The mainstay of generalized anxiety disorder (GAD) treatment involves pharmacologic treatment but can also consist of psychological treatment (i.e. cognitive behavioural therapy). First-line pharmacological treatment involves either the selective serotonin reuptake inhibitors (SSRIs) or the selective norepinephrine/noradrenaline reuptake inhibitors (SNRIs). While these are the most effective treatments, they can produce adverse events and they also have a slower onset of action, during which there may be an increase in anxiety. Benzodiazepines (BZDs) are a class of drug that is presumed to indirectly promote gamma-amino butyric acid (GABA) activity and rapidly control the core symptoms associated with GAD. They have been historically effective when used in the short-term treatment of GAD but have to be used with caution due to their adverse effect profile such as drowsiness, falls, confusion, impairment of memory, and incoordination (which can be particularly problematic in the elderly), their tendency for dependence, and potential for substance abuse. For these reasons and to determine their appropriate use, this report will review the evidence for the short- and long-term use of BZDs for the treatment of GAD.

Contents

• CONTEXT AND POLICY ISSUES
• RESEARCH QUESTION
• KEY FINDINGS
• METHODS
  • Literature Search Strategy
  • Selection Criteria and Methods
  • Exclusion Criteria
  • Critical Appraisal of Individual Studies
• SUMMARY OF EVIDENCE
  • Quantity of Research Available
  • Summary of Study Characteristics
  • Summary of Critical Appraisal
  • Summary of Findings
  • Limitations
• CONCLUSIONS AND IMPLICATIONS FOR DECISION OR POLICY MAKING
• REFERENCES
• APPENDIX 1 Selection of Included Studies
• APPENDIX 2 Additional Articles of Potential Interest
• APPENDIX 3 Characteristics of Included Systematic Reviews
• APPENDIX 4 Summary of Clinical Findings from Systematic Reviews
• APPENDIX 5 Summary of Guideline Evidence Levels and Strength of Recommendations
• APPENDIX 6 Guidelines and Recommendations for Benzodiazepine Treatment in GAD
• APPENDIX 7 Summary of Critical Appraisal
• APPENDIX 8 Recommendations and Important Notes and Advice Reported in the Evidence-Based Guidelines

Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.