Questions about drugs for anxiety disorders

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Publication bias and 'spin' raise questions about drugs for anxiety disorders

A new analysis raises serious questions about the increasingly common use of second-generation antidepressant drugs to treat anxiety disorders.

It concludes that studies supporting the value of these medications for that purpose have been distorted by publication bias, outcome reporting bias and "spin." Even though they may still play a role in treating these disorders, the effectiveness of the drugs has been overestimated.

In some cases the medications, which are among the most widely prescribed drugs in the world, are not significantly more useful than a placebo.

Publication bias was one of the most serious problems. Bias in "outcome reporting" was also observed, in which the positive 

outcomes from drug use were emphasized over those found to be negative. And simple spin was also reported. 

Some investigators concluded that treatments were beneficial, when their own published results for primary outcomes were actually insignificant.

"These findings mirror what we found previously with the same drugs when used to treat major depression, and with antipsychotics," said Erick Turner, M.D., associate professor of psychiatry in the OHSU School of Medicine, and the study's senior author. "When their studies don't turn out well, you usually won't know it from the peer-reviewed literature."

This points to a flaw in the way doctors learn about the drugs they prescribe, the researchers said.

"There is strong evidence that significant results from randomized controlled trials are more likely to be published than nonsignificant results," the researchers wrote in their study. 

"As a consequence, the published literature . . . may overestimate the benefits of treatment while underestimating their harms, thus misinforming clinicians, policy makers and patients."

Antidepressants are now widely prescribed for conditions other than depression, the study noted. They are being used for generalized anxiety disorder, panic disorder, social anxiety, post-traumatic stress disorder and other uses. 

In both the U.S. and Europe, use of antidepressant drugs has significantly increased in the past two decades, the researchers said, with much of that use driven by non-specialists in primary care settings.

Oregon State University, Oregon Health & Science University, and the University of Groningen in The Netherlands. JAMA Psychiatry