Buspirone and lorazepam in the treatment of generalized anxiety disorder in outpatients

Abstract

In this double-blind, placebo-controlled 10-week trial, the anxiolytic properties of the nonbenzodiazepine buspirone were compared with the benzodiazepine lorazepam and placebo in 125 outpatients with generalized anxiety disorder according to DSM-III. After a 3-to 7-day wash-out period, patients were allocated at random to receive orally 3 × 5 mg buspirone (n = 58), 3 × 1 mg lorazepam (n = 57), or placebo (n = 10) over a 4-week period. The study also comprised a 2-week taper period and a 4-week placebocontrol period to assess the stability of clinical improvement. The patient´s clinical state was estimated on entry and at weekly intervals by general practitioners using the Hamilton Rating Scale for Anxiety (HAM-A) and Clinical Global Impression (CGI) assessment and by a self-rating scale (State Trait Anxiety Inventory X2 = STAI-X2). Lorazepam treatment resulted in descriptively, but not signiÞcantly, greater improvement on the Hamilton Rating Scale for Anxiety during the whole treatment (week 0 4) and taper period (week 5, 6) than did buspirone. After treatment with active drugs had been discontinued, the 4-week placebo control period showed buspirone-treated patients to display a stability of clinical improvement, while the symptoms of lorazepam-treated patients worsened at week 710. Both buspirone and lorazepam were more e¦cacious in reducing anxiety symptoms than placebo during the treatment and taper period; however, in contrast to the active drugs (buspirone, lorazepam), patients of the placebo group showed further clinical improvement during the control period, especially in the HAM-A score, so di¤erences between placebo and active drugs became smaller at the end of the study.

How long should a trial of escitalopram treatment be in patients with major depressive disorder, generalised anxiety disorder or social anxiety disorder? An exploration of the randomised controlled trial database

“…An onset of effect within the first 2 weeks of treatment for GAD has been associated with greater likelihood of overall response at study end-point, for diazepam (Downing and Rickels, 1985), buspirone or lorazepam (Laakmann et al, 1998) and benzodiazepines, azapirones or placebo (Rynn et al, 2006).…”

Efficacy of Extended-Release Venlafaxine in Nondepressed Outpatients With Generalized Anxiety Disorder

“…A placebo-controlled, double-blind study by Laakmann et al (25), comparing the anxiolytic properties of buspirone with those of a benzodiazepine (lorazepam) and placebo in outpatients with generalized anxiety disorder (per DSM-III criteria), showed that buspirone and lorazepam were more efficacious than placebo during treatment and taper periods. The tricyclic imipramine has been systematically studied under placebo-controlled conditions in patients in whom generalized anxiety disorder without major depressive disorder has been diagnosed (15,16).…”

Pregabalin Influences Insula and Amygdala Activation During Anticipation of Emotional Images

“…The most frequently prescribed pharmacologic agents for treating anxiety are benzodiazepines and selective serotonin reuptake inhibitors (SSRIs), which are effective for 40-80% of patients depending on the disorder and the specific study (Asnis et al, 2001;Bandelow et al, 2004;Davidson et al, 1993Davidson et al, , 2004Hoffman and Mathew, 2008;Jorstad-Stein and Heimberg, 2009;Kasper et al, 2005;Laakmann et al, 1998;Mitte et al, 2005;Moroz and Rosenbaum, 1999;Pull and Damsa, 2008;Stein et al, 1999;Van Ameringen et al, 2009). Clinicians are often hesitant to prescribe benzodiazepines because of concerns about long-term efficacy, side effects (including sedation and cognitive impairment), and potential risks for abuse or dependence (Cloos and Ferreira, 2009;McIntosh et al, 2004).…”