CNS Update: GAD - Incidence and Drug Treatment


eMediNexus    19 January 2023

The presented thesis discussed time trends for the incidence of generalized anxiety recording in UK primary care, initial pharmacologic treatment in this setting, and compared the available treatment options. 


The first study that assessed the incidence of diagnoses of generalized anxiety and related illness found a substantial increase in general practitioner consulting for generalized anxiety and depression. It also found the population mainly comprised younger people, particularly women. 


The second analysis that examined trends in anxiolytic prescribing in UK primary care following diagnosis with generalized anxiety found that about half of psychotropic drug naïve patients receive pharmacologic therapy in the year following diagnosis. It also found that the most common initial therapy was a selective serotonin reuptake inhibitor. It observed a decline in the rate of benzodiazepine prescriptions over time. 


The third study that provided a comparison of the safety and efficacy of therapeutic options in GAD analyzed 89 trials, including 25,441 patients randomly assigned to 22 different active drugs or placebo. It found Duloxetine, pregabalin, venlafaxine, and escitalopram to be more efficacious than placebo with relatively good acceptability. Mirtazapine, sertraline, fluoxetine, buspirone, and agomelatine were also efficacious and well tolerated however were backed by small samples. Quetiapine showed the largest impact on anxiety severity, but it was poorly tolerated compared to a placebo. Similarly, paroxetine and benzodiazepine were effective but also poorly tolerated compared to the placebo.


Slee. Generalised Anxiety Disorder: Incidence and Drug Treatment. Doctoral thesis (Ph.D.), UCL (University College London). 2022. https://discovery.ucl.ac.uk/id/eprint/10146430

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