CLINICAL QUESTION

Are antidepressants effective and tolerable for treatment of moderate to severe generalized anxiety disorder (GAD) in patients without serious medical comorbidities?

EVIDENCE-BASED ANSWER

More patients with GAD achieve a 50% reduction in self-reported anxiety symptoms by using antidepressants compared with placebo (number needed to treat [NNT] for additional benefit = 7). Fewer participants who use antidepressants discontinue treatment due to lack of effectiveness (NNT = 27); more participants discontinue antidepressant treatment because of adverse effects (number needed to harm [NNH] = 17).¹ (Strength of Recommendation: A, consistent, good-quality patient-oriented evidence.)

PRACTICE POINTERS

GAD has a lifetime prevalence of 5.1%, according to the US National Comorbidity Survey.^2,3 GAD can cause significant morbidity and affects women twice as often as men.^2,3 Selective serotonin reuptake inhibitors (SSRIs) and serotoninnorepinephrine reuptake inhibitors (SNRIs) are considered first-line pharmacotherapy options for depression.^1,4 The authors of this Cochrane review sought to determine whether antidepressants are appropriate for patients with GAD. Known adverse effects of antidepressants include gastrointestinal, psychiatric, and sexual adverse effects.¹