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Generalised Anxiety Disorder: Incidence and Drug Treatment

Slee, April; (2022) Generalised Anxiety Disorder: Incidence and Drug Treatment. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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This thesis focused on time trends for the incidence of generalised anxiety recording in UK primary care, initial pharmacologic treatment in this setting, and comparing available treatment options. The first study assessed the incidence of diagnoses of generalised anxiety and related illness recorded in UK primary care electronic notes. This analysis found a substantial increase in general practitioner consulting for generalised anxiety and depression recently, concentrated within younger people and in particular women. The second, related analysis examined trends in anxiolytic prescribing in UK primary care following diagnosis with generalised anxiety. This analysis showed that about half of psychotropic drug naïve patients receive pharmacologic therapy in the year following diagnosis, and that the most common initial therapy was a selective serotonin reuptake inhibitor. It also found that the rate of benzodiazepine prescribing has fallen over time. The third study was a systematic review and network meta-analysis of randomised trials in GAD. The objective of this study was to provide a comparison of the safety and efficacy of therapeutic options. This analysis was based on 89 trials, which included 25,441 patients randomly assigned to 22 different active drugs or placebo. Duloxetine, pregabalin, venlafaxine and escitalopram were shown to be more efficacious than placebo with relatively good acceptability. Mirtazapine, sertraline, fluoxetine, buspirone and agomelatine were also found to be efficacious and well tolerated but these findings were limited by small samples. Quetiapine had the largest impact on anxiety severity, but it was poorly tolerated when compared to placebo. Likewise, paroxetine and benzodiazepine were effective but also poorly tolerated when compared to placebo.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Generalised Anxiety Disorder: Incidence and Drug Treatment
Open access status: An open access version is available from UCL Discovery
Language: English
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10146430
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