Evidence-based pharmacotherapy of generalized anxiety disorder
Evidence-based pharmacotherapy of generalized anxiety disorder
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DOI：
10.1017/s1461145704004870
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发表时间：
2005-06-01
影响因子：
4.8
通讯作者：
Polkinghorn, C
中科院分区：
文献类型：
--
作者：
Baldwin, DS;Polkinghorn, C
广泛性焦虑症（GAD）是一种常见且常常致残的疾病。本文根据已发表的荟萃分析和随机安慰剂对照研究的结果，回顾了广泛性焦虑症的药物治疗。这样做的目的是解决三个基本问题：广泛性焦虑症的一线治疗方法是什么？治疗应该持续多久？对于对一线和二线治疗没有反应的患者，最好的干预措施是什么？由于某些选择性血清素再摄取抑制剂（艾司西酞普兰、帕罗西汀、舍曲林）对广泛性焦虑症和共病焦虑和抑郁症的疗效、耐受性和安全性，应被视为大多数患者的一线治疗，尽管血清素去甲肾上腺素再摄取抑制剂文拉法辛是一个合理的替代方案。对于急性治疗反应后的最佳治疗时间知之甚少，但帕罗西汀的复发预防研究表明，持续治疗应持续至少 6 个月。对一线治疗无反应的患者的治疗尚不确定，但某些患者可能受益于某些三环类抗抑郁药、丁螺环酮或普瑞巴林。
Generalized anxiety disorder (GAD) is a common and often disabling disorder. This paper reviews the pharmacological treatment of GAD, based on the findings of published meta-analyses and randomized placebo-controlled studies. In doing so, it aims to address three fundamental questions: What is the first-line treatment for GAD? How long should treatment continue? What is the best intervention in patients who do not respond to first-line and second-line treatments? Due to their efficacy in GAD and comorbid anxiety and depressive disorders, their tolerability and safety, certain selective serotonin re-uptake inhibitors (escitalopram, paroxetine, sertraline) should be considered the first-line treatment for most patients, although the serotonin-noradrenaline re-uptake inhibitor venlafaxine is a reasonable alternative. Little is known about the optimal length of therapy after response to acute treatment but relapse-prevention studies with paroxetine suggest that continuation treatment should last for at least 6 months. The management of patients who do not respond to first-line treatment is uncertain, but some patients may benefit from certain tricyclic antidepressants, buspirone, or pregabalin.