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Minor tranquillizers for short-term treatment of newly onset symptoms of anxiety and distress: a systematic review with network meta-analysis of randomized trials: a systematic review with network meta-analysis of randomized trials

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Title: Minor tranquillizers for short-term treatment of newly onset symptoms of anxiety and distress: a systematic review with network meta-analysis of randomized trials: a systematic review with network meta-analysis of randomized trials
Authors: Klaus Munkholm, Anja Ussing, Maria Brink, Henriette Edemann-Callesen, Sengül Sari Canbolat, Robin Christensen, Kristine Søgaard Dahl, Bjørn H. Ebdrup, Mikkel Erik Juul Jensen, Casper Kierulf-Lassen, Gitte Krogh Madsen, Sabrina Mai Nielsen, Camilla Paludan Paulsen, Jeanett Friis Rohde, Simon Tarp, Lone Baandrup
Source: Eur Arch Psychiatry Clin Neurosci
Munkholm, K, Ussing, A, Brink, M, Edemann-Callesen, H, Canbolat, S S, Christensen, R, Dahl, K S, Ebdrup, B H, Jensen, M E J, Kierulf-Lassen, C, Madsen, G K, Nielsen, S M, Paulsen, C P, Rohde, J F, Tarp, S & Baandrup, L 2024, ' Minor tranquillizers for short-term treatment of newly onset symptoms of anxiety and distress : a systematic review with network meta-analysis of randomized trials ', European Archives of Psychiatry and Clinical Neuroscience, vol. 274, no. 3, pp. 475-486 . https://doi.org/10.1007/s00406-023-01680-0
Munkholm, K, Ussing, A, Brink, M, Edemann-Callesen, H, Canbolat, S S, Christensen, R, Dahl, K S, Ebdrup, B H, Jensen, M E J, Kierulf-Lassen, C, Madsen, G K, Nielsen, S M, Paulsen, C P, Rohde, J F, Tarp, S & Baandrup, L 2024, 'Minor tranquillizers for short-term treatment of newly onset symptoms of anxiety and distress : a systematic review with network meta-analysis of randomized trials', European Archives of Psychiatry and Clinical Neuroscience, vol. 274, no. 3, pp. 475-486. https://doi.org/10.1007/s00406-023-01680-0
Publisher Information: Springer Science and Business Media LLC, 2023.
Publication Year: 2023
Subject Terms: Original Paper, Distress, Minor tranquilizers, Anxiety/therapy, Network Meta-Analysis, Anti-Anxiety Agents/adverse effects, Anxiety, Psychological Distress, Anxiety Disorders, 3. Good health, Tranquilizing Agents, Outcome Assessment, Health Care, Systematic review, Humans, Network meta-analysis, Anxiety Disorders/drug therapy, Randomized Controlled Trials as Topic
Description: Unspecific symptoms of anxiety and distress are frequently encountered in patients in both general practice and acute psychiatric services. Minor tranquillizers may be a treatment option when non-pharmacological interventions are insufficient or unavailable. We conducted a systematic review with network meta-analysis of the evidence for short-term (1–4 weeks) pharmacological treatment of newly onset symptoms of anxiety and distress. We searched the PsycInfo, MEDLINE, EMBASE and Cochrane Library databases and extracted data following a predefined hierarchy of outcomes. We assessed risk of bias using the Cochrane Risk of Bias tool and the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation framework (GRADE). We included 34 randomized trials comprising a total of 7044 patients with adjustment disorders or anxiety spectrum disorders. The network meta-analysis showed that regarding the critical outcome symptoms of anxiety within 1–4 weeks benzodiazepines (SMD − 0.58, 95% CI − 0.77 to − 0.40), quetiapine (SMD − 0.51, 95% CI − 0.90 to − 0.13) and pregabalin (SMD − 0.58, 95% CI − 0.87 to − 0.28) all performed better than placebo with no statistically significant difference between the drugs. Data on other important outcomes were inconsistently reported. Adverse effects varied, but overall, it was uncertain whether adverse effects differed between interventions. The evidence regarding the risk of dependence was uncertain, but dependence may be a concern in susceptible individuals even with short-term treatment. Overall, the certainty of the evidence according to GRADE was rated as low to very low across outcomes. Despite the limitations in the evidence, the results of this review can inform treatment guidelines, supporting clinicians in the choice of minor tranquillizer in this prevalent and help-seeking, clinically heterogeneous population.
Document Type: Article
Other literature type
File Description: application/pdf
Language: English
ISSN: 1433-8491
0940-1334
DOI: 10.1007/s00406-023-01680-0
Access URL: https://pubmed.ncbi.nlm.nih.gov/37624378
https://curis.ku.dk/ws/files/387439149/s00406_023_01680_0.pdf
https://portal.findresearcher.sdu.dk/da/publications/ad2748a8-6cb7-47d8-a208-2d9334199996
https://doi.org/10.1007/s00406-023-01680-0
https://pure.au.dk/portal/en/publications/4b4672e1-90fb-4618-8c1f-23037f44d632
https://doi.org/10.1007/s00406-023-01680-0
Rights: CC BY
Accession Number: edsair.doi.dedup.....87cecf4645faca8710919f8138501d66
Database: OpenAIRE
Description
Abstract:Unspecific symptoms of anxiety and distress are frequently encountered in patients in both general practice and acute psychiatric services. Minor tranquillizers may be a treatment option when non-pharmacological interventions are insufficient or unavailable. We conducted a systematic review with network meta-analysis of the evidence for short-term (1–4 weeks) pharmacological treatment of newly onset symptoms of anxiety and distress. We searched the PsycInfo, MEDLINE, EMBASE and Cochrane Library databases and extracted data following a predefined hierarchy of outcomes. We assessed risk of bias using the Cochrane Risk of Bias tool and the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation framework (GRADE). We included 34 randomized trials comprising a total of 7044 patients with adjustment disorders or anxiety spectrum disorders. The network meta-analysis showed that regarding the critical outcome symptoms of anxiety within 1–4 weeks benzodiazepines (SMD − 0.58, 95% CI − 0.77 to − 0.40), quetiapine (SMD − 0.51, 95% CI − 0.90 to − 0.13) and pregabalin (SMD − 0.58, 95% CI − 0.87 to − 0.28) all performed better than placebo with no statistically significant difference between the drugs. Data on other important outcomes were inconsistently reported. Adverse effects varied, but overall, it was uncertain whether adverse effects differed between interventions. The evidence regarding the risk of dependence was uncertain, but dependence may be a concern in susceptible individuals even with short-term treatment. Overall, the certainty of the evidence according to GRADE was rated as low to very low across outcomes. Despite the limitations in the evidence, the results of this review can inform treatment guidelines, supporting clinicians in the choice of minor tranquillizer in this prevalent and help-seeking, clinically heterogeneous population.
ISSN:14338491
09401334
DOI:10.1007/s00406-023-01680-0