Up to one in five people may have generalised anxiety disorder (GAD) at some point, and most have other health problems. Less than half of people have full remission after 5 years. GAD may have a genetic component, and has also been linked to previous psychological or other trauma.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for GAD? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 74 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: abecarnil, antidepressants (duloxetine, escitalopram, fluoxetine, fluvoxamine, imipramine, opipramol, paroxetine, sertraline, and venlafaxine), antipsychotic drugs (trifluoperazine), applied relaxation, benzodiazepines, buspirone, cognitive behavioural therapy, hydroxyzine, and pregabalin.
Generalised anxiety disorder (GAD) is excessive worry and tension about everyday events, on most days, for at least 6 months, to the extent that there is distress or difficulty in performing day-to-day tasks. However, diagnosing GAD accurately can be difficult.
Up to 1 in 20 people may have GAD at any one time, and most have other health problems. Less than half of people have full remission after 5 years.GAD may have a genetic component, and has also been linked to previous psychological or other trauma.
CBT (including exposure, relaxation, and cognitive restructuring) improves anxiety compared with waiting list control, treatment as usual, or enhanced usual care.
It is unclear whether CBT is more effective than supportive therapy.
Applied relaxation may be as effective as CBT, but we found insufficient RCT evidence about applied relaxation compared with no treatment.
Various drug treatments, such as benzodiazepines, buspirone, hydroxyzine, antidepressants, and pregabalin may all reduce symptoms of anxiety in people with GAD, but they can have unpleasant adverse effects, and most trials have been short term.
Benzodiazepines increase the risk of dependence, sedation, and accidents, and can cause adverse effects in neonates if used during pregnancy.Buspirone may be less effective if used in people who have recently been taking benzodiazepines.Antidepressants (imipramine, paroxetine, sertraline, escitalopram, venlafaxine, and opipramol) have been shown to reduce symptoms compared with placebo, but antidepressants can cause a variety of adverse effects including sedation, dizziness, falls, nausea, and sexual dysfunction.In general, comparisons between different antidepressants have shown similar effectiveness in reducing anxiety, although one RCT found limited evidence of an increased benefit with escitalopram compared with paroxetine.
Antipsychotic drugs may reduce anxiety in people who have not responded to other treatments, but these drugs may have adverse effects including drowsiness, and movement disorders.
We don't know whether abecarnil reduces anxiety as the RCTs we found reported inconsistent results.
In children and adolescents:
CBT improves symptoms compared with waiting list control or active control.
Most RCTs of CBT in children and adolescents have included other anxiety disorders.
We found limited RCT evidence regarding the efficacy of antidepressants for childhood GAD. SSRIs (fluvoxamine, fluoxetine, sertraline) have shown some promise, but antidepressants are associated with abdominal pain and nausea, and other well documented adverse effects.
We found no RCT evidence on the effects of applied relaxation, benzodiazepines, buspirone, hydroxyzine, abecarnil, pregabalin, or antipsychotics in children and adolescents.