Predictors of Pharmacotherapy Response in Generalized Anxiety Disorder: A Systematic Review

Mochcovitch, Marina Dyskant; Cabo, Mariana Costa do; Nardi, Antônio Egídio; Freire, Rafael C.

doi:10.1097/hrp.0000000000000127

Cited by 8 publications

(5 citation statements)

References 63 publications

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“…However, some of the literature suggests that both drug classes may be associated with similar discontinuation effects[14]. Furthermore, despite the current prescribing guidelines, physician surveys (including psychiatrists and non-psychiatrists) indicate that BZs are prescribed just as frequently as SSRIs and SNRIs, though primarily by non-psychiatrists[15]. It is therefore important that researchers and clinicians have an accurate understanding the overall efficacy of these commonly prescribed agents among adults with GAD.…”

Section: Introductionmentioning

confidence: 99%

Comparing the efficacy of benzodiazepines and serotonergic anti-depressants for adults with generalized anxiety disorder: a meta-analytic review

Gómez

Barthel

Hofmann

2018

Expert Opinion on Pharmacotherapy

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Introduction: Generalized anxiety disorder (GAD) is a common form of anxiety disorder. Selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines (BZs) are the most commonly prescribed medications for GAD, but little is known about the relative efficacy of these pharmacological treatments. Areas Covered: This study provides a meta-analytic review of the efficacy of these medications in the treatment of adults with GAD.A comprehensive literature search yielded 54 articles reporting 56 unique studies with 12,655 participants treated with either pill placebo (6,191 participants), SSRIs (16 trials, 2,712 participants), SNRIs (17 trials, 2,603 participants), or BZs (23 trials, 1,149 participants). The overall combined effect size was modest to moderate (Hedges’ g = 0.37, p< 0.0001). Effect sizes decreased significantly over time. SSRIs (Hedges’ g = 0.33) and SNRIs (Hedges’ g = 0.36) demonstrated significantly lower effect sizes than BZs (Hedges’ g = 0.50). Expert opinion: These findings were not due to differences in treatment length or publication year. The results of this study suggest that the most common forms of pharmacotherapy for adult GAD are moderately effective, with BZs being the most effective drug.

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Section: Introductionmentioning

confidence: 99%

Comparing the efficacy of benzodiazepines and serotonergic anti-depressants for adults with generalized anxiety disorder: a meta-analytic review

Gómez

Barthel

Hofmann

2018

Expert Opinion on Pharmacotherapy

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“…This dorsal region comprises a fear network along with the ventromedial prefrontal cortex and amygdala [63,64], with GABA levels in this region contributing to the maintenance of anxiety cognition-emotion fear responses and reducing fear extinction [61,62], suggesting that the cognitive control of worry thoughts is a hallmark of GAD. Yet, despite the evidence that ACC sub-regions are a significant predictor in intervention studies-at least in structural and functional studies [26,64]-it has received little focus in terms of metabolic data quantification to establish patterns in GAD symptomology, and for these reasons, the dACC is of particular interest in this investigation.…”

Section: The Dorsal Anterior Cingulate Cortex (Dacc) As a Region Of I...mentioning

confidence: 99%

“…This voxel image indicates the location of the MRS voxel, when overlapping on the corresponding structural image at the same scan session. To check whether the location of the MRS voxel covered the target region, i.e., dACC at coordinates [0, 34,26] in MNI (standard) space, individual structural images were co-registered to a MNI template, and the same transform matrix was applied on the corresponding voxel images. Finally, tissue segmentation was conducted at individual space to segment grey matter (GM), white matter (WM), and CSF.…”

Section: Voxel Placement and Checkmentioning

confidence: 99%

“…GAD remains the most understudied of the anxiety disorders [6,24]. One promising avenue to advance GAD diagnosis and the assessment of treatment efficacy is to investigate the neuroimaging biomarkers [25][26][27][28] that may offer insight into the mechanisms of anxiety; however, the extent to which brain metabolic processes are instrumental in pathology remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Neuroimaging Insights: Kava’s (Piper methysticum) Effect on Dorsal Anterior Cingulate Cortex GABA in Generalized Anxiety Disorder

