Which drug for anxiety?

A systematic review of 27 randomised controlled trials of drugs used to treat anxiety disorder has found that fluoxetine had “the greatest probability of being the most effective treatment” compared with eight other drugs. 

Fluoxetine also ranked first in terms of remission while sertraline ranked best in terms of tolerability, with fewest withdrawals due to adverse effects. 

The authors say the findings confirm the usefulness of SSRIs and SNRIs for treating anxiety, but caution that the fluoxetine analysis was based on limited evidence, and add that neither fluoxetine nor sertraline have proven efficacy in relapse prevention. 

The meta-analysis compared escitalopram, fluoxetine, duloxetine, lorazepam, paroxetine, pregabalin, sertraline, tiagabine, and venlafaxine.

BMJ 2011;342:d1199