Treatment of anxiety disorders in clinical practice: a critical overview of recent systematic evidence

The aim of this study was to review emerging evidence of novel treatments for anxiety disorders. We searched PubMed and EMBASE for evidence-based therapeutic alternatives for anxiety disorders in adults, covering the past five years. Eligible articles were systematic reviews (with or without meta-analysis), which evaluated treatment effectiveness of either nonbiological or biological interventions for anxiety disorders. Retrieved articles were summarized as an overview. We assessed methods, quality of evidence, and risk of bias of the articles. Nineteen systematic reviews provided information on almost 88 thousand participants, distributed across 811 clinical trials. Regarding the interventions, 11 reviews investigated psychological or nonbiological treatments; 5, pharmacological or biological; and 3, more than one type of active intervention. Computerdelivered psychological interventions were helpful for treating anxiety of low-to-moderate intensity, but the therapist-oriented approaches had greater results. Recommendations for regular exercise, mindfulness, yoga, and safety behaviors were applicable to anxiety. Transcranial magnetic stimulation, medication augmentation, and new pharmacological agents (vortioxetine) presented inconclusive benefits in patients with anxiety disorders who presented partial responses or refractoriness to standard treatment. New treatment options for anxiety disorders should only be provided to the community after a thorough examination of their efficacy

Epidemiologia dos transtornos de ansiedade em regiões do Brasil: uma revisão de literatura

Aim: To identify the frequency, the determining factors and the use of health services available for the treatment of anxiety disorders in Brazil. Methods: The searches were performed in the following databases: PubMed, LILACs and Google Scholar, covering the last 10 years. The descriptors were: “epidemiology”, “anxiety disorders”, “prevalence” and “Brazil”. Articles containing original data from representative samples of the community were selected. Inclusion criteria: anxiety disorders should have been assessed through standardized diagnostic interviews. Results: The year-prevalence of anxiety disorders in some regions of Brazil (mainly southeastern and southern regions) was high, reaching 19.9% and life prevalence of 28.1% in the metropolitan region of São Paulo. The prevalence ratio, or the relationship between the rate in the last year and throughout life, was 0.71, showing the high persistence of anxiety disorders. Some sociodemographic factors and comorbidity with other mental (especially depression) and physical disorders were associated with anxiety. The most persistent conditions were those most associated with physical comorbidity and chronic diseases. Only 23% of respondents (with the highest healthcare seeking among patients with panic disorder) had some form of healthcare in the year prior to the interview. Discussion: In the regions included in the present review, anxiety disorders represent the most prevalent psychiatric condition among the studies that have assessed other mental disorders, whose course had high persistence or chronicity. Compared with high-income countries, there is some evidence that the proportion of individuals who have received some form of treatment in our country is lower. Based on the data collected, it was found that most of the studies evaluated comment on the importance of implementing comprehensive public services in order to provide a support network for the population in need.Objetivo: Identificar a frequência, os fatores determinantes e o uso de serviços de saúde disponíveis para o tratamento dos transtornos ansiosos no Brasil. Métodos: As buscas foram realizadas nas seguintes bases de dados: PubMed, LILACS e Google Acadêmico, cobrindo os 10 últimos anos. Os descritores foram: “epidemiologia”, “transtornos de ansiedade”, “prevalência” e “Brasil”. Foram selecionados os artigos com dados originais, de amostras representativas da comunidade. Critérios de inclusão: os transtornos de ansiedade devem ter sido avaliados por meio de entrevistas diagnósticas padronizadas. Resultados: A prevalência-ano de transtornos ansiosos em algumas regiões do Brasil (principalmente regiões sudeste e sul) foi elevada, chegando a 19,9% e prevalência-vida de 28,1% na região metropolitana de São Paulo. A razão de prevalência, ou a relação entre a taxa no último ano e ao longo da vida, foi de 0,71, mostrando a alta persistência dos transtornos ansiosos. Alguns fatores sociodemográficos e a comorbidade com outros transtornos mentais (principalmente com a depressão) e fïsicos foram associados com a ansiedade. Os quadros mais persistentes foram os mais associados com a comorbidade física e doenças crônicas. Somente 23% dos indivíduos entrevistados (com a maior procura entre os pacientes com transtorno do pânico) obtiveram alguma forma de tratamento de saúde no ano anterior à entrevista. Discussão: Nas regiões incluídas na presente revisão, os transtornos ansiosos representam a condição psiquiátrica mais prevalente entre os estudos que avaliaram outros transtornos mentais, cujo curso apresentou alta persistência ou cronicidade. Em comparação com países de alta renda, há alguns indícios que a proporção de indivíduos que obtiveram alguma forma de tratamento no nosso meio seja menor. Com base nos dados levantados, constatou-se que grande parte dos estudos avaliados comenta sobre a importância de implementar serviços públicos abrangentes, a fim de fornecer uma rede de apoio para as necessidades da população