Savage,

Sarris,

Hughes

et al. 2023

Nutrients

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Generalised Anxiety Disorder (GAD) is a prevalent, chronic mental health disorder. The measurement of regional brain gamma-aminobutyric acid (GABA) offers insight into its role in anxiety and is a potential biomarker for treatment response. Research literature suggests Piper methysticum (Kava) is efficacious as an anxiety treatment, but no study has assessed its effects on central GABA levels. This study investigated dorsal anterior cingulate (dACC) GABA levels in 37 adult participants with GAD. GABA was measured using proton magnetic resonance spectroscopy (1H-MRS) at baseline and following an eight-week administration of Kava (standardised to 120 mg kavalactones twice daily) (n = 20) or placebo (n = 17). This study was part of the Kava for the Treatment of GAD (KGAD; ClinicalTrials.gov: NCT02219880), a 16-week intervention study. Compared with the placebo group, the Kava group had a significant reduction in dACC GABA (p = 0.049) at eight weeks. Baseline anxiety scores on the HAM-A were positively correlated with GABA levels but were not significantly related to treatment. Central GABA reductions following Kava treatment may signal an inhibitory effect, which, if considered efficacious, suggests that GABA levels are modulated by Kava, independent of reported anxiety symptoms. dACC GABA patterns suggest a functional role of higher levels in clinical anxiety but warrants further research for symptom benefit. Findings suggest that dACC GABA levels previously un-examined in GAD could serve as a biomarker for diagnosis and treatment response.

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“…Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are widespread mental health problems and both illnesses are associated with high recurrence, comorbidity, and they prove to be difficult to treat, so treatment resistance is not uncommon [1,2]. Pharmacologically managed very similarly with serotonergic based antidepressants [3], it remains, however, unclear how the serotonergic system is involved in the comorbid occurrence of GAD in the depressed state.…”

Section: Introductionmentioning

confidence: 99%

Hostility in medication-resistant major depression and comorbid generalized anxiety disorder is related to increased hippocampal–amygdala 5-HT2A receptor density

Baeken

et al. 2021

Eur Arch Psychiatry Clin Neurosci

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Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are severe and difficult-to-treat psychiatric illnesses with high rates of comorbidity. Although both disorders are treated with serotonergic based psychotropic agents, little is known on the influence of the serotonergic neurotransmitter system on the occurrence of comorbid GAD when clinically depressed. To investigate this poorly understood clinical question, we examined the involvement of frontolimbic post-synaptic 5-HT2A receptors in 20 medication-resistant depressed (MRD) patients with half of them diagnosed with comorbid GAD with 123I-5-I-R91150 SPECT. To explore whether 5-HT2A receptor-binding indices (BI) associated with comorbid GAD could be related to distinct psychopathological symptoms, all were assessed with the symptom Checklist-90-Revised (SCL-90-R). MRD patients with comorbid GAD displayed significantly higher 5-HT2A receptor BI in the hippocampal–amygdala complex, compared to MRD patients without GAD. Correlation analyses revealed that the 5-HT2A receptor BI in these areas were significantly related to the SCL-90-R subscale hostility (HOS), especially for those MRD patients with comorbid GAD. Comorbid MRD-GAD may be characterized with increased hippocampal–amygdala 5-HT2A receptor BI which could represent enhanced levels in hostility in such kinds of patients. Adapted psychotherapeutic interventions may be warranted.

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Predictors of Pharmacotherapy Response in Generalized Anxiety Disorder: A Systematic Review

Cited by 8 publications

References 63 publications

Comparing the efficacy of benzodiazepines and serotonergic anti-depressants for adults with generalized anxiety disorder: a meta-analytic review

Comparing the efficacy of benzodiazepines and serotonergic anti-depressants for adults with generalized anxiety disorder: a meta-analytic review

Neuroimaging Insights: Kava’s (Piper methysticum) Effect on Dorsal Anterior Cingulate Cortex GABA in Generalized Anxiety Disorder

Hostility in medication-resistant major depression and comorbid generalized anxiety disorder is related to increased hippocampal–amygdala 5-HT2A receptor density

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