Antipsychotic agents in anxiety disorders: An umbrella review

IF 5.3 2区医学 Q1 PSYCHIATRY Acta Psychiatrica Scandinavica Pub Date : 2024-02-21 DOI:10.1111/acps.13669

Amir Garakani, Frank D. Buono, Mona Salehi, Melissa C. Funaro, Anna Klimowicz, Harshit Sharma, Clara G. F. Faria, Kaitlyn Larkin, Rafael C. Freire

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Abstract

Background

Although not approved for the treatment of anxiety disorders (except trifluoperazine) there is ongoing off-label, unapproved use of first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) for anxiety disorders. There have been systematic reviews and meta-analyses on the use of antipsychotics in anxiety disorders, most of which focused on SGAs.

Objective

The specific aims of this umbrella review are to: (1) Evaluate the evidence of efficacy of FGAs and SGAs in anxiety disorders as an adjunctive treatment to traditional antidepressant treatments and other nonantipsychotic medications; (2) Compare monotherapy with antipsychotics to first-line treatments for anxiety disorders in terms of effectiveness, risks, and side effects. The review protocol is registered on PROSPERO (CRD42021237436).

Methods

An initial search was undertaken to identify systematic reviews and meta-analyses from inception until 2020, with an updated search completed August 2021 and January 2023. The searches were conducted in PubMed, MEDLINE (Ovid), EMBASE (Ovid), APA PsycInfo (Ovid), CINAHL Complete (EBSCOhost), and the Cochrane Library through hand searches of references of included articles. Review quality was measured using the AMSTAR-2 (A MeaSurement Tool to Assess Systematic Reviews) scale.

Results

The original and updated searches yielded 1796 and 3744 articles respectively, of which 45 were eligible. After final review, 25 systematic reviews and meta-analyses were included in the analysis. Most of the systematic reviews and meta-analyses were deemed low-quality through AMSTAR-2 with only one review being deemed high-quality. In evaluating the monotherapies with antipsychotics compared with first-line treatments for anxiety disorder there was insufficient evidence due to flawed study designs (such as problems with randomization) and small sample sizes within studies. There was limited evidence suggesting efficacy of antipsychotic agents in anxiety disorders other than quetiapine in generalized anxiety disorder (GAD).

Conclusions

This umbrella review indicates a lack of high-quality studies of antipsychotics in anxiety disorders outside of the use of quetiapine in GAD. Although potentially effective for anxiety disorders, FGAs and SGAs may have risks and side effects that outweigh their efficacy, although there were limited data. Further long-term and larger-scale studies of antipsychotics in anxiety disorders are needed.

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抗精神病药物治疗焦虑症：综述。

背景：虽然第一代抗精神病药物（FGAs）和第二代抗精神病药物（SGAs）未被批准用于治疗焦虑症（三氟拉嗪除外），但仍有未经批准的标示外使用。关于抗精神病药物在焦虑症中的应用，已有系统性综述和荟萃分析，其中大部分侧重于 SGAs：本综述的具体目的是(1）评估 FGAs 和 SGAs 作为传统抗抑郁治疗和其他非抗精神病药物的辅助治疗手段对焦虑症的疗效证据；（2）比较抗精神病药物单药治疗与焦虑症一线治疗在疗效、风险和副作用方面的差异。综述方案已在 PROSPERO（CRD42021237436）上注册：方法：进行了初步检索，以确定从开始到 2020 年的系统综述和荟萃分析，并于 2021 年 8 月和 2023 年 1 月完成了更新检索。检索在 PubMed、MEDLINE (Ovid)、EMBASE (Ovid)、APA PsycInfo (Ovid)、CINAHL Complete (EBSCOhost)和 Cochrane 图书馆中进行，对纳入文章的参考文献进行人工检索。采用 AMSTAR-2（系统性综述评估工具）量表衡量综述质量：原始检索和更新检索分别获得了 1796 篇和 3744 篇文章，其中 45 篇符合条件。经过最终审核，25 篇系统综述和荟萃分析文章被纳入分析范围。大多数系统综述和荟萃分析在 AMSTAR-2 中被认为是低质量的，只有一篇综述被认为是高质量的。在评估抗精神病药物与焦虑症一线治疗方法的单一疗法时，由于研究设计存在缺陷（如随机化问题）以及研究样本量较小，因此证据不足。除了喹硫平对广泛性焦虑症（GAD）有疗效外，其他抗精神病药物对焦虑症的疗效证据有限：本综述表明，除了在 GAD 中使用喹硫平之外，缺乏高质量的抗精神病药物治疗焦虑症的研究。尽管FGAs和SGAs对焦虑症可能有效，但其风险和副作用可能超过其疗效，尽管数据有限。还需要对抗精神病药物治疗焦虑症进行更长期、更大规模的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Psychiatrica Scandinavica 医学-精神病学

CiteScore

11.20

自引率

3.00%

发文量

135

审稿时长

6-12 weeks

期刊介绍： Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.