Stuart and Emily Mudd Professor of Human Behavior and Professor of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
Professor of Psychiatry and former Chair, Department of Psychiatry of the Ludwig Maximilian University, Munich, Germany.
World J Biol Psychiatry. 2019 Sep;20(7):514-518. doi: 10.1080/15622975.2018.1500031. Epub 2018 Sep 25.
Benzodiazepines (BZs) are still widely prescribed for the treatment of anxiety disorders despite many publications in the literature which favour antidepressants (ADs) instead. What is the evidence? Treatment guidelines favour ADs over BZs for treatment of anxiety disorders without any head-to-head comparison of both drug groups with placebo. BZs are claimed to cause less efficacy and more safety issues than ADs, yet ADs also cause disturbing adverse events and, similar to BZs, discontinuation symptoms. Until evidence-based data become available, a look at two 6-month generalized anxiety disorder trials conducted by the same research group, one with a BZ and the other with an AD, might provide some guidance for the clinician. Most improvement with a BZ was obtained by 4 weeks, suggesting that BZ treatment longer than 4 weeks should only be offered to patients maximally improved at 4 weeks. In contrast, ADs may have to be prescribed for 3-6 months to obtain maximal benefits. Results of a controlled trial as proposed will go a long way in providing clinicians missing information to guide them in the appropriate use of both BZs and ADs in anxiety disorders.
苯二氮䓬类药物（BZs）尽管在文献中有很多出版物支持使用抗抑郁药（ADs），但仍被广泛用于治疗焦虑症。有什么证据？治疗指南倾向于 ADs 而不是 BZs 来治疗焦虑症，而没有对这两种药物组与安慰剂进行直接比较。与 ADs 相比，BZs 被认为疗效较低，安全性问题更多，但 ADs 也会引起令人不安的不良反应，而且与 BZs 类似，也会出现停药症状。在基于证据的资料出现之前，看看同一研究小组进行的两项为期 6 个月的广泛性焦虑症试验，一项使用 BZ，另一项使用 AD，可能会为临床医生提供一些指导。使用 BZ 治疗 4 周后，大多数患者的病情得到了最大程度的改善，这表明应仅向在 4 周时最大程度改善的患者提供超过 4 周的 BZ 治疗。相比之下，可能需要开具 AD 处方 3-6 个月才能获得最大益处。这样的对照试验结果将为临床医生提供缺失的信息，帮助他们在焦虑症中正确使用 BZ 和 AD。
