Recent network meta-analyses support the use of pharmacotherapy in patients with generalised anxiety disorder (GAD). Compared with placebo, drug treatment can improve symptoms and quality of life, and is more effective in preventing relapse. Selective serotonin reuptake inhibitors and serotonin–norepinephrine reuptake inhibitors are generally considered the first-line agents of choice in GAD, but in some patients, an alternative evidence-based treatment with a different mechanism of action may also be considered (e.g. those with severe GAD, inadequate response, adverse effects and/or contraindications). One example is agomelatine, a melatonin receptor agonist and serotonin 2C (5-HT_2C) receptor antagonist, which has been shown to have efficacy that is greater than placebo in patients with GAD, and to have a tolerability profile that compares favourably with that of escitalopram. Both agomelatine and escitalopram are efficacious in treating patients with GAD, including those with severe symptoms.

Video Abstract

最近的网络荟萃分析支持在广泛性焦虑症 (GAD) 患者中使用药物治疗。与安慰剂相比，药物治疗可以改善症状和生活质量，预防复发更有效。选择性 5-羟色胺再摄取抑制剂和 5-羟色胺-去甲肾上腺素再摄取抑制剂通常被认为是 GAD 的首选一线药物，但在某些患者中，也可以考虑具有不同作用机制的替代性循证治疗（例如患有严重 GAD 的患者） 、反应不足、不良反应和/或禁忌症）。一个例子是阿戈美拉汀，一种褪黑激素受体激动剂和血清素 2C (5-HT _2C) 受体拮抗剂，已被证明在 GAD 患者中的疗效优于安慰剂，并且其耐受性与依他普仑相媲美。阿戈美拉汀和依他普仑均能有效治疗 GAD 患者，包括症状严重的患者。

视频摘要