Technologies: Venlafaxine, citalopram and sertraline
Indication: Treatment of generalized anxiety disorder
Technology characterization: Citalopram and sertraline belong to the class of Selective Serotonin Reuptake Inhibitors (SSRIs) and venlafaxine belongs to the class of Serotonin Reuptake Inhibitors and norepinephrine (SNRI).
Question: Venlafaxine, citalopram and sertraline are more effective and safe in the treatment of patients with generalized anxiety disorder than the technologies available in SUS?
Search and analysis of scientific evidence: the foundations The Cochrane Library (via BIREME), Medline (via Pubmed), Lilacs, APA PsycNET (via PsychINFO) and Centre for Reviews and Dissemination (CRD) were surveyed. We searched for systematic reviews (SR) of clinical trials that compared the drugs with each other and with other therapeutic options available in the Health System for the treatment of anxiety disorders. Reviews of health technologies (ATS) in international agencies and the Brazilian Network for Health Technology Assessment websites were also selected. Studies published in English, Portuguese or Spanish were selected.
Summary of results of selected studies: Two systematic reviews about generalized anxiety disorder (GAD) were included. In none of the reviews scientific studies comparing citalopram for the treatment of TAG found. For other drugs, there were no studies that compared directly with each other or between alternative incorporated into the Unified Health System (SUS) and, in general, the comparisons versus placebo medications demonstrated statistically significant efficacy. Were still considered to Health Technology Assessments and therapeutic guidelines of international organizations on the subject. In none of these ratings was no indication of drug therapy as first choice and these studies advocated psychological interventions. These evaluations indicated antidepressants as a second line treatment, except for cases of specific phobias and demonstrated its effectiveness. The studies did not recommend therapy with benzodiazepines and antipsychotics.
Recommendations: Sertraline, venlafaxine and fluoxetine, the latter available in SUS, have demonstrated efficacy for the treatment of GAD. Of these three alternatives, only venlafaxine has indicated labeling for TAG approved by ANVISA, FDA and the EMA. Thus, we recommend the use of venlafaxine in the treatment of GAD.
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