Do Antidepressants Work for Generalised Anxiety Disorder
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Look.. we can all get anxiety but pathological anxiety is another kettle of fish.
I’m sure we’ve all encountered patients who have such bad anxiety that they are unable to function in places such as work, school, social settings or even at home.
Now typically, when we see patients with anxiety, we tend to prescribe medication pragmatically. The waiting list for CBT is so long that we can’t possibly let patients suffer whilst they wait so a strategy we’re all guilty of employing is prescribing anti depressants.
So should we be “guilty” of this practice? Not particularly, as the evidence for SSRIs in generalised anxiety disorder (GAD) is very strong. Let’s review what this evidence looks like.
What is a Cochrane Review?
A Cochrane Review is a trusted summary of medical research that helps doctors, patients, and policymakers make informed healthcare decisions. It carefully gathers and analyzes all the best available studies on a specific topic, usually focusing on high-quality research like clinical trials.
These reviews follow strict guidelines to ensure accuracy, reduce bias, and often include a meta-analysis, which combines data from multiple studies for stronger conclusions. Published in the Cochrane Library, they are regularly updated to reflect new evidence, making them a gold standard in evidence-based medicine.
In the case of antidepressants and GAD, we’ve based most of our practice on isolated randomised controlled trials (RCT), the evidence of which isn’t always compelling. Some critics have viewed antidepressants as simply having a placebo effect despite the well known role serotonin can play in anxiety and depressive disorders.
This particular review included 37 randomised controlled trials with a total of 12 226 patients and compared antidepressants to placebo. Each of these studies were based in high income countries and the studies were adjusted for age and sex. It used the Hamilton Anxiety Index to evaluate the degree of improvement and concluded with “high certainty,” that antidepressants improve symptoms of GAD.
Perfect.. Let’s Prescribe more Antidepressants
Is what you would have thought right? I mean.. the results are very compelling and lend to the suggestion that perhaps we should be prescribing more anti-depressants? Not necessarily. When putting the review under the microscope, we find two significant weaknesses. These are:
- This review only looked at GAD in isolation. In reality, patients present with mix mood and anxiety disorders. Think about the MED3 statements you might write for patients. I certainly find that many of my patients have a mixed anxiety and depressive picture. The results of this review cannot be extrapolated to these scenarios.
- Each study followed patients up for a period of 4 to 12 weeks. Now that’s all good and well until we realise that most patients are on antidepressants for much longer. Do antidepressants have the same effect as time goes on? We cannot say for certain whether this is the case.
For me, there are certainly some patients who come across as anxious with occasional pathological anxiety. These patients require help and I always explain to patients that whilst antidepressant doesn’t solve your anxiety, it does help to “numb” the feeling of anxiety they feel. This study certainly gives me more reassurance that prescribing anti depressants in patients with quite obvious GAD while they wait for CBT is certainly the right thing.
It would be interesting to hear your thoughts on this review and experiences in prescribing for patients with GAD.
Until next time
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