Venlafaxine and generalised anxiety disorder: new preparation. Minimise recourse to drugs
Prescrire international 10(55): 131-134
2001
ISSN/ISBN: 1167-7422 PMID: 11824426 Document Number: 540434
(1) Generalised anxiety disorder is defined as excessive anxiety for at least 6 months. (2) Management is based primarily on psychological measures, with the aim of limiting recourse to drugs. The reference drugs are benzodiazepines. The treatment period should be as short as possible, to avoid adverse effects such as sedation and dependence. (3) Venlafaxine is a non tricyclic, non MAOI antidepressant. A sustained-release formulation has just been granted marketing authorisation in France for generalised anxiety disorder. (4) The clinical assessment file on venlafaxine in this indication includes results from two 8-week trials and a placebo-controlled trial with 6 months follow-up. The trials showed a significant improvement with venlafaxine on standard anxiety scales, but the clinical impact (at best moderate) has been poorly assessed. We found no comparison between venlafaxine and benzodiazepines. (5) In one trial venlafaxine was no more effective than buspirone. (6) The most frequent adverse effects of venlafaxine are gastrointestinal disorders, insomnia and dizziness. Venlafaxine carries a risk of drug interactions and withdrawal symptoms. (7) In practice, venlafaxine provides nothing new in the treatment of generalised anxiety disorder. The reference drug treatment remains a benzodiazepine.