Long-term Treatment Of Generalized Anxiety Disorder Research Articles

A literature review of quetiapine for generalized anxiety disorder.

To evaluate the efficacy and tolerability of quetiapine for the treatment of generalized anxiety disorder (GAD), a literature search of the Medline database was conducted from inception to May 2014. The search was not restricted by language. Keywords used in the search were quetiapine and generalized anxiety disorder or anxiety. All studies assessing the use of quetiapine as monotherapy or adjunct therapy for the primary management of GAD in adults 18-65years of age were included in this review. The nine studies included in this review were three studies evaluating the use of quetiapine extended release (XR) as monotherapy for acute GAD treatment, one study evaluating quetiapine XR monotherapy for maintenance treatment of GAD, and five studies evaluating quetiapine (2 XR, 3 immediate release) as adjunct therapy for acute GAD treatment. Quetiapine displayed both efficacy and tolerability in all monotherapy trials evaluating its use for acute and long-term treatment of GAD. Despite some limitations to and heterogeneity among the five adjunct therapy studies, three studies showed that quetiapine resulted in statistically significant changes in the Hamilton Anxiety Rating Scale or Clinical Global Impressions-Severity of Illness Scale scores. Although future studies of longer duration with broader inclusion criteria are needed to further evaluate the benefits and risks of quetiapine for GAD, in patients failing to respond to conventional antidepressant therapy, quetiapine may be a potential treatment option. With appropriate monitoring and management of adverse effects, the potential benefits of quetiapine in patients with treatment-refractory GAD may outweigh the risks associated with its use.

Venlafaxine: A 2003 update

Background: venlafaxine has been available for use as an antidepressant in the United States for a decade. Objective: Comprehensive reviews of venlafaxine have been published elsewhere; thus, this update focuses on newer issues of treatment remission in depression, treatment-resistant depression, and extended-release venlafaxine for generalized anxiety disorder (GAD). Methods: Relevant clinical literature from 1993 through 2003 was identified from database searches of MEDLINE and International Pharmaceutical Abstracts, and from manual searches of reference lists of the identified papers. Search terms included venlafaxine extended-release, venlafaxine XR, treatment-resistant depression, depressive disorders, anxiety disorders, generalized anxiety disorder, and antidepressive agents second generation. Results: With its dual action of serotonin and noradrenergic reuptake inhibition, venlafaxine has been shown to be superior in efficacy to selective serotonin reuptake inhibitors for severe major depressive disorder, treatment-resistant depression, and depressive symptom remission. Its demonstrated efficacy for both short- and long-term treatment of GAD has led to its use for obsessive-compulsive disorder and chronic pain syndromes, although inadequate clinical literature currently exists to support these latter 2 uses. In the past decade, no new or unexpected adverse events have been identified with venlafaxine therapy, except a possibly greater risk of fatal overdose compared with other serotonergic drugs, suggesting the need for caution in patients with suicidal ideation. Because venlafaxine is a potent serotonin agonist, caution must also be exercised to prevent the possibility of serotonin syndrome when used with other serotonin agonists, and its dose should be tapered very gradually to minimize the risk of a serotonin withdrawal reaction. Conclusion: Venlafaxine has emerged as a successful post-SSRI-era antidepressant with an expanded range of uses since it was first marketed.

Efficacy and tolerability of long-term venlafaxine XR therapy for GAD. Results of long-term, double-blind, placebo-controlled studies.

Various antidepressants and anxiolytic agents have proved to be effective as short-term therapy for generalized anxiety disorder (GAD) and other anxiety disorders. However, less is known about their efficacy in the long-term treatment of GAD. This gap in our knowledge poses a problem for physicians, who treat GAD over several months or years. More information from long-term, placebo-controlled studies of the efficacy of drug therapy for GAD will help clinicians in treatment planning. Recently, the anxiolytic effectiveness exhibited by venlafaxine extended release (venlafaxine XR) in short-term, placebo-controlled studies of nondepressed patients was confirmed in 2 long-term, placebo-controlled trials. Venlafaxine XR maintained its efficacy for up to 6 months. Compared with placebo, it demonstrated statistically significant efficacy when administered once daily in doses ranging between 37.5 and 225 mg. In addition, the incidence of adverse events was low and generally comparable to that for placebo. In light of these results, venlafaxine XR has a unique role in the long-term treatment of GAD.