TY - JOUR
T1 - Minor tranquillizers for short-term treatment of newly onset symptoms of anxiety and distress
T2 - a systematic review with network meta-analysis of randomized trials
AU - Munkholm, Klaus
AU - Ussing, Anja
AU - Brink, Maria
AU - Edemann-Callesen, Henriette
AU - Canbolat, Sengül Sari
AU - Christensen, Robin
AU - Dahl, Kristine Søgaard
AU - Ebdrup, Bjørn H.
AU - Jensen, Mikkel Erik Juul
AU - Kierulf-Lassen, Casper
AU - Madsen, Gitte Krogh
AU - Nielsen, Sabrina Mai
AU - Paulsen, Camilla Paludan
AU - Rohde, Jeanett Friis
AU - Tarp, Simon
AU - Baandrup, Lone
N1 - Publisher Copyright:
© 2023, The Author(s).
PY - 2024/4
Y1 - 2024/4
N2 - Unspecific symptoms of anxiety and distress are frequently encountered in patients in both general practice and acute psychiatric services. Minor tranquillizers may be a treatment option when non-pharmacological interventions are insufficient or unavailable. We conducted a systematic review with network meta-analysis of the evidence for short-term (1–4 weeks) pharmacological treatment of newly onset symptoms of anxiety and distress. We searched the PsycInfo, MEDLINE, EMBASE and Cochrane Library databases and extracted data following a predefined hierarchy of outcomes. We assessed risk of bias using the Cochrane Risk of Bias tool and the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation framework (GRADE). We included 34 randomized trials comprising a total of 7044 patients with adjustment disorders or anxiety spectrum disorders. The network meta-analysis showed that regarding the critical outcome symptoms of anxiety within 1–4 weeks benzodiazepines (SMD − 0.58, 95% CI − 0.77 to − 0.40), quetiapine (SMD − 0.51, 95% CI − 0.90 to − 0.13) and pregabalin (SMD − 0.58, 95% CI − 0.87 to − 0.28) all performed better than placebo with no statistically significant difference between the drugs. Data on other important outcomes were inconsistently reported. Adverse effects varied, but overall, it was uncertain whether adverse effects differed between interventions. The evidence regarding the risk of dependence was uncertain, but dependence may be a concern in susceptible individuals even with short-term treatment. Overall, the certainty of the evidence according to GRADE was rated as low to very low across outcomes. Despite the limitations in the evidence, the results of this review can inform treatment guidelines, supporting clinicians in the choice of minor tranquillizer in this prevalent and help-seeking, clinically heterogeneous population.
AB - Unspecific symptoms of anxiety and distress are frequently encountered in patients in both general practice and acute psychiatric services. Minor tranquillizers may be a treatment option when non-pharmacological interventions are insufficient or unavailable. We conducted a systematic review with network meta-analysis of the evidence for short-term (1–4 weeks) pharmacological treatment of newly onset symptoms of anxiety and distress. We searched the PsycInfo, MEDLINE, EMBASE and Cochrane Library databases and extracted data following a predefined hierarchy of outcomes. We assessed risk of bias using the Cochrane Risk of Bias tool and the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation framework (GRADE). We included 34 randomized trials comprising a total of 7044 patients with adjustment disorders or anxiety spectrum disorders. The network meta-analysis showed that regarding the critical outcome symptoms of anxiety within 1–4 weeks benzodiazepines (SMD − 0.58, 95% CI − 0.77 to − 0.40), quetiapine (SMD − 0.51, 95% CI − 0.90 to − 0.13) and pregabalin (SMD − 0.58, 95% CI − 0.87 to − 0.28) all performed better than placebo with no statistically significant difference between the drugs. Data on other important outcomes were inconsistently reported. Adverse effects varied, but overall, it was uncertain whether adverse effects differed between interventions. The evidence regarding the risk of dependence was uncertain, but dependence may be a concern in susceptible individuals even with short-term treatment. Overall, the certainty of the evidence according to GRADE was rated as low to very low across outcomes. Despite the limitations in the evidence, the results of this review can inform treatment guidelines, supporting clinicians in the choice of minor tranquillizer in this prevalent and help-seeking, clinically heterogeneous population.
KW - Anxiety
KW - Distress
KW - Minor tranquilizers
KW - Network meta-analysis
KW - Systematic review
KW - Anxiety Disorders/drug therapy
KW - Humans
KW - Network Meta-Analysis
KW - Anti-Anxiety Agents/adverse effects
KW - Anxiety/therapy
KW - Randomized Controlled Trials as Topic
U2 - 10.1007/s00406-023-01680-0
DO - 10.1007/s00406-023-01680-0
M3 - Journal article
C2 - 37624378
AN - SCOPUS:85168957352
SN - 0940-1334
VL - 274
SP - 475
EP - 486
JO - European Archives of Psychiatry and Clinical Neuroscience
JF - European Archives of Psychiatry and Clinical Neuroscience
IS - 3
ER -