Antidepressant drugs in the treatment of anxiety disorders

Abstract

In March 1997 APT published two reviews of the use of benzodiazepines, buspirone, beta-blocking drugs and antidepressants in the treatment of anxiety disorders (Cowen, 1997; Tyrer, 1997). These were followed by a paper on the practical pharmacotherapy of anxiety (Nutt & Bell, 1997). The present review was originally prompted for several reasons. A number of large-scale investigations of the use of antidepressants in anxiety disorders have been completed since those papers were published. Indeed, several antidepressant drugs have since been licensed to treat anxiety disorders, and more applications are being considered. El-Khayat & Baldwin (1998) found that the prescription of antipsychotic drugs for anxiety disorders was widespread, but concluded there was no methodologically sound evidence to support their prescription. They suggested that this use of antipsychotic drugs reflected the fears of practitioners about the risks associated with benzodiazepines. There is no reason why the prescription of antidepressant drugs should arouse such fears, and it seemed timely to produce an up-to-date review of their efficacy in the treatment of anxiety disorders. This view was reinforced while this manuscript was in preparation, when the Committee on Safety of Medicines issued a statement in December 2000 that restricted the indications for the prescription of thioridazine because of concerns about rare but serious cardiotoxicity; thioridazine was no longer to be indicated for the treatment of anxiety or psychomotor agitation.