Eficácia dos benzodiazepínicos no tratamento de transtornos ansiosos: uma revisão de literatura
DOI:
https://doi.org/10.11606/issn.1679-9836.v101i6e-194499Palavras-chave:
Psicologia, Psiquiatria, Psicofarmacologia, Benzodiazepínicos, AnsiedadeResumo
Com o crescente índice de transtornos ansiosos na população mundial, cresce a necessidade de se investigar psicofármacos que possibilitem experiências de tratamento, segurança e sustentabilidade ao paciente. Dessa forma, o objetivo desta pesquisa é realizar uma revisão sistemática metodológica acerca da eficácia dos benzodiazepínicos (BZ) para o tratamento de transtornos ansiosos (TA). Os estudos foram pesquisados nas bases de dados da PubMed e ScienceDirect, a partir dos descritores: “benzodiazepines” e “anxiety disorder”. Será utilizado o operador booleano “AND”. Foram revisados 27 artigos científicos, com amostra total de 120.418 pacientes de estudos publicados entre os anos de 2011 e 2021, sendo 15 revisões sistemáticas, 5 revisões sistemáticas com meta-análise, 2 meta-análises, 1 revisão sistemática com estudo original, 1 ensaio clínico, 1 ensaio clínico com caso controle, 1 ensaio clínico com estudo prospectivo e 1 estudo duplo cego com ensaio clínico utilizando placebo. Percebeu-se que os BZ se mostraram efetivos no tratamento de transtornos ansiosos (ansiedade generalizada e fobia social), mas inviável em termos de qualidade e seguridade em relação ao seu potencial de dependência a longo prazo. Novos medicamentos foram considerados como possível substituição do BZ para os TA. Novos estudos considerando outros transtornos ansiosos são necessários, além dos que foram abordados nesta pesquisa.
Downloads
Referências
Offidani E, Guidi J, Tomba E, Fava GA. Efficacy and tolerability of benzodiazepines versus antidepressants in anxiety disorders: a systematic review and meta-analysis. Psychother Psychosom. 2013;82(6):355-62. doi: https://doi.org/10.1159/000353198
American Psychiatric Association (APA). DSM-5. Manual diagnóstico e estatístico de transtornos mentais. Porto Alegre: Artmed Editora; 2014.
Gale C, Glue P, Guaiana G, Coverdale J, McMurdo M, Wilkinson S. Influence of covariates on heterogeneity in Hamilton Anxiety Scale ratings in placebo-controlled trials of benzodiazepines in generalized anxiety disorder: systematic review and meta-analysis. J Psychopharmacol. 2019;33(5):543-7. doi: https://doi.org/10.1177/0269881118822146
Starcevic V. The reappraisal of benzodiazepines in the treatment of anxiety and related disorders. Expert Rev Neurother. 2014;14(11):1275-86. doi: https://doi.org/10.1586/14737175.2014.963057
Balon R, Starcevic V. Role of benzodiazepines in anxiety disorders. Adv Exp Med Biol. 2020;1191:367-88. doi: https://doi.org/10.1007/978-981-32-9705-0_20
Choi KW, Kim Y, Jeon HJ. Comorbid anxiety and depression: clinical and conceptual consideration and transdiagnostic treatment. Adv Exp Med Biol. 2020;1191:219-235. doi: https://doi.org/10.1007/978-981-32-9705-0_14
Bandelow B. Current and novel psychopharmacological drugs for anxiety disorders. In: Kim K, editor. Anxiety disorders. Advances in experimental medicine and biology, v.1191. Singapore: Springer; 2020. p.347-365. (Book series - AEMB, v.1191). doi: https://doi.org/10.1007/978-981-32-9705-0_19
Gomez AF, Barthel AL, Hofmann SG. Comparing the efficacy of benzodiazepines and serotonergic anti-depressants for adults with generalized anxiety disorder: a meta-analytic review. Expert Opin Pharmacother. 2018;19(8):883-94. doi: https://doi.org/10.1080/14656566.2018.1472767
Takeshima M, Otsubo T, Funada D, Murakami M, Usami T, Maeda Y, et al. Does cognitive behavioral therapy for anxiety disorders assist the discontinuation of benzodiazepines among patients with anxiety disorders? A systematic review and meta-analysis. Psychiatry Clin Neurosci. 2021;75(4):119-27. doi: https://doi.org/10.1111/pcn.13195
De Mesmaeker S, Zdanowicz N, Reynaert C, Jacques D. Role of benzodiazepines in the treatment of anxiety disorders in 2014. Psychiatr Danub. 2014;26:23-6. Available from: https://www.psychiatria-danubina.com/UserDocsImages/pdf/dnb_vol26%20Suppl%201_no/dnb_vol26%20Suppl%201_no_23.pdf
