 3
Figure 3
Forest plot of effect sizes by drug class.
See this image and copyright information in PMC

References

    1. American Psychiatric Association DSM-5 Task Force Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Arlington, VA: American Psychiatric Association, 2013
    1. Bandelow B, Michaelis S, Wedekind D. Treatment of anxiety disorders. Dialogues in Clinical Neuroscience 2017;19:93–107 - PMC - PubMed
    1. Newman MG, Llera SJ, Erickson TM, et al. Worry and generalized anxiety disorder. Annu Rev ClinPsychol2013;9:275–97 - PMC - PubMed

    2. **A well-written review of the literature on GAD, including: leading theoretical models; cognitive, affective, and neurobiological mechanisms; and the efficacy of various treatment options.

    1. Reinhold JA, Rickels K. Pharmacological treatment for generalized anxiety disorder in adults. Expert OpinPharmacother2015;16:1669–81 - PubMed
    1. Ravindran LN, Stein MB. The pharmacologic treatment of anxiety disorders. J. Clin. Psychiatry 2010;71:839–54 - PubMed

    2. *A well-written historical perspective and review of the literature on medication treatment for GAD.

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