You might be interested in…Psychiatry

Generalised anxiety disorder (GAD) is a mental health condition characterised by excessive anxiety and worry about everyday events. GAD is a common disorder and generally affects women twice as often as men. Treatments include various psychological and pharmacological therapies. Among the pharmacological therapies, antidepressants, in particular, selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs), are commonly used for its treatment.

The objective of this Cochrane Systematic review1 was to assess the effects of antidepressants in GAD in adults, specifically to determine the efficacy of antidepressants in alleviating symptoms of GAD compared to placebo. Also, to review the acceptability of antidepressants in GAD in terms of adverse effects, including the general prevalence of adverse effects compared to placebo. The authors concluded that antidepressants are more effective than placebo at improving treatment response and that antidepressants have similar acceptability to placebo. The authors identified some important gaps in the literature. They recommended, for example, that future reviews should also include people with comorbidities.

Dr Ray O’Connor

Psychotherapies are among the most recommended treatments for GAD, but which should be considered as first-line treatment was the topic of this network meta-analysis.2 The authors aimed to examine the short- and long-term associations of different psychotherapies with outcomes of effectiveness and acceptability in adults with GAD. Eight psychotherapies were compared against one another and with two control conditions (treatment as usual and waiting list).

The authors concluded that for its associations with both acute and long-term effectiveness, cognitive behavioural therapy (CBT) may represent the first-line therapy of GAD. Third-wave CBTs and relaxation therapy were associated with short-term effectiveness and may also be offered.

Currently, there is still debate over the effectiveness of transcranial direct current stimulation (tDCS) in treating obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and anxiety disorders. To investigate the immediate and long-term effectiveness of tDCS in these diseases, the authors of this study3 conducted a systematic review and quantitative analysis of existing literature on the treatment of OCD, PTSD, and anxiety disorders with tDCS.

The findings were that tDCS had a high effect in improving specific symptoms and general anxiety symptoms in OCD, PTSD and anxiety disorders, with effects lasting up to one month and showing a moderate effect size.

Furthermore, tDCS demonstrated immediate and significant alleviation of depressive symptoms in these diseases. This study concludes that tDCS can serve as a non-invasive brain stimulation technology for treating these disorders, and the therapeutic effects can be maintained for a period of time.

This next article4 describes research on three paediatric anxiety disorders: generalized anxiety (GAD), separation anxiety (SA), and social anxiety disorders (SAD). The article considers these disorders as a group, because most treatment studies target them together, given their high prevalence and frequent comorbidity.

The two established treatments for these conditions comprise CBT and antidepressant medications. The authors point out that many youths receiving these treatments fail to achieve remission, which creates a need for new treatments. These include transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS). Neither of these are established as yet. New treatments could also involve novel pharmacological agents, including small molecules capable of targeting circuits or mechanisms related to defensive behaviour and compounds that enhance neural plasticity.

Depression and anxiety are significant contributors to maternal perinatal morbidity and a range of negative child outcomes. This systematic review and meta-analysis5 aimed to review and assess the diagnostic test accuracy of selected screening tools (Edinburgh Postnatal Depression Scale [EPDS], EPDS-3A, Patient Health Questionnaire [PHQ-9]-, PHQ-2, Matthey Generic Mood Question [MGMQ], Generalized Anxiety Disorder scale [GAD-7], GAD-2, and the Whooley questions) used to identify women with antenatal depression or anxiety in Western countries. The authors screened 8,276 records for eligibility and included 16 original articles reporting on diagnostic test accuracy.

The analysis concluded that the EPDS alone is not perfectly suitable for detection of major depressive disorder during pregnancy. Few studies have evaluated the other instruments, therefore, their usefulness for identification of women with depression and anxiety during pregnancy remains very uncertain. At present, case-identification with any tool may best serve as a complement to a broader dialogue between healthcare professionals and their patients.

Finally, a look at loneliness. Previous randomised controlled trials have largely relied on self-reported volunteer work to assess the effects of volunteering, and have rarely provided structured volunteering activities during the intervention period. This randomised controlled trial6 aimed to investigate the effects of social volunteering work over 12 months on loneliness among older adults during the COVID-19 pandemic.

A dual randomised controlled trial was done in Hong Kong to investigate the long-term effects of telephone delivered psychosocial interventions by older Chinese volunteers who were screened as lonely, for older adult recipients who had low income, lived alone, felt lonely, and were digitally excluded. Participants were aged 50–70 years.

A total of 375 individuals were recruited to the trial, including 84 males (22 per cent) and 291 females (78 per cent). Of these, 185 were randomly assigned to the volunteering group and 190 were assigned to the control group. The findings were that volunteering demonstrated a beneficial effect on reducing loneliness in older adults who feel lonely, and that this benefit can be maintained through continued participation in voluntary work. The authors recommend that future intervention programmes should strengthen older adults’ commitment to volunteer.

References:

1. Kopcalic K et al. Antidepressants versus placebo for generalised anxiety disorder (GAD). Cochrane Database of Systematic Reviews 2025, Issue 1. Art. No.: CD012942. doi: 10.1002/14651858.CD012942.pub2
2. Papola D et al. Psychotherapies for Generalized Anxiety Disorder in Adults A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials. JAMA Psychiatry. 2024;81(3):250-259. doi:10.1001/jamapsychiatry.2023.3971
3. Xie L et al. Immediate and long-term efficacy of transcranial direct current stimulation (tCDS) in obsessive-compulsive disorder, posttraumatic stress disorder and anxiety disorders: a systematic review and meta-analysis. Translational Psychiatry (2024) 14:343; https://doi.org/10.1038/s41398-024-03053-0
4. Zugman A et al. Current and Future Approaches to Pediatric Anxiety Disorder Treatment. Am J Psychiatry. 2024 March 01; 181(3): 189–200. doi:10.1176/appi.ajp.20231037
5. Rondung E et al. Identification of depression and anxiety during pregnancy: A systematic review and meta-analysis of test accuracy. Acta Obstet Gynecol Scand. 2024;103:423–436. doi: 10.1111/aogs.14734
6. Yeung D et al. The effects of volunteering on loneliness among lonely older adults: the HEAL-HOA dual randomised controlled trial. Lancet Healthy Longev 2025; 6: 100664. Published Online January 21, 2025 https://doi.org/10.1016/j.lanhl.2024.100664