Williams T, Hattingh CJ, Kariuki CM, et al. Pharmacotherapy for social anxiety disorder (SAnD). Cochrane Database Sys. Rev. 2017;10(10):CD001206. doi: https://doi.org/10.1002/14651858.CD001206.pub3
Pradeep A, Geoji AS, George AE, Athira V, Chandrasekhar D, Xavier S, et al. Clinical management and outcome assessment of generalized anxiety disorder or panic disorder in refractory gastro-esophageal reflux disease: Evidence from a prospective interventional study of benzodiazepines and sertraline. Clin Epidemiol Glob Health. 2020;8(3):908-14. doi: https://doi.org/10.1016/j.cegh.2020.02.022
Chen TR, Huang HC, Hsu JH, Ouyang WC, Lin KC. Pharmacological and psychological interventions for generalized anxiety disorder in adults: a network meta-analysis. J Psychiatr Res. 2019;118(155):73-83. doi: https://doi.org/10.1016/j.jpsychires.2019.08.014
Mayo-Wilson E, Dias S, Mavranezouli I, Kew K, Clark DM, Ades AE, et al. Psychological and pharmacological interventions for social anxiety disorder in adults: A systematic review and network meta-analysis. Lancet Psychiatry. 2014;1(5):368-76. doi: https://doi.org/10.1016/s2215-0366(14)70329-3
Gale CK, Millichamp J. Generalised anxiety disorder in children and adolescents. BMJ Clin Evid. 2016;2016:1002. Availalbe from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4711893/pdf/2016-1002.pdf
Weich S, Pearce HL, Croft P, Singh S, Crome I, Bashford J, et al. Effect of anxiolytic and hypnotic drug prescriptions on mortality hazards: retrospective cohort study. BMJ. 2014;348(March):1–12. doi: http://dx.doi.org/doi:10.1136/bmj.g1996.
Langer E, Einat H, Stukalin Y. Similarities and dissimilarities in the effects of benzodiazepines and specific serotonin reuptake inhibitors (SSRIs) in the defensive marble burying test: A systematic review and meta-analysis. Eur Neuropsychopharmacol. 2020;36:38-49. doi: https://doi.org/10.1016/j.euroneuro.2020.04.007.
Lader M. Benzodiazepines revisited-will we ever learn? Addiction. 2011;106(12):2086-109. doi: https://doi.org/10.1111/j.1360-0443.2011.03563.x
Bernard MMT, Luc M, Carrier JD, Fournier L, Duhoux A, Côté E, et al. Patterns of benzodiazepines use in primary care adults with anxiety disorders. Heliyon. 2018;4(7). doi: https://doi.org/10.1016/j.heliyon.2018.e00688
Chen YT, Liu CY, Chang CM, Lai YM, Wang BH, Yang TY, et al. Perceptions, clinical characteristics, and other factors associated with prolonged and high daily dose of benzodiazepine use among patients with anxiety or depressive disorders. J Affect Disord. 2020;271(March):215-23. doi: https://doi.org/10.1016/j.jad.2020.03.077
Laurito LD, Loureiro CP, Dias R V., Vigne P, de Menezes GB, Freire RC, et al. Predictors of benzodiazepine use in a transdiagnostic sample of panic disorder, social anxiety disorder, and obsessive-compulsive disorder patients. Psychiatry Res. 2018;262:237-45. doi: https://doi.org/10.1016/j.psychres.2018.02.013
Hadley SJ, Mandel FS, Schweizer E. Switching from long-term benzodiazepine therapy to pregabalin in patients with generalized anxiety disorder: a double-blind, placebo-controlled trial. J Psychopharmacol. 2012;26(4):461-70. doi: https://doi.org/10.1177/0269881111405360
Boggs JM, Lindrooth RC, Battaglia C, Beck A, Ritzwoller DP, Ahmedani BK, et al. Association between suicide death and concordance with benzodiazepine treatment guidelines for anxiety and sleep disorders. Gen Hosp Psychiatry. 2020;62(August 2019):21-7. doi: https://doi.org/10.1016/j.genhosppsych.2019.11.005
Blanco C, Bragdon LB, Schneier FR, Liebowitz MR. The evidence-based pharmacotherapy of social anxiety disorder. Int J Neuropsychopharmacol. 2013;16(1):235-49. doi: https://doi.org/10.1017/s1461145712000119
Berger A, Edelsberg J, Bollu V, Alvir JMJ, Dugar A, Joshi A V, et al. Health care utilization and costs in patients with generalized anxiety disorder initiating add-on therapy with benzodiazepines. Health Outcomes Res Med. 2012;3(1):e45-54. doi: http://dx.doi.org/10.1016/j.ehrm.2011.11.002
