Intervention Review

Azapirones for generalized anxiety disorder

  1. Cheryl A Chessick1,*,
  2. Michael H Allen2,
  3. Michael E. Thase3,
  4. Angelo ABC Batista Miralha da Cunha4,
  5. Flávio Kapczinski5,
  6. Mauricio Silva de Lima6,
  7. Juliano JSS dos Santos Souza4

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 19 JUL 2006

Assessed as up-to-date: 23 MAY 2006

DOI: 10.1002/14651858.CD006115


How to Cite

Chessick CA, Allen MH, Thase ME, Batista Miralha da Cunha AABC, Kapczinski F, Silva de Lima M, dos Santos Souza JJSS. Azapirones for generalized anxiety disorder. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD006115. DOI: 10.1002/14651858.CD006115.

Author Information

  1. 1

    University of Colorado Health Sciences Center, Psychiatry, Devner, Colorado, USA

  2. 2

    University of Colorado Depression Centre, Department of Psychiatry, Aurora, Colorado, USA

  3. 3

    University of Pittsburgh Medical Center, Department of Psychiatry, Pittsburgh, USA

  4. 4

    Federal University of Santa Maria - UFSM, Department of Neuropsychiatry, Porto Alegre, RS, Brazil

  5. 5

    Hospital de Clínicas de Porto Alegre, Department of Psychiatry/INCT Translational Medicine, Porto Alegre, RS, Brazil

  6. 6

    Genentech, US Medical Affairs, South San Francisco, California, USA

*Cheryl A Chessick, Psychiatry, University of Colorado Health Sciences Center, 4455 E. 12th Avenue, A011-21, Devner, Colorado, 80220, USA. cheryl.chessick@ucdenver.edu.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 JUL 2006

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Azapirones are a group of drugs that work at the 5-HT1A receptor and are used to treat patients suffering from generalized anxiety disorder (GAD). However, several studies have shown conflicting results. Whether azapirones are useful as first line treatment in general anxiety disorders still needs to be answered.

Objectives

To assess the efficacy and the acceptability of azapirones for the treatment of GAD.

Search methods

Initiallyt the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR) and The Cochrane Central Register of Controlled Trials (CENTRAL) were searched, incorporating results of group searches of MEDLINE (1966 to June 2005), EMBASE (1980 to June 2005), CINAHL (1982 to June 2005), PsycLIT (1974 to June 2005), PSYNDEX (1977 to June 2005), and LILACS (1982 to June 2005). Subsequently the revised Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (CCDANCTR-Studies and CCDANCTR-References) were searched on 21-10-2005. Reference lists of relevant papers and major text books of anxiety disorder were examined. Authors, other experts in the field and pharmaceutical companies were contacted for knowledge of suitable trials, published or unpublished. Specialist journals concerning azapirones were handsearched.

Selection criteria

Randomized controlled trials of azapirones, including buspirone versus placebo and/or other medication and/or psychological treatment, were included. Participants were males and females of all ages with a diagnosis of generalized anxiety disorder.

Data collection and analysis

Data were extracted from the original reports independently by CC, MA and MT. The main outcomes studied were related to the objectives stated above. Data were analysed for generalized anxiety disorder versus placebo, versus other medication and versus psychological treatment separately. Data were analysed using Review Manager Version 4.2.7.

Main results

Thirty six trials were included in the review, reporting on 5908 participants randomly allocated to azapirones and/or placebo, benzodiazepines, antidepressants, psychotherapy or kava kava. Azapirones, including buspirone, were superior to placebo in treating GAD. The calculated number needed to treat for azapirones using the Clinical Global Impression scale was 4.4 (95% confidence interval (CI) 2.16 to 15.4). Azapirones may be less effective than benzodiazepines and we were unable to conclude if azapirones were superior to antidepressants, kava kava or psychotherapy. Azapirones appeared to be well tolerated. Fewer participants stopped taking benzodiazepines compared to azapirones. The length of studies ranged from four to nine weeks, with one study lasting 14 weeks.

Authors' conclusions

Azapirones appeared to be useful in the treatment of GAD, particularly for those participants who had not been on a benzodiazepine. Azapirones may not be superior to benzodiazepines and do not appear as acceptable as benzodiazepines. Side effects appeared mild and non serious in the azapirone treated group. Longer term studies are needed to show that azapirones are effective in treating GAD, which is a chronic long-term illness.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Azapirones for generalized anxiety disorder (GAD)

Generalized anxiety disorder is one of the most common anxiety disorders and can be costly if unrecognized or left untreated. Azapirones are a group of drugs that work at the 5-HT1A receptor and are used to treat patients suffering from GAD. This systematic review evaluates the effectiveness of azapirones compared to other treatments. From the results of 36 randomized controlled trials, azapirones appear to be superior to placebo in short-term studies (four to nine weeks) but may not be superior to benzodiazepines. We were unable to conclude if azapirones were superior to antidepressants, psychotherapy or kava kava. As GAD is generally chronic in nature, conclusions about azapirones' long-term efficacy are not able to be made and longer term trials are needed.