Affective Disorder Program, Department of Psychology, University of Bologna, Bologna, Italy.
Psychother Psychosom. 2013;82(6):355-62. doi: 10.1159/000353198. Epub 2013 Sep 20.
Placebo-controlled trials showed that both benzodiazepines (BDZ) and antidepressant drugs (AD) are effective in treating anxiety disorders. However, in the last years a progressive shift in the prescribing pattern from BDZ to newer AD has taken place. The aim of this systematic review and meta-analysis is to analyze whether controlled comparisons support such a shift.
CINHAL, the Cochrane Library, MEDLINE, PubMed and Web of Science were searched from inception up to December 2012. A total of 22 studies met the criteria for inclusion. They were mostly concerned with tricyclic antidepressants (TCA; 18/22) and involved different anxiety disorders. In order to reduce clinical heterogeneity, only the 10 investigations that dealt with the comparison between TCA and BDZ in panic disorder were submitted to meta-analysis, whereas the remaining papers were individually summarized and critically examined.
According to the systematic review, no consistent evidence emerged supporting the advantage of using TCA over BDZ in treating generalized anxiety disorder (GAD), complex phobias and mixed anxiety-depressive disorders. Indeed, BDZ showed fewer treatment withdrawals and adverse events than AD. In panic disorder with and without agoraphobia our meta-analysis found BDZ treatments more effective in reducing the number of panic attacks than TCA (risk ratio, RR = 1.13; 95% CI = 1.01-1.27). Furthermore, BDZ medications were significantly better tolerated than TCA drugs, causing less discontinuation (RR = 0.40; 95% CI = 0.20-0.57) and side effects (RR = 0.41; 95% CI = 0.34-0.50). As to newer AD, BDZ trials resulted in comparable or greater improvements and fewer adverse events in patients suffering from GAD or panic disorder.
The change in the prescribing pattern favoring newer AD over BDZ in the treatment of anxiety disorders has occurred without supporting evidence. Indeed, the role and usefulness of BDZ need to be reappraised.
安慰剂对照试验表明，苯二氮䓬类药物（BDZ）和抗抑郁药（AD）均能有效治疗焦虑症。然而，近年来，处方模式从 BDZ 向新型 AD 药物转变的趋势越来越明显。本系统评价和荟萃分析旨在分析对照研究是否支持这种转变。
从建库至 2012 年 12 月，我们在 CINHAL、Cochrane 图书馆、MEDLINE、PubMed 和 Web of Science 中进行了检索。共有 22 项研究符合纳入标准。这些研究大多涉及三环类抗抑郁药（TCA；22 项中的 18 项），并涉及不同的焦虑症。为了减少临床异质性，仅将涉及 TCA 与 BDZ 治疗惊恐障碍的 10 项研究纳入荟萃分析，而其余的研究则单独进行总结和批判性评估。
根据系统评价，没有一致的证据支持在治疗广泛性焦虑症（GAD）、复杂恐惧症和混合性焦虑-抑郁障碍时使用 TCA 优于 BDZ。实际上，BDZ 比 AD 导致更少的治疗中断和不良反应。在伴有或不伴有广场恐惧症的惊恐障碍中，我们的荟萃分析发现，BDZ 治疗在减少惊恐发作次数方面比 TCA 更有效（风险比，RR = 1.13；95%置信区间 = 1.01-1.27）。此外，BDZ 药物的耐受性明显优于 TCA 药物，导致更少的停药（RR = 0.40；95%置信区间 = 0.20-0.57）和不良反应（RR = 0.41；95%置信区间 = 0.34-0.50）。对于新型 AD，BDZ 试验在治疗 GAD 或惊恐障碍患者时，在改善效果或减少不良反应方面与新型 AD 药物相当或更优。
在治疗焦虑症时，处方模式从 BDZ 向新型 AD 药物转变的趋势没有得到支持证据。实际上，BDZ 的作用和用途需要重新评估。
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