Quetiapine helps reduce anxiety disorder, but the side effects may outweigh the benefits

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Anxiety disorders are common and disabling conditions, with a lifetime prevalence of 17% in the general population. Due to high rates of treatment resistance, there is interest in new pharmacological treatment options.

Second-generation antipsychotic drugs may be a helpful treatment for anxiety disorders.  This Cochrane review looked at RCTs comparing quetiapine, olanzapine and risperidone with placebo and antidepressants.  Only the data on quetiapine was considered good enough to draw any conclusions.  Patients taking quetiapine showed significant improvement, but also experienced lots of side effects, which led to high drop out rates.

The plain language (!) Cochrane summary:

Anxiety disorders are a prevalent and disabling condition. Because of high rates of treatment resistance, there is interest in new pharmacological treatment options such as second-generation antipsychotics. This systematic review evaluated the efficacy and tolerability of second-generation antipsychotics in the treatment of anxiety disorders. We found eleven randomised placebo-controlled trials, comparing quetiapine, olanzapine and risperidone with placebo and antidepressants.

The vast majority of the available data was on quetiapine (> 3000 participants). Participants with generalised anxiety disorder responded significantly better to quetiapine than to placebo, measured as a reduction in the Hamilton Anxiety Scale (HAM-A). Participants treated with quetiapine were more likely to drop out due to adverse events, to gain weight, to suffer from sedation or to suffer from extrapyramidal side effects. The evidence on the other second-generation antipsychotics is currently too limited to draw any conclusions.

Depping AM, Komossa K, Kissling W, Leucht S. Second-generation antipsychotics for anxiety disorders. Cochrane Database of Systematic Reviews 2010, Issue 12. Art. No.: CD008120. DOI: 10.1002/14651858.CD008120.pub2.


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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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