Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark.
Mental Health Centre Copenhagen, Hovedvejen 17, 1st Floor, 2000, Frederiksberg, Denmark.
Eur Arch Psychiatry Clin Neurosci. 2024 Apr;274(3):475-486. doi: 10.1007/s00406-023-01680-0. Epub 2023 Aug 25.
Unspecific symptoms of anxiety and distress are frequently encountered in patients in both general practice and acute psychiatric services. Minor tranquillizers may be a treatment option when non-pharmacological interventions are insufficient or unavailable. We conducted a systematic review with network meta-analysis of the evidence for short-term (1-4 weeks) pharmacological treatment of newly onset symptoms of anxiety and distress. We searched the PsycInfo, MEDLINE, EMBASE and Cochrane Library databases and extracted data following a predefined hierarchy of outcomes. We assessed risk of bias using the Cochrane Risk of Bias tool and the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation framework (GRADE). We included 34 randomized trials comprising a total of 7044 patients with adjustment disorders or anxiety spectrum disorders. The network meta-analysis showed that regarding the critical outcome symptoms of anxiety within 1-4 weeks benzodiazepines (SMD - 0.58, 95% CI - 0.77 to - 0.40), quetiapine (SMD - 0.51, 95% CI - 0.90 to - 0.13) and pregabalin (SMD - 0.58, 95% CI - 0.87 to - 0.28) all performed better than placebo with no statistically significant difference between the drugs. Data on other important outcomes were inconsistently reported. Adverse effects varied, but overall, it was uncertain whether adverse effects differed between interventions. The evidence regarding the risk of dependence was uncertain, but dependence may be a concern in susceptible individuals even with short-term treatment. Overall, the certainty of the evidence according to GRADE was rated as low to very low across outcomes. Despite the limitations in the evidence, the results of this review can inform treatment guidelines, supporting clinicians in the choice of minor tranquillizer in this prevalent and help-seeking, clinically heterogeneous population.
焦虑和困扰的非特异性症状在普通科诊所和急性精神病服务的患者中经常遇到。当非药物干预措施不足或不可用时，轻度镇静剂可能是一种治疗选择。我们对新出现的焦虑和困扰症状的短期（1-4 周）药物治疗进行了系统评价和网络荟萃分析。我们搜索了 PsycInfo、MEDLINE、EMBASE 和 Cochrane 图书馆数据库，并按照预先设定的结果层次结构提取数据。我们使用 Cochrane 风险偏倚工具评估风险偏倚，并使用推荐评估、制定和评估框架（GRADE）评估证据的确定性。我们纳入了 34 项随机试验，共纳入了 7044 名患有调整障碍或焦虑症谱系障碍的患者。网络荟萃分析显示，在 1-4 周内，苯二氮䓬类药物（SMD-0.58，95%CI-0.77 至-0.40）、喹硫平（SMD-0.51，95%CI-0.90 至-0.13）和普瑞巴林（SMD-0.58，95%CI-0.87 至-0.28）在焦虑的关键症状方面均优于安慰剂，药物之间无统计学差异。其他重要结局的数据报告不一致。不良反应各不相同，但总体而言，尚不确定干预措施之间是否存在不良反应差异。关于依赖风险的证据不确定，但即使是短期治疗，易感个体也可能存在依赖问题。根据 GRADE，总体而言，所有结局的证据确定性均为低至极低。尽管证据存在局限性，但本综述的结果可以为治疗指南提供信息，支持临床医生在这个普遍存在且寻求帮助的、临床异质性大的人群中选择轻度镇静剂。
