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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.

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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.
Authors: Munkholm, Klaus (AUTHOR), Ussing, Anja (AUTHOR), Brink, Maria (AUTHOR), Edemann-Callesen, Henriette (AUTHOR), Canbolat, Sengül Sari (AUTHOR), Christensen, Robin (AUTHOR), Dahl, Kristine Søgaard (AUTHOR), Ebdrup, Bjørn H. (AUTHOR), Jensen, Mikkel Erik Juul (AUTHOR), Kierulf-Lassen, Casper (AUTHOR), Madsen, Gitte Krogh (AUTHOR), Nielsen, Sabrina Mai (AUTHOR), Paulsen, Camilla Paludan (AUTHOR), Rohde, Jeanett Friis (AUTHOR), Tarp, Simon (AUTHOR), Baandrup, Lone (AUTHOR)
Source: European Archives of Psychiatry & Clinical Neuroscience. Apr2024, Vol. 274 Issue 3, p475-486. 12p.
Subjects: Mental health services, Anxiety, Drug therapy, Anxiety disorders, Symptoms, Adjustment disorders, Brief psychotherapy
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. [ABSTRACT FROM AUTHOR]
Copyright of European Archives of Psychiatry & Clinical Neuroscience is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Minor tranquillizers for short-term treatment of newly onset symptoms of anxiety and distress: a systematic review with network meta-analysis of randomized trials.
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  Data: <searchLink fieldCode="AR" term="%22Munkholm%2C+Klaus%22">Munkholm, Klaus</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ussing%2C+Anja%22">Ussing, Anja</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Brink%2C+Maria%22">Brink, Maria</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Edemann-Callesen%2C+Henriette%22">Edemann-Callesen, Henriette</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Canbolat%2C+Sengül+Sari%22">Canbolat, Sengül Sari</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Christensen%2C+Robin%22">Christensen, Robin</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Dahl%2C+Kristine+Søgaard%22">Dahl, Kristine Søgaard</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ebdrup%2C+Bjørn+H%2E%22">Ebdrup, Bjørn H.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Jensen%2C+Mikkel+Erik+Juul%22">Jensen, Mikkel Erik Juul</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kierulf-Lassen%2C+Casper%22">Kierulf-Lassen, Casper</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Madsen%2C+Gitte+Krogh%22">Madsen, Gitte Krogh</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Nielsen%2C+Sabrina+Mai%22">Nielsen, Sabrina Mai</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Paulsen%2C+Camilla+Paludan%22">Paulsen, Camilla Paludan</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Rohde%2C+Jeanett+Friis%22">Rohde, Jeanett Friis</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Tarp%2C+Simon%22">Tarp, Simon</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Baandrup%2C+Lone%22">Baandrup, Lone</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22European+Archives+of+Psychiatry+%26+Clinical+Neuroscience%22">European Archives of Psychiatry & Clinical Neuroscience</searchLink>. Apr2024, Vol. 274 Issue 3, p475-486. 12p.
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  Label: Abstract
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  Data: 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. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of European Archives of Psychiatry & Clinical Neuroscience is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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