Hidalgo Rosario B, Tupler Larry A, Davidson Jonathan R T
Anxiety and Traumatic Stress Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
J Psychopharmacol. 2007 Nov;21(8):864-72. doi: 10.1177/0269881107076996.
Generalized anxiety disorder (GAD) is a prevalent and impairing disorder, associated with extensive psychiatric and medical comorbidity and usually characterized by a chronic course. Different drugs have been investigated in GAD; among them are the following: 1) SSRIs: paroxetine, sertraline, fluvoxamine and escitalopram; 2) SNRI1s: venlafaxine; 3) benzodiazepines (BZs): alprazolam, diazepam and lorazepam; 4) azapirones (AZAs): buspirone; 5) antihistamines (AHs): hydroxyzine; 6) pregabalin (PGB); and 7) complementary/alternative medicine (CAM): kava-kava and homeopathic preparation. We conducted an effect size (ES) analysis of 21 double-blind placebo-controlled trials of medications treating DSM-III-R, DSM-IV or ICD-10 GAD using HAM-A change in score from baseline or endpoint score as the main efficacy measure. Literature search was performed using MEDLINE and PsycINFO databases including articles published between 1987 and 2003 and personal communications with investigators and sponsors. comparing all drugs versus placebo, the ES was 0.39. Mean ESs, excluding children, were PGB: 0.50, AH: 0.45, SNRI: 0.42, BZ: 0.38, SSRI: 0.36, AZA: 0.17 and CAM: -0.31. Comparing ES for adults versus children/adolescents (excluding CAM) and conventional drugs versus CAM (excluding children/adolescents) we found significantly higher ES for children/adolescents and for conventional drugs (p < 0.001 and p < 0.01, respectively). No significant differences were found when comparing date of publication, location of site (i.e. US versus other), fixed versus flexible dosing, number of study arms, or number of outcome measures used. Medications varied in the magnitude of their ES, ranging from moderate to poor. Adolescents and children showed a much greater ES compared with adults. Subjects taking CAM had worse outcomes than placebo.
广泛性焦虑症（GAD）是一种常见且具有损害性的疾病，与广泛的精神和躯体共病相关，通常具有慢性病程。已对不同药物用于治疗GAD进行了研究；其中包括以下药物：1）选择性5-羟色胺再摄取抑制剂（SSRIs）：帕罗西汀、舍曲林、氟伏沙明和艾司西酞普兰；2）5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）：文拉法辛；3）苯二氮䓬类药物（BZs）：阿普唑仑、地西泮和劳拉西泮；4）阿扎哌隆类药物（AZAs）：丁螺环酮；5）抗组胺药（AHs）：羟嗪；6）普瑞巴林（PGB）；以及7）补充/替代医学（CAM）：卡瓦胡椒和顺势疗法制剂。我们对21项双盲安慰剂对照试验进行了效应量（ES）分析，这些试验使用汉密尔顿焦虑量表（HAM-A）从基线得分的变化或终点得分作为主要疗效指标来治疗符合《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）、第四版（DSM-IV）或《国际疾病分类》第十版（ICD-10）标准的GAD。使用医学文献数据库（MEDLINE）和心理学文摘数据库（PsycINFO）进行文献检索，包括1987年至2003年发表的文章以及与研究者和赞助商的个人交流。将所有药物与安慰剂进行比较，效应量为0.39。排除儿童后的平均效应量分别为：PGB：0.50，AH：0.45，SNRI：0.42，BZ：0.38，SSRI：0.36，AZA：0.17，CAM：-0.31。比较成人与儿童/青少年（不包括CAM）以及传统药物与CAM（不包括儿童/青少年）的效应量，我们发现儿童/青少年和传统药物的效应量显著更高（分别为p < 0.001和p < 0.01）。在比较发表日期、研究地点（即美国与其他地区）、固定剂量与灵活剂量、研究臂数量或所使用的结局指标数量时，未发现显著差异。药物的效应量大小各不相同，范围从中度到较差。与成人相比，青少年和儿童的效应量要大得多。服用CAM的受试者比服用安慰剂的受试者结局更差。
