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Trajectory and magnitude of response in adults with anxiety disorders: a Bayesian hierarchical modeling meta-analysis of selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, and benzodiazepines

Published online by Cambridge University Press:  25 March 2024

Eric M. Mendez ,
Jeffrey A. Mills ,
Vikram Suresh ,
Julia N. Stimpfl  and
Jeffrey R. Strawn Open the ORCID record for Jeffrey R. Strawn [Opens in a new window]
Eric M. Mendez
Affiliation:
Department of Psychiatry & Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
Jeffrey A. Mills
Affiliation:
Department of Economics, Lindner College of Business, University of Cincinnati, Cincinnati, OH, USA
Vikram Suresh
Affiliation:
Department of Economics, Lindner College of Business, University of Cincinnati, Cincinnati, OH, USA
Julia N. Stimpfl
Affiliation:
Department of Psychiatry & Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
Jeffrey R. Strawn*
Affiliation:
Department of Psychiatry & Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, USA Divisions of Child & Adolescent Psychiatry and Clinical Pharmacology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
*
Corresponding author: Jeffrey R. Strawn; Email: strawnjr@uc.edu
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Abstract

Background

How the trajectory of response to medication (and placebo response) varies among selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), benzodiazepines and across anxiety disorders is unknown.

Methods

We performed a meta-analysis using weekly symptom severity data from randomized, parallel-group, placebo-controlled trials of SSRIs, SNRIs, and benzodiazepines in adults with anxiety disorders. Response was modeled for the standardized change in anxiety using Bayesian hierarchical models.

Results

Across 122 trials (N=15,760), SSRIs, SNRIs, and benzodiazepines produced significant improvement in anxiety compared to placebo. Benzodiazepines produced faster improvement by the first week of treatment (p < 0.001). By week 8, the response for benzodiazepines and SSRIs (p = 0.103) and SNRIs (p = 0.911) did not differ nor did SSRIs and SNRIs differ (p = 0.057), although for patients with generalized anxiety disorder (GAD), the benzodiazepines produced greater improvement than SNRIs at week 8 (difference − 12.42, CrI: −25.05 to −0.78, p = 0.037). Medication response was similar across anxiety disorders except for benzodiazepines, which produced greater improvement over the first 4 weeks compared to SSRIs and SNRIs in panic disorder. For SSRIs and SNRIs, women improved more than men, and for benzodiazepines, older patients improved more compared to younger patients. Finally, placebo response plateaued by week 4 of treatment, and, at week 8, social anxiety disorder trials had lower placebo response compared to other anxiety disorders.

Conclusions

Benzodiazepines show early improvement compared to SSRIs and SNRIs. However, by week 8, all treatments yield similar results. Patient characteristics influence the improvement trajectory and magnitude, suggesting potential for personalized medication selection.

Keywords

Anxietyselective serotonin reuptake inhibitorserotonin norepinephrine reuptake inhibitorbenzodiazepineplaceboantidepressant
Type
Original Research
Information
CNS Spectrums , Volume 29 , Issue 3 , June 2024 , pp. 187 - 196
Copyright
© The Author(s), 2024. Published by Cambridge University Press

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