The Graduate Center, The City University of New York, NY, USA.
J Affect Disord. 2010 Jun;123(1-3):9-16. doi: 10.1016/j.jad.2009.06.021. Epub 2009 Jul 17.
We assessed the efficacy of continuation treatment with antidepressants in a meta-analysis of relapse prevention studies in the five principal anxiety disorders, to explore the benefit of continuation treatment in each disorder, and their relative efficacy across these disorders.
Double-blind placebo-controlled studies with relapse prevention designs in Panic Disorder, Generalized Anxiety Disorder, Social Phobia, Post-Traumatic Stress Disorder and Obsessive-Compulsive Disorder were identified in a systematic literature search. The primary efficacy comparison was relapse rates between active and placebo arms calculated as odds ratios (ORs) using Review Manager version 5.0. Relapse data were also used to calculate relative risk (RR), risk difference (RD) and number needed to treat (NNT).
Twenty-two relapse prevention trials were identified for these 5 disorders. Continuation antidepressant treatment produced robust treatment effects for each disorder, however the magnitude varied by indication. The greatest treatment effect was noted for GAD (pooled OR 0.20), whereas the pooled ORs for PD and OCD were for almost 2-fold higher (0.35 and 0.38 respectively). RR, RD and NNT showed similar statistically significant trends.
This study cannot identify an optimal duration of therapy. This analysis only examined studies testing monoamine reuptake inhibiting antidepressants, and therefore these results might not be generalizable to other classes of antianxiety agents.
This meta-analysis underscores the importance of continuation treatment following acute response in all 5 anxiety disorders, however the relative efficacy of continuation antidepressant treatment appears to vary by disorder.
我们通过对五种主要焦虑障碍的复发预防研究进行荟萃分析，评估了继续使用抗抑郁药进行治疗的疗效，以探索每种障碍继续治疗的益处，以及它们在这些障碍中的相对疗效。
通过系统文献检索，确定了惊恐障碍、广泛性焦虑障碍、社交恐惧症、创伤后应激障碍和强迫症中具有复发预防设计的双盲安慰剂对照研究。主要疗效比较是采用 Review Manager 版本 5.0 计算的活跃组和安慰剂组之间的复发率，计算为比值比（ORs）。还使用复发数据计算相对风险（RR）、风险差异（RD）和需要治疗的人数（NNT）。
确定了这 5 种疾病的 22 项复发预防试验。继续使用抗抑郁药治疗对每种疾病都产生了显著的治疗效果，但疗效因适应症而异。GAD 的治疗效果最大（汇总 OR 0.20），而 PD 和 OCD 的汇总 OR 几乎高 2 倍（分别为 0.35 和 0.38）。RR、RD 和 NNT 显示出相似的具有统计学意义的趋势。
本研究无法确定最佳治疗持续时间。本分析仅检查了测试单胺再摄取抑制抗抑郁药的研究，因此这些结果可能不适用于其他类别的抗焦虑药物。
这项荟萃分析强调了在所有 5 种焦虑障碍中，在急性反应后继续治疗的重要性，然而，继续抗抑郁药治疗的相对疗效似乎因障碍而异。
