Department of Psychiatry, University of Cape Town, South Africa.
Institute of Science and Technology Austria, Austria.
Compr Psychiatry. 2024 Jul;132:152479. doi: 10.1016/j.comppsych.2024.152479. Epub 2024 Mar 24.
Benzodiazepines and antidepressants are effective agents for the treatment of generalized anxiety disorder (GAD), with the HAM-A frequently used as a primary outcome measure. The GAD literature is inconsistent regarding which medications are more effective for somatic versus psychic symptoms of GAD, and treatment guidelines do not advocate for prescribing based on subtype. This meta-analysis aimed to determine whether benzodiazepines and antidepressants have a differential impact on the somatic versus psychic subscales of the HAM-A in GAD.
An electronic search was undertaken for randomized controlled trials of either benzodiazepines or antidepressants for GAD that reported treatment response using the HAM-A subscales. Data were extracted by independent reviewers. A random effects assessment of weighted mean difference with 95% confidence intervals and subgroup difference was applied. All analysis was done on SPSS 26. An assessment of bias, and of quality of evidence was performed.
24 randomized controlled trials met the inclusion criteria: 18 antidepressant trials, 5 benzodiazepine trials and 1 of both. 14 studies were assessed as having between some and high risk of bias, while 10 were assessed as having low risk of bias. Benzodiazepines (WMD of 1.81 [CI 1.03, 2.58]) were significantly more effective than antidepressants (WMD of 0.83 [CI 0.64, 1.02]) for reducing somatic symptoms of GAD (Chi = 5.81, p = 0.02), and were also more effective (WMD of 2.46 [CI 1.83, 3.09]) in reducing psychic symptoms than antidepressants (WMD of 1.83 [CI 1.55, 2.10]), although this comparison did not reach statistical significance (Chi = 3.31, p = 0.07).
The finding that benzodiazepines were significantly more effective than antidepressants for somatic symptoms needs to be weighed up against potential benefits of antidepressants over benzodiazepines. It may be useful for future treatment guidelines for GAD to explicitly consider symptom subtype.
苯二氮䓬类药物和抗抑郁药是治疗广泛性焦虑症 (GAD) 的有效药物，汉密尔顿焦虑量表 (HAM-A) 常用于主要的疗效评估指标。在 GAD 相关文献中，关于哪种药物对躯体症状和精神症状更为有效存在不一致的结果，治疗指南也不主张根据亚型进行药物选择。本项荟萃分析旨在确定苯二氮䓬类药物和抗抑郁药治疗 GAD 时，是否对 HAM-A 的躯体和精神分量表有不同的影响。
对使用 HAM-A 分量表评估治疗反应的苯二氮䓬类药物或抗抑郁药治疗 GAD 的随机对照试验进行电子检索。由独立的评审员提取数据。采用加权均数差的随机效应评估，置信区间为 95%，并进行亚组差异分析。所有分析均在 SPSS 26 中进行。还对偏倚和证据质量进行了评估。
共有 24 项随机对照试验符合纳入标准：18 项抗抑郁药试验，5 项苯二氮䓬类药物试验和 1 项同时使用两种药物的试验。14 项研究被评估为存在一定程度至高度偏倚风险，而 10 项研究被评估为低偏倚风险。苯二氮䓬类药物（WMD 为 1.81 [CI 1.03, 2.58]）在减轻 GAD 的躯体症状方面明显优于抗抑郁药（WMD 为 0.83 [CI 0.64, 1.02]）（卡方检验=5.81，p=0.02），在减轻精神症状方面也比抗抑郁药更有效（WMD 为 2.46 [CI 1.83, 3.09]）（WMD 为 1.83 [CI 1.55, 2.10]），尽管这一比较未达到统计学意义（卡方检验=3.31，p=0.07）。
与抗抑郁药相比，苯二氮䓬类药物在躯体症状方面的疗效更显著，但需要权衡其潜在的益处。对于 GAD 的未来治疗指南，明确考虑症状亚型可能会有所帮助。
