Pharmacological and psychological interventions for generalized anxiety disorder in adults: A network meta-analysis

Ting Ren Chen, Hui Chuan Huang, Jer Hwa Hsu, Wen Chen Ouyang, Kuan Chia Lin

研究成果: 雜誌貢獻文章

摘要

Generalized anxiety disorder (GAD) is a significant and common mental illness with a lifetime prevalence of 3.7%. Regardless of the complexity of treatment decisions for GAD, few studies have conducted systematic comparisons of the efficacies of varying interventions. Thus, this study performed a valid network meta-analysis (NMA) of randomized controlled trials (RCTs) to synthesize direct and indirect evidence for alternative interventions for GAD. We searched four major bibliographic databases, the Cochrane Central Register of Controlled Trials, Embase, PsycINFO, and PubMed, for published RCTs of adult patients with a diagnosis of GAD and allowed for all comorbidities. A total of 91 articles (14,812 participants) were identified in the final NMA. The results showed that all pharmacological treatments except for serotonin modulators and second-generation antipsychotics had greater effects than placebo: norepinephrine–dopamine reuptake inhibitors (standardized mean difference (SMD) −1.84, 95% credible interval −3.05 to −0.62), noradrenergic and specific serotonergic antidepressants (−0.91, −1.62 to −0.20), melatonergic receptor agonists (−0.68, −1.15 to −0.21), selective serotonin reuptake inhibitors (SSRIs; −0.67, −0.90 to −0.43), azapirones (−0.58, −1.00 to −0.17), anticonvulsants (−0.56, −0.85 to −0.28), serotonin–norepinephrine reuptake inhibitors (SNRIs; −0.54, −0.79 to −0.30), and benzodiazepines (BZDs; −0.40, −0.65 to −0.15). Most psychological and self-help interventions exerted greater effects than the waitlist group. However, no psychological interventions had greater effects compared with the psychological placebo. Overall, most pharmacological interventions had larger effect sizes than psychological interventions, and most psychological interventions showed larger effect sizes than self-help interventions.

原文英語
頁(從 - 到)73-83
頁數11
期刊Journal of Psychiatric Research
118
DOIs
出版狀態已發佈 - 十一月 1 2019

指紋

Anxiety Disorders
Pharmacology
Psychology
Randomized Controlled Trials
Bibliographic Databases
Placebo Effect
Serotonin Uptake Inhibitors
Benzodiazepines
PubMed
Anticonvulsants
Antidepressive Agents
Antipsychotic Agents
Comorbidity
Serotonin
Placebos
Network Meta-Analysis
Therapeutics

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

引用此文

Pharmacological and psychological interventions for generalized anxiety disorder in adults : A network meta-analysis. / Chen, Ting Ren; Huang, Hui Chuan; Hsu, Jer Hwa; Ouyang, Wen Chen; Lin, Kuan Chia.

於: Journal of Psychiatric Research, 卷 118, 01.11.2019, p. 73-83.

研究成果: 雜誌貢獻文章

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title = "Pharmacological and psychological interventions for generalized anxiety disorder in adults: A network meta-analysis",
abstract = "Generalized anxiety disorder (GAD) is a significant and common mental illness with a lifetime prevalence of 3.7{\%}. Regardless of the complexity of treatment decisions for GAD, few studies have conducted systematic comparisons of the efficacies of varying interventions. Thus, this study performed a valid network meta-analysis (NMA) of randomized controlled trials (RCTs) to synthesize direct and indirect evidence for alternative interventions for GAD. We searched four major bibliographic databases, the Cochrane Central Register of Controlled Trials, Embase, PsycINFO, and PubMed, for published RCTs of adult patients with a diagnosis of GAD and allowed for all comorbidities. A total of 91 articles (14,812 participants) were identified in the final NMA. The results showed that all pharmacological treatments except for serotonin modulators and second-generation antipsychotics had greater effects than placebo: norepinephrine–dopamine reuptake inhibitors (standardized mean difference (SMD) −1.84, 95{\%} credible interval −3.05 to −0.62), noradrenergic and specific serotonergic antidepressants (−0.91, −1.62 to −0.20), melatonergic receptor agonists (−0.68, −1.15 to −0.21), selective serotonin reuptake inhibitors (SSRIs; −0.67, −0.90 to −0.43), azapirones (−0.58, −1.00 to −0.17), anticonvulsants (−0.56, −0.85 to −0.28), serotonin–norepinephrine reuptake inhibitors (SNRIs; −0.54, −0.79 to −0.30), and benzodiazepines (BZDs; −0.40, −0.65 to −0.15). Most psychological and self-help interventions exerted greater effects than the waitlist group. However, no psychological interventions had greater effects compared with the psychological placebo. Overall, most pharmacological interventions had larger effect sizes than psychological interventions, and most psychological interventions showed larger effect sizes than self-help interventions.",
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AU - Chen, Ting Ren

