A Cochrane review looks at the effectiveness of antidepressants for anxiety disorder.
Dr Gemma Lewis, Senior Research Associate in Psychiatric Epidemiology, University College London (UCL), said:
“This is a high-quality piece of research, which combined data from 37 studies. This approach (meta-analysis) allows scientists to provide more precise estimates than just replying upon smaller individual studies. Meta-analyses are often considered the best way of informing guidelines for clinical practice. Importantly, the individual studies were generally of good quality too.
“The authors only included Randomised placebo-controlled trials. This type of study is the best way of evaluating whether a treatment is effective. The randomised design eliminates the possibility of confounding.
“One limitation of the data is that most studies only followed people for up to 12 weeks. In reality, we know that many people use antidepressants for much longer than this, often for several years. In the future, we need trials that follow people for longer periods. Another limitation of the data is that most studies only included people with a clinical diagnosis of anxiety, which is quite severe. In reality, many people are prescribed antidepressants in primary care for milder symptoms of anxiety as milder symptoms can still be debilitating.
“GAD is the most common mental health problem, and it can be very debilitating. However, in research, and also perhaps clinically, it is often neglected, particularly when compared to depression. The antidepressants were generally well accepted by people who used them although some people of course experienced side effects, as is the case with most medications. These findings reinforce the usefulness of antidepressants for treating symptoms of anxiety as well as depression.”
Prof Christiaan Vinkers, Department of Psychiatry and Anatomy and Neurosciences, Amsterdam UMC, said:
“The Cochrane review confirms what science has long shown: antidepressants work for Generalized Anxiety Disorder (GAD), with SSRIs and SNRIs consistently outperforming placebo. Their effects are meaningful, with a low number needed to treat (NNT), and dropout rates are comparable to placebo. However, antidepressants continue to face disproportionate skepticism, whether it is for GAD or depression. If these results were for heart disease or diabetes treatments, they’d be celebrated. Instead, antidepressants are often unfairly stigmatized, fueling misinformation which can deter people from seeking treatment that can have added value. Antidepressants aren’t a cure-all, but they are an essential, effective tool. Let’s shift the narrative from fear to facts: science should guide treatment, not stigma.”
Prof Katharina Domschke, Department of Psychiatry and Psychotherapy, University of Freiburg, Germany, said:
“This is a comprehensive, long awaited update on the efficacy of antidepressants versus placebo in generalized anxiety disorder (GAD).
“SSRIs and SNRIs, the first line treatment options for anxiety disorders according to all international guidelines, were shown to have a significant benefit of a placebo.
“The study is methodologically strong, applied a conservative outcome measure (greater than 50% reduction in Hamilton Anxiety score), excluded regular benzodiazepine use and controlled for study quality.
“Limitations of the present study comprise its limitation to adult patients and the wide range of treatment duration (4 to 28 weeks).
“Interestingly and importantly, no difference in overall acceptability was discerned between antidepressants and placebo.
“The presently reported effect sizes are very convincing, particularly in light of a recent study by Bschor et al. in JAMA Psychiatry 2024 reporting very high pooled pre-post placebo effect sizes in pharmacological studies in GAD.
“The present results are very important and ought to increase patients’ trust in the efficacy of pharmacological treatment of GAD. “
Prof Peter Tyrer, Professor of Community Psychiatry, Imperial College London, said:
“The findings of this review are unequivocal – antidepressants are effective in the treatment of generalised anxiety in the short-term. But in responding to this evidence the long-term implications have to be considered also. Here the conclusions of efficacy have to be tempered. Long-term treatment, as noted in the review, is often the norm, and there is increasing concern that patients have difficulties in stopping antidepressants because of withdrawal problems. Bearing in mind that the main reason why antidepressants were preferred to benzodiazepines (drugs that are equally effective in treating generalised anxiety) was the dependence risk, we just seem to have shifted the problem of adverse effects from one class of drugs to another. Brief resolution does not effect a cure”.
‘Antidepressants versus placebo for generalised anxiety disorder’ by Kopcalic et al. was published in Cochrane Database of Systematic Reviews at 01:00 UK time on Thursday 30th January 2025.
DOI: 10.1002.14651858.CD012942.pub2
Declared interests:
Prof Christiaan Vinkers “No COIs”
Prof Katharina Domschke “None”
Prof Peter Tyrer “None”
For all other experts no response to or request for COIs was received
