What is it about?

Anxiety disorders, obsessive-compulsive, and stress-related disorders combined are the second leading cause of disability due to psychiatric disorders worldwide and patients commonly present symptoms of these disorders simultaneously. While these conditions affect around 10% of world’s population, only 10% of affected patients receive appropriate treatment. Despite of being recognized as first line pharmacological treatments, the efficacy of antidepressants on reducing overall symptom severity in these conditions is still questioned in the literature. Moreover, their efficacy has not been previously examined considering their multiple symptom presentations and robust comparisons of efficacy between medications is still lacking. Our study recently published in PLOS Medicine aimed to evaluate the overall clinical improvement of children and adults diagnosed with any anxiety, obsessive-compulsive, or stress-related disorder and to compare the efficacy of antidepressants for the treatment of these disorders. Using a methodology that allowed us to evaluate multiple symptom domains reported within studies, we reviewed all studies that evaluated the efficacy of antidepressants for anxiety, obsessive-compulsive, and stress-related disorders. We analyzed 469 assessments of symptoms of 30,245 patients and our findings indicate that all considered antidepressants are effective for the global improvement of mental health symptoms, as well as for all specific symptom domains and in patients from all included diagnostic categories. Concerning efficacy and acceptability, we found only minimal differences between medications.

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Why is it important?

Studies assessing the frequency of multiple diagnoses in people diagnosed with anxiety, obsessive-compulsive, and stress-related disorders indicate that more than 50% of these individuals present more than one diagnosis. In spite of that, previous reviews are designed to evaluate symptom domains separately, which might not represent most patients in clinical settings; thus, current evidence may be potentially misleading. This suggests the need to evaluate efficacy of treatments in multiple symptom domains simultaneously, given patients seek help for overall improvement in mental health and functioning rather than improvements in specific symptom domains. In addition, there are no specific scales that are recommended as the best instruments to assess symptoms of the diagnoses evaluated in this review and previous studies often restrict measures of symptoms to specific scales. Given assessment instruments often measure different symptoms although they are designed to evaluate the same symptom domain, findings of previous studies may be biased to these specific symptoms. We also found that the restriction to the most used assessment instruments would lead to exclusion of 72.71% of all available measures of symptoms, suggesting that great amount of the literature is not included in previous studies, which significantly constraint current evidence.


This study contributes to an ongoing discussion about the true benefits of antidepressants with robust evidence, considering the significantly larger quantity of data when compared to previous studies. In addition, we provide critical information for evidence-based practice assisting not only psychiatrists, but also patients, general practitioners, and policy makers on selecting treatments for global mental health improvement of people diagnosed with these highly prevalent, disabling, and costly disorders.

Natan Pereira Gosmann
Universidade Federal do Rio Grande do Sul

Read the Original

This page is a summary of: Selective serotonin reuptake inhibitors, and serotonin and norepinephrine reuptake inhibitors for anxiety, obsessive-compulsive, and stress disorders: A 3-level network meta-analysis, PLoS Medicine, June 2021, PLOS,
DOI: 10.1371/journal.pmed.1003664.
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