Smith KS, Engin E, Meloni EG, Rudolph U. Benzodiazepine-induced anxiolysis and reduction of conditioned fear are mediated by distinct GABAA receptor subtypes in mice. Neuropharmacology. 2012;63(2):250-8. doi: http://dx.doi.org/10.1016/j.neuropharm.2012.03.001
Wu CH, Farley JF, Gaynes BN. Evaluating the association of initial benzodiazepine use and antidepressant adherence among adults with anxiety disorders. J Exp Clin Med. 2012;4(6):338-344. doi: https://doi.org/10.1016/j.jecm.2012.10.007
Bushnell GA, Crystal S, Olfson M. Prescription benzodiazepine use in privately insured U.S. children and adolescents. Am J Prev Med. 2019;57(6):775-85. doi: https://doi.org/10.1016/j.amepre.2019.07.006
Gale C, Glue P, Guaiana G, Coverdale J, McMurdo M, Wilkinson S, et al. Prescription Benzodiazepine Use in Privately Insured U.S. Children and Adolescents. Am J Prev Med. 2019;57(6):775-85. doi: http://dx.doi.org/10.1016/j.neuropharm.2012.03.001
Simen A, Whitlock M, Qiu R, Miceli J, Zumpano L, Du Metz M, Dua P, Binneman B. An 8-Week, Randomized, Phase 2, Double-Blind, Sequential Parallel-Group Comparison Study of Two Dose Levels of the GABAA Positive Allosteric Modulator PF-06372865 Compared with Placebo as an Adjunctive Treatment in Outpatients with Inadequate Response to Standard of Care for Generalized Anxiety Disorder. J Clin Psychopharmacol. 2019;39(1):20-27. doi: https://doi.org/10.1097/JCP.0000000000000997.
Offidani E, Guidi J, Tomba E, Fava GA. Efficacy and tolerability of benzodiazepines versus antidepressants in anxiety disorders: a systematic review and meta-analysis. Psychother Psychosom. 2013;82(6):355-62. doi: https://doi.org/10.1159/000353198
Chen YT, Liu CY, Chang CM, Lai YM, Wang BH, Yang TY, Hsu SC. Perceptions, clinical characteristics, and other factors associated with prolonged and high daily dose of benzodiazepine use among patients with anxiety or depressive disorders. J Affect Disord. 2020;271:215-223. doi: https://doi.org/10.1016/j.jad.2020.03.077
Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci. 2015;17(3):327-35. doi: https://doi.org/10.31887/DCNS.2015.17.3/bbandelow
Baldwin D, Woods R, Lawson R, Taylor D. Efficacy of drug treatments for generalised anxiety disorder: systematic review and meta-analysis. BMJ. 2011;342(7798):637. doi: https://doi.org/10.1136/bmj.d1199
Strawn JR, Wehry AM, Delbello MP, Rynn MA, Strakowski S. Establishing the neurobiologic basis of treatment in children and adolescents with generalized anxiety disorder. Depress Anxiety. 2012;29(4):328-39. doi: https://doi.org/10.1002/da.21913
Masdrakis VG, Turic D, Baldwin DS. Pharmacological treatment of social anxiety disorder. Anxiety Disord. 2013;29:144–53. doi: https://doi.org/10.1159/000351960
Reinhold JA, Rickels K. Pharmacological treatment for generalized anxiety disorder in adults: an update. Expert Opin Pharmacother. 2015;16(11):1669-81. doi: https://doi.org/10.1517/14656566.2015.1059424
Strawn JR, Geracioti L, Rajdev N, Clemenza K, Levine A. Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert Opin Pharmacother. 2018;19(10):1057-70. doi: https://doi.org/10.1080/14656566.2018.1491966
Rickels K, Moeller HJ. Benzodiazepines in anxiety disorders: Reassessment of usefulness and safety. World J Biol Psychiatry. 2019;20(7):514-518. doi: https://doi.org/10.1080/15622975.2018.1500031
Generoso MB, Trevizol AP, Kasper S, Cho HJ, Cordeiro Q, Shiozawa P. Pregabalin for generalized anxiety disorder: an updated systematic review and meta-analysis. Int Clin Psychopharmacol. 2017;32(1):49-55. doi: https://doi.org/10.1097/YIC.0000000000000147.
Slee A, Nazareth I, Bondaronek P, Liu Y, Cheng Z, Freemantle N. Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-analysis. Lancet. 2019;393(10173):768-777. Erratum in: Lancet. 2019;393(10182):1698. doi: https://doi.org/10.1016/S0140-6736(18)31793-8
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2022 Gabriel Luiz de Jesus Ribeiro, Josué da Silva Brito
Este trabalho está licenciado sob uma licença Creative Commons Attribution-ShareAlike 4.0 International License.