Question: How effective is CBT compared to SSRI's (Selective Serotonin Reuptake Inhibitor's) for treating anxiety disorders in adults?


Plain language summary

Most of the research found suggests that CBT and SSRI's have similar effects in improving symptoms of anxiety. One study suggests that SSRI's are significantly better than CBT at reducing frequency of panic attacks in people with Panic Disorder, however this particular study was of poor quality.


Clinical and research implications

Overall there was a small amount of moderate quality evidence to suggest that CBT and SSRIs have similar effects in improving symptoms of hypochondriasis, anxiety and worry after up to 16 weeks of treatment in adults with anxiety disorders. However one poor quality RCT found that SSRIs were better than CBT in reducing the frequency of panic attacks in adults with panic disorder, with or without agoraphobia. It recommended that for those with moderate or severe agoraphobia combined CBT and SSRI is advised but that SSRIs alone could be used for milder cases.

As most of these RCTs only measured outcomes in the short-term (up to 16 weeks) further research is needed to evaluate whether the positive effects of CBT and SSRIs are maintained over a longer time period. One of the RCTs in older adults aged 60 years or more also stated that there has been a lack of research into the treatment of later life anxiety with SSRIs and more research is needed into other psychological interventions such as reminiscence therapy.


What do guidelines say?

Neither NICE or SIGN guidelines comment on specific research conducted about CBT vs SSRI's for treating anxiety disorders in adults. However two NICE guidelines do make recommendations for how each intervention should be administered for Social or General anxiety disorders and recommendations on research that should be conducted on this topic.


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