Influence of baseline severity on antidepressant efficacy for anxiety disorders: Meta-analysis and meta-regression

Ymkje Anna De Vries, Peter De Jonge, Edwin Den Van Heuvel, Erick Turner, Annelieke M. Roest

Research output: Contribution to journalReview article

18 Citations (Scopus)

Abstract

Background Antidepressants are established first-line treatments for anxiety disorders, but it is not clear whether they are equally effective across the severity range. Aims To examine the influence of baseline severity of anxiety on antidepressant efficacy for generalised anxiety disorder (GAD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and panic disorder. Method Fifty-six trials of second-generation antidepressants for the short-term treatment of an anxiety disorder were included. Baseline and change scores were extracted for placebo and treatment groups in each trial. Mixed effects meta-regression was used to investigate the effects of treatment group, baseline severity and their interaction. Results Increased baseline severity did not predict greater improvement in drug groups compared with placebo groups. Standardised regression coefficients of the interaction term between baseline severity and treatment group were 0.04 (95% CI 70.13 to 0.20, P = 0.65) for GAD, 70.06 (95% CI 70.20 to 0.09, P = 0.43) for SAD, 0.04 (95% CI 70.07 to 0.16, P = 0.46) for OCD, 0.16 (95% CI 70.22 to 0.53, P = 0.37) for PTSD and 0.002 (95% CI 70.10 to 0.10, P = 0.96) for panic disorder. For OCD, baseline severity did predict improvement in both placebo and drug groups equally (b = 0.11, 95% CI 0.05 to 0.17, P = 0.001). Conclusions No relationship between baseline severity and drug-placebo difference was found for anxiety disorders. These results suggest that if the efficacy of antidepressants is considered clinically relevant, they may be prescribed to patients with anxiety regardless of symptom severity.

Original languageEnglish (US)
Pages (from-to)515-521
Number of pages7
JournalBritish Journal of Psychiatry
Volume208
Issue number6
DOIs
StatePublished - Jun 1 2016

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Anxiety Disorders
Antidepressive Agents
Meta-Analysis
Obsessive-Compulsive Disorder
Placebos
Panic Disorder
Post-Traumatic Stress Disorders
Anxiety
Pharmaceutical Preparations
Therapeutics
Social Phobia

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Influence of baseline severity on antidepressant efficacy for anxiety disorders : Meta-analysis and meta-regression. / De Vries, Ymkje Anna; De Jonge, Peter; Van Heuvel, Edwin Den; Turner, Erick; Roest, Annelieke M.

In: British Journal of Psychiatry, Vol. 208, No. 6, 01.06.2016, p. 515-521.

Research output: Contribution to journalReview article

De Vries, Ymkje Anna ; De Jonge, Peter ; Van Heuvel, Edwin Den ; Turner, Erick ; Roest, Annelieke M. / Influence of baseline severity on antidepressant efficacy for anxiety disorders : Meta-analysis and meta-regression. In: British Journal of Psychiatry. 2016 ; Vol. 208, No. 6. pp. 515-521.
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abstract = "Background Antidepressants are established first-line treatments for anxiety disorders, but it is not clear whether they are equally effective across the severity range. Aims To examine the influence of baseline severity of anxiety on antidepressant efficacy for generalised anxiety disorder (GAD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and panic disorder. Method Fifty-six trials of second-generation antidepressants for the short-term treatment of an anxiety disorder were included. Baseline and change scores were extracted for placebo and treatment groups in each trial. Mixed effects meta-regression was used to investigate the effects of treatment group, baseline severity and their interaction. Results Increased baseline severity did not predict greater improvement in drug groups compared with placebo groups. Standardised regression coefficients of the interaction term between baseline severity and treatment group were 0.04 (95{\%} CI 70.13 to 0.20, P = 0.65) for GAD, 70.06 (95{\%} CI 70.20 to 0.09, P = 0.43) for SAD, 0.04 (95{\%} CI 70.07 to 0.16, P = 0.46) for OCD, 0.16 (95{\%} CI 70.22 to 0.53, P = 0.37) for PTSD and 0.002 (95{\%} CI 70.10 to 0.10, P = 0.96) for panic disorder. For OCD, baseline severity did predict improvement in both placebo and drug groups equally (b = 0.11, 95{\%} CI 0.05 to 0.17, P = 0.001). Conclusions No relationship between baseline severity and drug-placebo difference was found for anxiety disorders. These results suggest that if the efficacy of antidepressants is considered clinically relevant, they may be prescribed to patients with anxiety regardless of symptom severity.",
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AU - Roest, Annelieke M.

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N2 - Background Antidepressants are established first-line treatments for anxiety disorders, but it is not clear whether they are equally effective across the severity range. Aims To examine the influence of baseline severity of anxiety on antidepressant efficacy for generalised anxiety disorder (GAD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and panic disorder. Method Fifty-six trials of second-generation antidepressants for the short-term treatment of an anxiety disorder were included. Baseline and change scores were extracted for placebo and treatment groups in each trial. Mixed effects meta-regression was used to investigate the effects of treatment group, baseline severity and their interaction. Results Increased baseline severity did not predict greater improvement in drug groups compared with placebo groups. Standardised regression coefficients of the interaction term between baseline severity and treatment group were 0.04 (95% CI 70.13 to 0.20, P = 0.65) for GAD, 70.06 (95% CI 70.20 to 0.09, P = 0.43) for SAD, 0.04 (95% CI 70.07 to 0.16, P = 0.46) for OCD, 0.16 (95% CI 70.22 to 0.53, P = 0.37) for PTSD and 0.002 (95% CI 70.10 to 0.10, P = 0.96) for panic disorder. For OCD, baseline severity did predict improvement in both placebo and drug groups equally (b = 0.11, 95% CI 0.05 to 0.17, P = 0.001). Conclusions No relationship between baseline severity and drug-placebo difference was found for anxiety disorders. These results suggest that if the efficacy of antidepressants is considered clinically relevant, they may be prescribed to patients with anxiety regardless of symptom severity.

AB - Background Antidepressants are established first-line treatments for anxiety disorders, but it is not clear whether they are equally effective across the severity range. Aims To examine the influence of baseline severity of anxiety on antidepressant efficacy for generalised anxiety disorder (GAD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and panic disorder. Method Fifty-six trials of second-generation antidepressants for the short-term treatment of an anxiety disorder were included. Baseline and change scores were extracted for placebo and treatment groups in each trial. Mixed effects meta-regression was used to investigate the effects of treatment group, baseline severity and their interaction. Results Increased baseline severity did not predict greater improvement in drug groups compared with placebo groups. Standardised regression coefficients of the interaction term between baseline severity and treatment group were 0.04 (95% CI 70.13 to 0.20, P = 0.65) for GAD, 70.06 (95% CI 70.20 to 0.09, P = 0.43) for SAD, 0.04 (95% CI 70.07 to 0.16, P = 0.46) for OCD, 0.16 (95% CI 70.22 to 0.53, P = 0.37) for PTSD and 0.002 (95% CI 70.10 to 0.10, P = 0.96) for panic disorder. For OCD, baseline severity did predict improvement in both placebo and drug groups equally (b = 0.11, 95% CI 0.05 to 0.17, P = 0.001). Conclusions No relationship between baseline severity and drug-placebo difference was found for anxiety disorders. These results suggest that if the efficacy of antidepressants is considered clinically relevant, they may be prescribed to patients with anxiety regardless of symptom severity.

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