Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a guideline (underpinned by a systematic review) that focuses on the above important clinical question.
Confidence in the evidence is high or moderate to high where GRADE has been performed and there is a trade off between benefits and harms of the intervention.
Population: People with GAD
Intervention: Benzodiazepines
Comparison: Placebo
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Diazepam versus placebo | ||
Hamilton Anxiety Rating Scale (HAM-A) | No statistically significant difference | Moderate |
Nonresponse (response defined by at least 50% reduction on Brief Symptom Inventory - 12 items [BSI-12]) | Favors intervention | High |
Discontinuation due to adverse events | No statistically significant difference | Moderate |
Libido | No statistically significant difference | Moderate |
Fatigue | Occurs more commonly with diazepam compared with placebo (favors comparison) | Moderate |
Dizziness | Occurs more commonly with diazepam compared with placebo (favors comparison) | High |
Alprazolam versus placebo | ||
HAM-A | Favors intervention | High |
Nonresponse | No statistically significant difference | Moderate |
Nonremission | No statistically significant difference | Moderate |
Discontinuation due to adverse events | No statistically significant difference | Moderate |
Nausea | No statistically significant difference | Moderate |
Insomnia | No statistically significant difference | Moderate |
Fatigue | No statistically significant difference | Moderate |
Dizziness | No statistically significant difference | Moderate |
Lorazepam versus placebo | ||
HAM-A | Favors intervention | High |
Nonresponse | No statistically significant difference | Low |
Nonremission | No statistically significant difference | Low |
Discontinuation due to adverse events | Occurs more commonly with lorazepam compared with placebo (favors comparison) | High |
Nausea | No statistically significant difference | Moderate |
Insomnia | No statistically significant difference | Very Low |
Dizziness | Occurs more commonly with lorazepam compared with placebo (favors comparison) | High |
Recommendations as stated in the source guideline The guideline committee recommends that benzodiazepines should not be offered to people with GAD in primary or secondary care except as a short-term measure during crises, and that advice in the British National Formulary should be followed on the use of benzodiazepines in this context.
Note The guideline committee notes that benzodiazepines are not recommended due to the potential for people developing tolerance and dependence on them in a condition that may require long-term treatment.
This evidence table is related to the following section/s:
This table is a summary of the analysis reported in a guideline (underpinned by a systematic review) that focuses on the above important clinical question.
Confidence in the evidence is high or moderate to high where GRADE has been performed and there is no difference in effectiveness between the intervention and comparison for key outcomes.
Population: People with GAD
Intervention: Venlafaxine, buspirone, or pregabalin
Comparison: Benzodiazepines
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Venlafaxine versus diazepam | ||
Nonresponse (response defined by at least 50% reduction on Brief Symptom Inventory - 12 items [BSI-12]) | No statistically significant difference | Moderate |
Discontinuation due to adverse events | Occurs more commonly with venlafaxine compared with diazepam (favors comparison) | Moderate |
Buspirone versus lorazepam | ||
Hamilton Anxiety Rating Scale (HAM-A) | No statistically significant difference | Moderate |
Pregabalin versus lorazepam | ||
HAM-A | No statistically significant difference | Moderate |
Nonresponse (response defined by at least 50% reduction on BSI-12) | No statistically significant difference | Low |
Nonremission | No statistically significant difference | High |
Discontinuation due to adverse events | Occurs more commonly with lorazepam compared with pregabalin (favors intervention) | High |
Dizziness | Occurs more commonly with pregabalin compared with lorazepam (favors comparison) | Moderate |
Somnolence | No statistically significant difference | Low |
Pregabalin versus alprazolam | ||
HAM-A | No statistically significant difference | Moderate |
Nonresponse (response defined by at least 50% reduction on BSI-12) | No statistically significant difference | Moderate |
Non-remission | No statistically significant difference | High |
Discontinuation due to adverse events | No statistically significant difference | Moderate |
Dizziness | Occurs more commonly with pregabalin compared with alprazolam (favors comparison) | High |
Somnolence | No statistically significant difference | Moderate |
Recommendations as stated in the source guideline The guideline committee recommends that benzodiazepines should not be offered to people with GAD in primary or secondary care except as a short-term measure during crises, and that advice in the British National Formulary should be followed on the use of benzodiazepines in this context.
Note The guideline committee notes that benzodiazepines are not recommended due to the potential for people developing tolerance and dependence on them in a condition that may require long-term treatment.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- What are the benefits of cognitive behavioral therapy (with a therapist's support) when delivered over the Internet?
- Is there randomized controlled trial evidence to support the use of short-term psychodynamic psychotherapies in people with common mental disorders?
- How does cognitive‐behavioral therapy (CBT) compare with wait‐list control and alternative psychological therapies for children and adolescents with anxiety disorders?
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