Anxiety neurosis in general practice. A double-blind comparative study of diazepam and clovoxamine, a novel inhibitor of noradrenaline and serotonin reuptake.

This was a multicentre prospectively randomized double-blind parallel comparison of clovoxamine (n = 37) and diazepam (n = 35) in 72 patients suffering from anxiety neurosis, in general practice. Patients were seen weekly. Treatment was for 4 weeks (50 mg clovoxamine b.d. or 5 mg diazepam b.d.) rising according to response to a maximum of 300 mg clovoxamine or 30 mg diazepam daily. Drug was tapered off in week 5 and patients were seen again in week 6 after they had been off drug for at least a week. A treatment period of 4 weeks was selected in line with WHO guidelines for the testing of anxiolytic drugs. Although more patients dropped out due to intolerance on clovoxamine (24%) compared with diazepam (11%), analysis of completed patients showed that clovoxamine was equally effective with significant improvement in both groups at week 4 (p less than .001) compared with baseline Morbid Anxiety Inventory scores and Hamilton Anxiety Scale scores. Diazepam patients had a more rapid response which levelled off, whereas those on clovoxamine continued to improve after 2 weeks. At 6 weeks after taper off the improvement on clovoxamine was sustained whereas on diazepam there was evidence of deterioration after stopping the drug. Clovoxamine appears to have potential as an alternative treatment to diazepam for anxiety in general practice.