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21-03-2011 | General practice | Article

SSRIs supported for anxiety


BMJ 2011; 342: d1199

Fluoxetine came out top for response and remission of generalised anxiety disorder in a meta-analysis of available treatments, researchers report in the BMJ.

The study of 27 randomised trials suggested that fluoxetine is most likely to be effective for treatment response, defined as patients achieving at least a 50% reduction from baseline score on the Hamilton anxiety scale (HAM-A).

And it found fluoxetine is most likely to enable patients to achieve remission at the end of treatment, with a final HAM-A score of 7 or lower.

The analysis indicated that sertraline is best in terms of tolerability, however, being least likely to cause patients to withdraw because of adverse events.

A subanalysis of treatments currently licensed specifically for generalised anxiety disorder in the UK suggested that duloxetine is best for response and escitalopram comes top for remission, while pregabalin is the best tolerated.

The study authors, led by Professor David Baldwin (Southampton University), caution that only one study involved fluoxetine and the main result could merely reflect publication bias.

They nevertheless conclude: "The findings of this meta-analysis suggest that selective serotonin reuptake inhibitors [SSRIs] are the most effective drug treatment option for patients with generalised anxiety disorder."

This, they add, supports NICE guidelines, which recommend SSRIs for first-line treatment for long-term management.

However, the researchers further caution that neither fluoxetine nor sertraline has evidence for the prevention of relapse.

GP News is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Caroline Price