title: Quetiapine monotherapy in acute treatment of generalized anxiety disorder: a systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Some studies have indicated the efficacy of quetiapine in the treatment of generalized anxiety disorder (GAD).
  
  
  OBJECTIVE
  The purpose of this study was to systematically review the efficacy, acceptability, and tolerability of quetiapine in adult patients with GAD.
  
  
  METHODS
  The SCOPUS, MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched in April 2015. All randomized controlled trials (RCTs) of GAD were considered to be included in this meta-analysis. All RCTs of quetiapine in GAD patients providing endpoint outcomes relevant to severity of anxiety, response rate, remission rate, overall discontinuation rate, or discontinuation rate due to adverse events were included. The version reports from suitable clinical studies were explored, and the important data were extracted. Measurement for efficacy outcomes consisted of the mean-changed scores of the rating scales for anxiety, and response rate.
  
  
  RESULTS
  A total of 2,248 randomized participants in three RCTs were included. The pooled mean-changed score of the quetiapine-treated group was greater than that of the placebo-treated group and comparable to selective serotonin reuptake inhibitors (SSRIs). Unfortunately, the response and the remission rates in only 50 and 150 mg/day of quetiapine-XR (extended-release) were better than those of the placebo. Their response and remission rates were comparable to SSRIs. The rates of pooled overall discontinuation and discontinuation due to adverse events of quetiapine-XR were greater than placebo. Only the overall discontinuation rate of quetiapine-XR at 50 and 150 mg/day and the discontinuation rate due to adverse events of quetiapine-XR at 50 mg/day were comparable to SSRIs.
  
