Pharmacotherapy augmentation strategies in treatment-resistant anxiety disorders

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dc.contributor.authorIpser J.C.
dc.contributor.authorCarey P.
dc.contributor.authorDhansay Y.
dc.contributor.authorFakier N.
dc.contributor.authorSeedat S.
dc.contributor.authorStein D.J.
dc.date.accessioned2011-05-15T16:01:28Z
dc.date.available2011-05-15T16:01:28Z
dc.date.issued2006
dc.description.abstractBackground: A large proportion of patients with anxiety disorders fail to respond to first-line medication interventions, despite evidence of the effectiveness of these agents. Objectives: To assess the effects of medication versus placebo augmentation in the treatment of patients with anxiety disorders who have failed to respond adequately to first-line drug therapies. Search strategy: The Cochrane Depression, Anxiety & Neurosis Group (CCDAN) specialised registers (CCDANCTR-Studies and CCDANCTR-References) were searched on 3/8/2005, MEDLINE (January 1966 to July 2005) and PsycINFO (1966 to 2005, Part A). Unpublished trials were identified through the Controlled Trials database and the National Institute of Health's Computer Retrieval of Information on Scientific Projects (CRISP) service (1972 to 2005). Additional studies in any language were sought in reference lists of retrieved articles. Selection criteria: All randomised controlled trials (RCTs) of the medication augmentation of pharmacotherapy for treatment resistant anxiety disorders. Data collection and analysis: Two raters independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. Investigators were contacted to obtain missing data. Summary statistics were stratified by class of augmentation agent and anxiety disorder. Overall effect estimates were calculated using a random-effects model, heterogeneity was assessed and subgroup/sensitivity analyses were undertaken. Main results: Twenty eight short-term (average of seven weeks) randomised controlled trials (740 participants) were included in the review, 20 of which investigated augmentation of medication for treatment-resistant obsessive compulsive disorder (OCD). Summary statistics for responder status from nine trials demonstrate overall superiority of a variety of medication agents to placebo (relative risk of nonresponse (RR) 3.16, 95% CI 1.08 to 9.23). Similarly, symptom severity was significantly reduced in the medication groups, relative to placebo (number of trials (N) = 14, standardised mean difference (SMD) -0.87, 95% CI -1.37 to -0.36). There is no evidence of a difference between medication and placebo in total dropout rate, or in the number of dropouts due to adverse events. Authors' conclusions Medication augmentation can be an effective and well-tolerated short-term treatment strategy for non-responders to first-line pharmacotherapy of anxiety disorders. However, any conclusions must be tentative in view of methodological and clinical heterogeneity, and the fact that much of the relevant database is based on antipsychotic augmentation trials in OCD patients resistant to serotonin reuptake inhibitors (SRIs). Additional data are needed to address several areas, including the efficacy of augmentation over the longerterm, and the value of medication augmentation in comparison to other strategies (eg switching medication, adding psychotherapy). Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
dc.description.versionReview
dc.identifier.citationCochrane Database of Systematic Reviews
dc.identifier.citation4
dc.identifier.issn1469493X
dc.identifier.other10.1002/14651858.CD005473.pub2
dc.identifier.urihttp://hdl.handle.net/10019.1/11993
dc.subjectalprazolam
dc.subjectamitriptyline
dc.subjectbenzodiazepine
dc.subjectbrofaromine
dc.subjectbuspirone
dc.subjectcitalopram
dc.subjectclomipramine
dc.subjectclonazepam
dc.subjectdesipramine
dc.subjectescitalopram
dc.subjectfluoxetine
dc.subjecthaloperidol
dc.subjectimipramine
dc.subjectinositol
dc.subjectliothyronine
dc.subjectlithium
dc.subjectlorazepam
dc.subjectmonoamine oxidase inhibitor
dc.subjectmorphine
dc.subjectneuroleptic agent
dc.subjectolanzapine
dc.subjectparoxetine
dc.subjectphenelzine
dc.subjectpindolol
dc.subjectprazosin
dc.subjectquetiapine
dc.subjectrisperidone
dc.subjectserotonin uptake inhibitor
dc.subjecttricyclic antidepressant agent
dc.subjectunindexed drug
dc.subjectanxiety disorder
dc.subjectappetite
dc.subjectblurred vision
dc.subjectclinical trial
dc.subjectcomorbidity
dc.subjectconfidence interval
dc.subjectconstipation
dc.subjectdisease severity
dc.subjectdizziness
dc.subjectdrug withdrawal
dc.subjectdystonia
dc.subjectfatigue
dc.subjectgastrointestinal symptom
dc.subjectHamilton scale
dc.subjecthuman
dc.subjectlethargy
dc.subjectmeta analysis
dc.subjectmethodology
dc.subjectnausea
dc.subjectObsessive-compulsive disorderen_ZA
dc.subjectorgasm
dc.subjectoutcome assessment
dc.subjectpanic
dc.subjectposttraumatic stress disorder
dc.subjectrating scale
dc.subjectreview
dc.subjectsedation
dc.subjectside effect
dc.subjectsomnolence
dc.subjectstatistics
dc.subjectsystematic review
dc.subjecttreatment response
dc.subjectweight gain
dc.subjectxerostomia
dc.titlePharmacotherapy augmentation strategies in treatment-resistant anxiety disorders
dc.typeReview
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