Antidepressants Less Effective in Mild Anxiety, Panic Disorder
For patients with milder cases of generalized anxiety disorder (GAD) and panic disorder (PD), the benefits of antidepressants may not outweigh the risks, according to an individual patient data meta-analysis published online in Depression and Anxiety.
Noting that previous research has suggested antidepressants may be less beneficial in milder cases of depression, researchers conducted the study to investigate whether initial symptom severity influenced antidepressant effectiveness for patients with GAD and PD, as well as social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). Nearly 30 randomized, controlled trials spanning more than 8900 patients were included in the analysis.
“We found that antidepressants are equally effective across the severity range generally included in clinical trials for SAD, OCD, and PTSD,” researchers reported. “For GAD and PD, however, the benefits of antidepressants over and above placebo are small at low severity, and the trade-off between benefits and risks may therefore be unfavorable for these patients.”
Specifically, the analysis showed a difference between treatment with an antidepressant and treatment with a placebo of 4.0 points on the Hamilton Anxiety Rating Scale for patients with severe GAD. For patients with mild GAD, the antidepressant-placebo difference was just 1.4 points.
For patients with panic disorder, those experiencing 40 panic attacks every 2 weeks at baseline saw 4.7 fewer panic attacks every 2 weeks when treated with antidepressants. Patients experiencing 10 panic attacks every 2 weeks at baseline, however, experienced a decrease of 0.4 panic attacks every 2 weeks with antidepressants, according to the study.
“[I]t is clear that the risk-benefit ratio for GAD and PD becomes less favorable as initial severity decreases,” researchers wrote. “It is therefore imperative that clinicians transparently discuss the expected benefits of antidepressants with patients with mild to moderate symptoms, who constitute the majority of patients in primary care.”
de Vries YA, Roest AM, Burgerhof JGM, de Jonge P. Initial severity and antidepressant efficacy for anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder: an individual patient data meta-analysis. Depression and Anxiety. 2018 April 16;[Epub ahead of print].