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Comparative efficacy of pregabalin and benzodiazepines in treating the psychic and somatic symptoms of generalized anxiety disorder

  • R. Bruce Lydiard (a1), Karl Rickels (a2), Barry Herman (a3) and Douglas E. Feltner (a3)
  • DOI: http://dx.doi.org/10.1017/S1461145709990460
  • Published online: 09 September 2009
Abstract
Abstract

Prior research suggests that SSRIs may have greater efficacy for psychic compared to somatic anxiety, while benzodiazepines show greater somatic efficacy. The goal of this analysis was to evaluate the efficacy of pregabalin (PGB) in treating psychic and somatic symptoms of anxiety. Data were combined from six short-term, double-blind, placebo-controlled, fixed-dose trials of PGB in patients with generalized anxiety disorder (GAD). The following PGB daily dose groups were studied: 150 mg (n=210), 300–450 mg (n=455), and 600 mg (n=406), benzodiazepines (6 mg/d lorazepam and 1.5 mg/d alprazolam, n=299), vs. placebo (n=484). Changes in Hamilton Anxiety Rating Scale (HAMA) psychic and somatic anxiety factors and individual items were analysed. Treatment with 300–600 mg PGB significantly improved both the HAMA psychic and somatic anxiety factors. In contrast, treatment with 150 mg PGB appeared to be less effective, achieving significance only on the psychic anxiety factor. PGB (300–450 mg) was associated with significant improvement on 13 out of 14 HAMA items, while treatment with 600 mg PGB was associated with significant improvement in 10 out of 14 HAMA items. Treatment with benzodiazepines was also associated with significant improvement in both psychic and somatic anxiety factors, with significant improvement occurring in 5 out of 14 HAMA items. The results of this pooled analysis indicate that both PGB and benzodiazepines had significant efficacy in treating both HAMA psychic and somatic anxiety. A dose–response effect was evident for PGB that reached a plateau at a dose of 300 mg/d.

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Corresponding author
Address for correspondence: R. Bruce Lydiard, Ph.D., M.D., Psychiatry/Mental Health Ralph H. Johnson VA Medical Center, 109 Bee St, Charleston, SC29401-5799, USA. Tel.: 843-789-6744Fax: 843-789-6290Email: lydiardb@mindyourhealth.net
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DJ Dooley , CA Mieske , SA Borosky (2000 b). Inhibition of K(+)-evoked glutamate release from rat neocortical and hippocampal slices by gabapentin. Neuroscience Letters 280, 107110.

JC Fehrenbacher , CP Taylor , MR Vasko (2003). Pregabalin and gabapentin reduce release of substance P and CGRP from rat spinal tissues only after inflammation or activation of protein kinase C. Pain 105, 133144.

JP Feighner , JB Cohn (1989). Analysis of individual symptoms in generalized anxiety – a pooled, multistudy, double-blind evaluation of buspirone. Neuropsychobiology 21, 124130.

DE Feltner , JG Crockatt , SJ Dubovsky , CK Cohn , (2003). A randomized, double-blind, placebo-controlled, fixed-dose, multicenter study of pregabalin in patients with generalized anxiety disorder. Journal of Clinical Psychopharmacology 23, 240249.

X Fink , DJ Dooley , WP Meder , N Suman-Chauhan , (2002). Inhibition of neuronal Ca2+ influx by gabapentin and pregabalin in the human neocortex. Neuropharmacology 42, 229236.

NS Gee , JP Brown , VU Dissanayake , J Offord , (1996). The novel anticonvulsant drug, gabapentin (neurontin), binds to the alpha2delta subunit of a calcium channel. Journal of Biological Chemistry 271, 57685776.

M Hamilton (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology 32, 5055.

M Hamilton (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology 6, 278296.

S Kasper , B Herman , G Nivoli , M van Ameringen , (2009). Efficacy of pregabalin and venlafaxine-XR in generalized anxiety disorder: results of a double-blind, placebo-controlled 8-week trial. International Clinical Psychopharmacology 24, 8796.

IR Katz , CF Reynolds , GS Alexopoulos , D Hackett (2002). Venlafaxine ER as a treatment for generalized anxiety disorders in older adults: pooled analysis of five randomized placebo-controlled trials. Journal of the American Geriatric Society 50, 1825.