AU - Huang, Hui Chuan

AU - Hsu, Jer Hwa

AU - Ouyang, Wen Chen

AU - Lin, Kuan Chia

N1 - Copyright © 2019 Elsevier Ltd. All rights reserved.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Generalized anxiety disorder (GAD) is a significant and common mental illness with a lifetime prevalence of 3.7%. Regardless of the complexity of treatment decisions for GAD, few studies have conducted systematic comparisons of the efficacies of varying interventions. Thus, this study performed a valid network meta-analysis (NMA) of randomized controlled trials (RCTs) to synthesize direct and indirect evidence for alternative interventions for GAD. We searched four major bibliographic databases, the Cochrane Central Register of Controlled Trials, Embase, PsycINFO, and PubMed, for published RCTs of adult patients with a diagnosis of GAD and allowed for all comorbidities. A total of 91 articles (14,812 participants) were identified in the final NMA. The results showed that all pharmacological treatments except for serotonin modulators and second-generation antipsychotics had greater effects than placebo: norepinephrine–dopamine reuptake inhibitors (standardized mean difference (SMD) −1.84, 95% credible interval −3.05 to −0.62), noradrenergic and specific serotonergic antidepressants (−0.91, −1.62 to −0.20), melatonergic receptor agonists (−0.68, −1.15 to −0.21), selective serotonin reuptake inhibitors (SSRIs; −0.67, −0.90 to −0.43), azapirones (−0.58, −1.00 to −0.17), anticonvulsants (−0.56, −0.85 to −0.28), serotonin–norepinephrine reuptake inhibitors (SNRIs; −0.54, −0.79 to −0.30), and benzodiazepines (BZDs; −0.40, −0.65 to −0.15). Most psychological and self-help interventions exerted greater effects than the waitlist group. However, no psychological interventions had greater effects compared with the psychological placebo. Overall, most pharmacological interventions had larger effect sizes than psychological interventions, and most psychological interventions showed larger effect sizes than self-help interventions.

AB - Generalized anxiety disorder (GAD) is a significant and common mental illness with a lifetime prevalence of 3.7%. Regardless of the complexity of treatment decisions for GAD, few studies have conducted systematic comparisons of the efficacies of varying interventions. Thus, this study performed a valid network meta-analysis (NMA) of randomized controlled trials (RCTs) to synthesize direct and indirect evidence for alternative interventions for GAD. We searched four major bibliographic databases, the Cochrane Central Register of Controlled Trials, Embase, PsycINFO, and PubMed, for published RCTs of adult patients with a diagnosis of GAD and allowed for all comorbidities. A total of 91 articles (14,812 participants) were identified in the final NMA. The results showed that all pharmacological treatments except for serotonin modulators and second-generation antipsychotics had greater effects than placebo: norepinephrine–dopamine reuptake inhibitors (standardized mean difference (SMD) −1.84, 95% credible interval −3.05 to −0.62), noradrenergic and specific serotonergic antidepressants (−0.91, −1.62 to −0.20), melatonergic receptor agonists (−0.68, −1.15 to −0.21), selective serotonin reuptake inhibitors (SSRIs; −0.67, −0.90 to −0.43), azapirones (−0.58, −1.00 to −0.17), anticonvulsants (−0.56, −0.85 to −0.28), serotonin–norepinephrine reuptake inhibitors (SNRIs; −0.54, −0.79 to −0.30), and benzodiazepines (BZDs; −0.40, −0.65 to −0.15). Most psychological and self-help interventions exerted greater effects than the waitlist group. However, no psychological interventions had greater effects compared with the psychological placebo. Overall, most pharmacological interventions had larger effect sizes than psychological interventions, and most psychological interventions showed larger effect sizes than self-help interventions.

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