Anxiety Disorders III: Efficacy and safety of sertraline, citalopram and venlafaxine in the treatment of Obsessive-Compulsive Disorder and Panic Disorder

ABSTRACT

Technologies: Venlafaxine, Citalopram and Sertraline

Indication: Treatment of panic disorder and obsessive-compulsive disorder

Characterization of technology: Citalopram and Sertraline belong to the class of Selective Serotonin Reuptake Inhibitors (SSRIs) and Velafaxine belong the class of Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs).

Question: Venlafaxine, Citalopram and Sertraline are safer and more effective in treating patients with panic disorder and obsessive-compulsive disorder than the technologies incorporated into the Brazilian Public Health System (SUS)?

Search and analysis of scientific evidence: The databases The Cochrane Library (via Bireme), Medline (via Pubmed), Lilacs, APA PsycNET (via PsychINFO) and Centre for Reviews and Dissemination (CRD) were investigated. We searched for systematic reviews (SR) of clinical trials that compared the drugs within each other and with other therapeutic options incorporated in SUS  for the treatment of anxiety disorders. Health Technology Assessments (HTA) in international agencies sites and in Brazilian Network for Health Technology Assessment (REBRATS) were also selected. Studies published in English, Portuguese or Spanish were selected.

Summary of results of the selected studies: Six systematic reviews, one about panic disorder and 5 about obsessive-compulsive, were included. None of the reviews of scientific studies compared these drugs directly between themselves or between the alternatives incorporated into SUS and, in general, was found statistically significant efficacy in studies comparing drugs versus placebo.  SixHTA´s of international organizations on the subject were considered. These HTA´sfound no indication of drug therapy as first choice and these studies advocated psychological interventions. These evaluations have demonstrated the effectiveness of antidepressants as second choice for the treatment of anxiety disorders. The studies did not recommend therapy with benzodiazepines (BZD) and antipsychotics.

Recommendations: Venlafaxine, citalopram and sertraline presented similar efficacy and safety profiles when compared to clomipramine and fluoxetine, available in SUS. Thus, we recommend the use of clomipramine for panic disorder and fluoxetine or clomipramine for OCD.

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