RC Kessler , WT Chiu , O Demler , KR Merikangas , EE Walters (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617627.

YP Maneuf , J Hughes , AT McKnight (2001). Gabapentin inhibits the substance P-facilitated K+-evoked release of [3H]glutamate from rat caudal trigeminal nucleus slices. Pain 93, 191196.

P Meoni , D Hackett , M Lader (2004). Pooled analysis of venlafaxine XR efficacy on psychic and somatic symptoms of anxiety in patients with generalized anxiety disorder. Depression and Anxiety 19, 127132.

P Meoni , E Salinas , Y Brault , D Hackett (2001). Pattern of symptom improvement following treatment with venlafaxine XR in patients with generalized anxiety disorder. Journal of Clinical Psychiatry 62, 888893.

SA Montgomery , K Tobias , GL Zornberg , S Kasper , AC Pande (2006). Efficacy and safety of pregabalin in the treatment of generalized anxiety disorder: a 6-week, multicenter, randomized, double-blind, placebo-controlled comparison of pregabalin and venlafaxine. Journal of Clinical Psychiatry 67, 771782.

RB Pohl , DE Feltner , RR Fieve , AC Pande (2005). Efficacy of pregabalin in the treatment of generalized anxiety disorder: double-blind, placebo controlled comparison of BID versus TID dosing. Journal of Clinical Psychopharmacology 25, 151158.

MH Pollack , R Zaninelli , A Goddard , JP McCafferty , (2001). Paroxetine in the treatment of generalized anxiety disorder: results of a placebo-controlled, flexible-dosage trial. Journal of Clinical Psychiatry 62, 350357.

A Raskin , J Schulterbrandt , N Reatig , JJ McKeon (1969). Replication of factors of psychopathology in interview, ward behaviour and self-report ratings of hospitalized depressives. Journal of Nervous and Mental Diseases 148, 8798.

JL Rhudy , MW Meagher (2000). Fear and anxiety: divergent effects on human pain thresholds. Pain 84, 6575.

K Rickels , R Downing , E Schweizer , H Hassman (1993). Antidepressants for the treatment of generalized anxiety disorder. A placebo-controlled comparison of imipramine, trazodone, and diazepam. Archives of General Psychiatry 50, 884895.

K Rickels , MH Pollack , DE Feltner , RB Lydiard , (2005) Pregabalin for treatment of generalized anxiety disorder: a 4-week, multicenter, double-blind, placebo-controlled trial of pregabalin and alprazolam. Archives of General Psychiatry 62, 10221030.

K Rickels , MH Pollack , DV Sheehan , JT Haskins (2000). Efficacy of extended-release venlafaxine in nondepressed outpatients with generalized anxiety disorder. American Journal of Psychiatry 157, 968974.

K Rickels , E Schweizer , I Csanalosi , WG Case , H Chung (1988). Long-term treatment of anxiety and risk of withdrawal. Prospective comparison of clorazepate and buspirone. Archives of General Psychiatry 45, 444450.

K Rickels , R Zaninelli , J McCafferty , K Bellew , (2003). Paroxetine treatment of generalized anxiety disorder: a double-blind, placebo-controlled study. American Journal of Psychiatry 160, 749756.

DS Robinson , A Khan (2004). Dosing strategies for antidepressant clinical trials: a commentary. Journal of Clinical Psychopharmacology 24, 13.

CP Taylor , MG Vartanian , PW Yuen , C Bigge , (1993). Potent and stereospecific anticonvulsant activity of 3-isobutyl GABA relates to in vitro binding at a novel site labeled by tritiated gabapentin. Epilepsy Research 14, 1115.

KA Yonkers , SE Bruce , IR Dyck , MB Keller (2003). Chronicity, relapse, and illness – course of panic disorder, social phobia, and generalized anxiety disorder: findings in men and women from 8 years of follow-up. Depression and Anxiety 17, 173179.

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The International Journal of Neuropsychopharmacology
  • ISSN: 1461-1457
  • EISSN: 1469-5111
  • URL: /core/journals/the-international-journal-of-neuropsychopharmacology
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