A review of all the relevant research comparing benzodiazepines (BDZ) to antidepressants (AD) for the treatment of anxiety was published Psychotherapy and Psychosomatics this Friday. The study, by researchers in Italy and the United States, concludes “The change in the prescribing pattern favoring newer AD over BDZ in the treatment of anxiety disorders has occurred without supporting evidence. Indeed, the role and usefulness of BDZ need to be reappraised.”
￼Offidania, E., Guidia, J., Tombaa, E., Fava, G.; Efficacy and Tolerability of Benzodiazepines versus Antidepressants in Anxiety Disorders: A Systematic Review and Meta-Analysis. ￼￼￼￼Psychotherapy and Psychosomatics. Online September 20, 2013
Of further interest:
An editorial by Karl Rickers, a significant researcher in the pharmacotherapy of anxiety, in the same issue of Psychotherapy and Psychosomatics (“Should Benzodiazepines Be Replaced by Antidepressants in the Treatment of Anxiety Disorders? Fact or Fiction?“) notes:
“In fact, no evidence for the superiority of the newer ADs over BZs, both in terms of efficacy or safety, exists for either short-term or long-term treatment. BZ toxicity, adverse events, and withdrawal symptoms, not better efficacy, are usually cited in support of the use of ADs over BZs in anxiety disorders. Yet ADs are not better tolerated than BZs and they also cause withdrawal symptoms. Therefore, gradual, not abrupt, taper is indicated after treatment with BZs and ADs, and a distinction between withdrawal symptoms and a return of anxiety, often a most difficult task, is critical for clinical management.
“A well-conducted comparison trial of a BZ and a newer AD simply does not exist, neither for acute nor chronic treatment. In fact, when in the late 1970s the National Institute of Mental Health (NIMH) made the decision to withdraw largely from supporting clinical trials of new drugs, turning new drug development over to industry, many clinically important trials, such as a comparison of BZs versus selective serotonin reuptake inhibitor ADs in anxiety disorders for example, were simply not done. It is therefore time that such comparison trials are conducted if possible under other sponsorship than that of the industy.”