The safety of SSRIs in generalised anxiety disorder: any reason to be anxious?

Generalised anxiety disorder (GAD) significantly impacts upon quality of life and has a chronic and persistent nature. GAD requires pharmacological therapies that are well-tolerated, lessen the mitigating effects of common comorbidities and do not pose a high risk for dependency or abuse. Selective serotonin and serotonin-noradrenaline re-uptake inhibitors have become more viable treatments for GAD than the traditionally used benzodiazepines due to greater efficacy and a more tolerable adverse event profile. Among these newer-generation antidepressants, only paroxetine and venlafaxine are currently FDA-approved for the treatment of GAD. Paroxetine was approved after three double-blind, placebo-controlled studies demonstrated its superior efficacy compared to placebo for short-term treatment of GAD. Venlafaxine was approved for both short- and long-term treatment of GAD after demonstrating efficacy in 8-week and 6-month double-blind, placebo-controlled trials. For both paroxetine and venlafaxine, the safety and tolerability profiles during treatment of GAD are consistent with those demonstrated during the short- and long-term treatment of patients with major depressive disorder.