Anxiety Disorders I: Efficacy and safety of sertraline, citalopram and venlafixine in the treatment of Posttraumatic Stress Disorder and Social Phobia

ABSTRACT

Technologies: venlafaxine, citalopram and sertraline

Indication: Treatment of post-traumatic stress disorder and social anxiety disorder (social phobia)

Technology characterization: Technologies 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 safer and more effective in treating patients suffering from post-traumatic stress disorder and social anxiety than the technologies available in SUS (clomipramine, diazepam, clonazepam, clobazam and fluoxetine?

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: We included three RS on PTSD, and three RS on TAS. In none of the revisions scientific studies comparing these drugs directly between themselves or between alternative incorporated into the Unified Health System (SUS) and, in general, the comparisons versus placebo medications demonstrated statistically significant efficacy were found. Still Health Technology Assessments (HTA​​) were considered 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 as second-line antidepressants for the treatment and demonstrated its effectiveness. The studies did not recommend therapy with benzodiazepines (BZD) and antipsychotics.

Recommendations: In the current therapeutic indications listed in the National Formulary or the Therapeutic Therapeutic Guidelines and Clinical Protocols, there is no pharmacological treatment option for patients with PTSD and SAD in the Unified Health System. Fluoxetine showed efficacy and safety comparable to the alternatives evaluated in this PTC. Considering approved indications in bull and results of RS included, as well as estimated costs, it is recommended the use of sertraline for PTSD and SAD.

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