The available Guidelines recommend SSRI and SNRI drugs as first-line treatments for generalized anxiety disorder (GAD). The present study updated the evidence using network meta-analysis by comparing the efficacy and acceptability of first-line drugs.

It searched the relevant electronic databases for placebo-controlled and head-to-head trials of 11 drugs used for the acute treatment of adults with GAD. 

The study extracted the relevant data and looked for efficacy (the change in the total score on the Hamilton Anxiety Scale from baseline) and acceptability (treatment discontinuations due to any cause). 

The study included 41 RCTs. All of the drugs except fluoxetine and vortioxetine showed greater efficacy than placebo, with the weighted mean difference of the Hamilton Anxiety Scale score being −3.2 for Escitalopram and −1·8 for vilazodone. Only vilazodone showed worse acceptability than placebo, while others did not show significant differences from placebo. In head-to-head comparisons, vortioxetine showed better acceptability and tolerability but worse efficacy and response rate. 

This study shows that most drugs are more effective than placebo, and there are few significant differences between the active drugs and placebo on acceptability. Overall, duloxetine and Escitalopram have better efficacy, while vortioxetine has better acceptability.

He H, Xiang Y, Gao F, et al. Comparative efficacy and acceptability of first-line drugs for the acute treatment of generalized anxiety disorder in adults: A network meta-analysis. Journal of Psychiatric Research. 2019;118:21-30. https://doi.org/10.1016/j.jpsychires.2019.08.009.