Anxiety reduction confirmed with antidepressants, long-term effects uncertain

Anxiety reduction confirmed with antidepressants, long-term effects uncertain

A new Cochrane review confirms that antidepressants are effective in reducing generalized anxiety disorder (GAD) symptoms under experimental conditions, although there is limited data on long-term use.

GAD affects millions of people worldwide and is characterized by excessive worry about everyday problems. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin-norephrine reuptake inhibitors (SNRIs), are recognized treatments for GAD, recommended by many national bodies, including the UK National Institute for Health and Care. However, misconceptions continue to persist among some medical professionals and patients who do not recognize that “antidepressants” are more than depression, while the term also carries a stigma for many people.

The review analyzed 37 randomized controlled trials involving over 12,000 participants and compared antidepressants with a placebo. Most experiments were conducted primarily in high-income countries, including the United States of America and various European countries, and recruited adults of both genders. In most cases, there were slightly more female participants (~60%), reflecting the clinical prevalence of GAD.

The results showed that antidepressants were more effective than placebo in reducing anxiety symptoms, with 41% higher response rates among those taking the drug compared to those taking a placebo. The review found no significant difference in dropout rates between those taking antidepressants and people, indicating that these medications are generally well tolerated.

The research shows that antidepressants are highly effective in treating GAD, at least under the specific circumstances observed in trials. For people with generalized anxiety disorder and no other medical conditions, we have good evidence that antidepressants produce clinically meaningful improvements over a period of one to three months compared to placebo.

We don't have enough evidence about how effective they can be in patients with GAD among other mental illnesses, which is much more common in clinical practice. Most patients I see with GAD also have other mental illnesses, so future studies should examine the effects of different treatment strategies on patients with multiple disorders. “

Dr. Giuseppe Guaiana,Senior Author,Associate Professor of Psychiatry at the Schulich School of Medicine & Dentistry, Western University and Chief of Psychiatry at St. Thomas Elgin General Hospital

The review also highlights the lack of data on the long-term effects of antidepressants. Most included trials lasted between 4 and 12 weeks, with no long-term follow-up.

"We don't have enough information about the potential long-term benefits and harms of antidepressants, even though people often take them for years," says first author Katarina Kopcalic, who conducted the review at Western University. “This is an area that requires further investigation in future trials.”

Despite these limitations, the review provides a clear message: antidepressants are effective for the treatment of GAD, particularly for patients who do not respond well to non-pharmacological treatments. However, independent, long-term research is needed to understand their full effects, particularly in patients with multiple medical conditions.

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