  
  CONCLUSIONS
  Based on this meta-analysis, quetiapine-XR is efficacious in the treatment of GAD in adult patients. Despite its low acceptability and tolerability, the use of 50-150 mg/day quetiapine-XR for adult GAD patients may be considered as an alternative treatment. Further well-defined studies should be conducted to warrant these outcomes.
authors.affiliation: Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Narong
authors.initials: N
authors.lastname: Maneeton
authors.affiliation: Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Benchalak
authors.initials: B
authors.lastname: Maneeton
authors.affiliation: Psychiatric Nursing Division, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Pakapan
authors.initials: P
authors.lastname: Woottiluk
authors.affiliation: Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Surinporn
authors.initials: S
authors.lastname: Likhitsathian
authors.affiliation: Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Sirijit
authors.initials: S
authors.lastname: Suttajit
authors.affiliation: Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Vudhichai
authors.initials: V
authors.lastname: Boonyanaruthee
authors.affiliation: Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Manit
authors.initials: M
authors.lastname: Srisurapanont
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy*; D003692:Delayed-Action Preparations; D004305:Dose-Response Relationship, Drug; D006801:Humans; D000069348:Quetiapine Fumarate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; D000069348:Quetiapine Fumarate; D017367:Selective Serotonin Reuptake Inhibitors
keywords: acceptability; efficacy; generalized anxiety disorder; quetiapine; tolerability
references.citation: Clin Psychol Rev. 2014 Mar;34(2):130-40
references.pmid: 24487344
references.citation: J Clin Psychiatry. 2002;63 Suppl 14:9-16
references.pmid: 12562113
references.citation: Drug Des Devel Ther. 2014;8:827-38
references.pmid: 25028535
references.citation: CNS Spectr. 2008 Jul;13(7 Suppl 11):27-33
references.pmid: 18622372
references.citation: Prog Neuropsychopharmacol Biol Psychiatry. 2009 Mar 17;33(2):199-204
references.pmid: 18948162
references.citation: Int Clin Psychopharmacol. 2011 Jan;26(1):11-24
references.pmid: 20881846
references.citation: J Clin Epidemiol. 2006 Apr;59(4):342-53
references.pmid: 16549255
references.citation: J Affect Disord. 2013 Dec;151(3):906-13
references.pmid: 24135509
references.citation: Adv Ther. 2011 Nov;28(11):1021-37
references.pmid: 22057726
references.citation: J Clin Psychiatry. 2003 Mar;64(3):250-8
references.pmid: 12716265
references.citation: Prim Care Companion J Clin Psychiatry. 2007;9(2):100-7
references.pmid: 17607331
references.citation: Lancet. 2006 Dec 16;368(9553):2156-66
references.pmid: 17174708
references.citation: Depress Anxiety. 2004;19(4):234-40
references.pmid: 15274172
references.citation: Psychopharmacol Bull. 2008;41(1):46-51
references.pmid: 18362870
references.citation: JAMA. 2009 Jan 21;301(3):295-303
references.pmid: 19155456
references.citation: Lancet. 2009 Feb 28;373(9665):746-58
references.pmid: 19185342
references.citation: Cochrane Database Syst Rev. 2004;(2):CD000967
references.pmid: 15106155
references.citation: Clin Pharmacokinet. 2001;40(7):509-22
references.pmid: 11510628
references.citation: J Anxiety Disord. 2013 Mar;27(2):197-203
references.pmid: 23474909
references.citation: Int Clin Psychopharmacol. 2012 Jan;27(1):40-54
references.pmid: 22045039
references.citation: J Affect Disord. 2005 Aug;87(2-3):161-7
references.pmid: 15982747
references.citation: Ann Clin Psychiatry. 2012 Aug;24(3):215-24
references.pmid: 22860241
references.citation: Ther Drug Monit. 2011 Apr;33(2):222-6
references.pmid: 21383647
references.citation: J Clin Psychiatry. 1999;60 Suppl 22:18-22
references.pmid: 10634351
references.citation: Int Rev Psychiatry. 2005 Aug;17(4):229-36
references.pmid: 16194794
references.citation: Int J Neuropsychopharmacol. 2010 Apr;13(3):305-20
references.pmid: 19691907
references.citation: J Clin Psychiatry. 2008;69 Suppl E1:8-13
references.pmid: 18494538
references.citation: Br J Med Psychol. 1959;32(1):50-5
references.pmid: 13638508
references.citation: Am J Psychiatry. 2003 Apr;160(4):749-56
references.pmid: 12668365
references.citation: Behav Ther. 2014 Jan;45(1):7-20
references.pmid: 24411110
references.citation: Depress Anxiety. 2008;25(10):854-61
references.pmid: 18050245
references.citation: BMC Psychiatry. 2012;12:160
references.pmid: 23017200
references.citation: Rev Bras Psiquiatr. 2005 Mar;27(1):18-24
references.pmid: 15867979
references.citation: Depress Anxiety. 2008;25(3):182-9
references.pmid: 17311303
references.citation: Am J Psychiatry. 2004 Sep;161(9):1642-9
references.pmid: 15337655
references.citation: J Clin Psychiatry. 2005 Nov;66(11):1441-6
references.pmid: 16420082
references.citation: Sleep Med Rev. 2000 Jun;4(3):263-276
references.pmid: 12531169
references.citation: Cochrane Database Syst Rev. 2003;(2):CD003592
references.pmid: 12804478
references.citation: J Clin Psychiatry. 2002 Jan;63(1):66-74
references.pmid: 11838629
references.citation: Drug Des Devel Ther. 2013;7:657-67
references.pmid: 23926422
references.citation: CNS Drugs. 2006;20(5):389-409
references.pmid: 16696579
references.citation: Int J Gen Med. 2009 Dec 29;2:153-62
references.pmid: 20360899
references.citation: Drugs. 2005;65(7):927-47
references.pmid: 15892588
references.citation: J Clin Psychiatry. 2001 May;62(5):350-7
references.pmid: 11411817
references.citation: Int Clin Psychopharmacol. 2002 May;17(3):103-7
references.pmid: 11981350
references.citation: J Am Pharm Assoc (Wash). 1999 Nov-Dec;39(6):811-21; quiz 877-9
references.pmid: 10609447
references.citation: Int Clin Psychopharmacol. 2014 Sep;29(5):252-62
references.pmid: 24394383
references.citation: J Clin Psychiatry. 2006 Jun;67(6):874-81
references.pmid: 16848646
references.citation: J Anxiety Disord. 2010 May;24(4):379-86
references.pmid: 20369395
references.citation: Chin Med J (Engl). 2011 Oct;124(20):3260-8
references.pmid: 22088518
references.citation: J Am Geriatr Soc. 2002 Jan;50(1):18-25
references.pmid: 12028242
references.citation: Br J Psychiatry. 2001 Jul;179:15-22
references.pmid: 11435263
references.citation: J Clin Psychopharmacol. 2011 Aug;31(4):418-28
references.pmid: 21694613
references.citation: Neuropsychopharmacology. 2008 Sep;33(10):2303-12
references.pmid: 18059438
references.citation: Psychopharmacology (Berl). 2005 Jan;177(3):280-8
references.pmid: 15258718
references.citation: Neuropsychiatr Dis Treat. 2012;8:301-11
references.pmid: 22848184