Skip to main content
Log in

The Impact of Medication on Health-Related Quality of Life in Patients with Generalized Anxiety Disorder

  • Systematic Review
  • Published:
CNS Drugs Aims and scope Submit manuscript

Abstract

Background and Objective

Generalized anxiety disorder (GAD) is a psychiatric disorder characterized by excess worry and anxiety. GAD impacts overall health-related quality of life (HRQL), level of functioning, and disability. This literature review was conducted to understand the impact of pharmacological treatments on HRQL and functional outcomes.

Methods

A literature review was conducted to identify randomized controlled trials (RCTs) comparing GAD pharmacological treatments with one or more patient-reported outcome (PRO) measure assessing HRQL, disability, functioning, or work productivity. Four databases were searched (PubMed, EMBASE, Cochrane Reviews, PsycInfo). Limits included English-language publications from 2004–2014. Abstracts and articles were reviewed to select articles reporting results of RCTs of pharmacological treatments for GAD that included one or more PRO measure. Article abstraction and summarization focused on key elements of the study design and PRO results.

Results

One hundred sixty-three abstracts were reviewed; 44 articles were requested; 12 articles, representing 19 studies, were deemed relevant. The Sheehan Disability Scale (SDS) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) were the most frequently utilized PRO measures. In clinical trials with significant anxiety symptom reductions, the SDS and Q-LES-Q also improved with treatment and differentiated from placebo. Two trials included a measure of work productivity; both demonstrated significant improvements with short-term treatment.

Conclusion

Treatments that reduce anxiety symptoms are also associated with improvements in patient-reported HRQL, function, and disability. In addition to evaluation of treatment impacts on anxiety symptoms, clinical trials should include PRO measures of HRQL, disability, and functioning.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Benjamin CL, Harrison JP, Settipani CA, Brodman DM, Kendall PC. Anxiety and related outcomes in young adults 7 to 19 years after receiving treatment for child anxiety. J Consult Clin Psychol. 2013;81(5):865–76.

    Article  PubMed  Google Scholar 

  2. Revicki DA, Travers K, Wyrwich KW, Svedsater H, Locklear J, Mattera MS, et al. Humanistic and economic burden of generalized anxiety disorder in North America and Europe. J Affect Disord. 2012;140(2):103–12. doi:10.1016/j.jad.2011.11.014.

    Article  PubMed  Google Scholar 

  3. Wyrwich KW, Harnam N, Locklear JC, Svedsater H, Revicki DA. Understanding the relationships between health outcomes in generalized anxiety disorder clinical trials. Qual Life Res. 2011;20(2):255–62. doi:10.1007/s11136-010-9734-1.

    Article  PubMed  Google Scholar 

  4. Nutt D, Argyropoulos S, Hood S, Potokar J. Generalized anxiety disorder: a comorbid disease. Eur Neuropsychopharmacol. 2006;16(Suppl. 2):S109–18.

    Article  CAS  PubMed  Google Scholar 

  5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Press; 2000.

    Google Scholar 

  6. Kapczinski F, Lima MS, Souza JS, Schmitt R. Antidepressants for generalized anxiety disorder. Cochrane Database Syst Rev. 2003;(2):CD003592. doi:10.1002/14651858.CD003592.

  7. Harnam N, Wyrwich KW, Revicki D, Locklear JC, Endicott J. The measurement of health-related quality of life in a population with generalized anxiety disorder—findings from the QUEST Study. In: Selek S, editor. Different views of anxiety disorders. InTech; 2011. http://www.intechopen.com/books/different-views-of-anxiety-disorders.

  8. Kessler RC, DuPont RL, Berglund P, Wittchen HU. Impairment in pure and comorbid generalized anxiety disorder and major depression at 12 months in two national surveys. Am J Psychiatry. 1999;156(12):1915–23.

    CAS  PubMed  Google Scholar 

  9. Kessler RC, Keller MB, Wittchen HU. The epidemiology of generalized anxiety disorder. In: Brawman-Mintzer O, editor. Psychiatric clinics of North America: generalized anxiety disorder. Philadelphia: W. B. Saunders; 2001. p. 19–40.

    Google Scholar 

  10. Kessler RC, Wittchen HU. Patterns and correlates of generalized anxiety disorder in community samples. J Clin Psychiatry. 2002;63(Suppl 8):4–10.

    PubMed  Google Scholar 

  11. Massion AO, Warshaw MG, Keller MB. Quality of life and psychiatric morbidity in panic disorder and generalized anxiety disorder. Am J Psychiatry. 1993;150(4):600–7.

    Article  CAS  PubMed  Google Scholar 

  12. Wittchen HU. Generalized anxiety disorder: prevalence, burden, and cost to society. Depress Anxiety. 2002;16(4):162–71. doi:10.1002/da.10065.

    Article  PubMed  Google Scholar 

  13. Wittchen HU, Carter RM, Pfister H, Montgomery SA, Kessler RC. Disabilities and quality of life in pure and comorbid generalized anxiety disorder and major depression in a national survey. Int Clin Psychopharmacol. 2000;15(6):319–28.

    Article  CAS  PubMed  Google Scholar 

  14. Wyrwich K, Harnam N, Revicki DA, Locklear JC, Svedsater H, Endicott J. Assessing health-related quality of life in generalized anxiety disorder using the Quality of Life Enjoyment and Satisfaction Questionnaire. Int Clin Psychopharmacol. 2009;24(6):289–95. doi:10.1097/YIC.0b013e32832d6bf4.

    Article  PubMed  Google Scholar 

  15. Revicki DA, Brandenburg N, Matza L, Hornbrook MC, Feeny D. Health-related quality of life and utilities in primary-care patients with generalized anxiety disorder. Qual Life Res. 2008;17(10):1285–94. doi:10.1007/s11136-008-9406-6.

    Article  PubMed  Google Scholar 

  16. Bereza BG, Machado M, Einarson TR. Systematic review and quality assessment of economic evaluations and quality-of-life studies related to generalized anxiety disorder. Clin Ther. 2009;31(6):1279–308.

    Article  PubMed  Google Scholar 

  17. Allgulander C, Jorgensen T, Wade A, Francois C, Despiegel N, Auquier P, et al. Health-related quality of life (HRQOL) among patients with generalised anxiety disorder: evaluation conducted alongside an escitalopram relapse prevention trial. Curr Med Res Opin. 2007;23(10):2543–9. doi:10.1185/030079907x226087.

    Article  CAS  PubMed  Google Scholar 

  18. Bose A, Korotzer A, Gommoll C, Li D. Randomized placebo-controlled trial of escitalopram and venlafaxine XR in the treatment of generalized anxiety disorder. Depress Anxiety. 2008;25(10):854–61. doi:10.1002/da.20355.

    Article  PubMed  Google Scholar 

  19. Davidson JR, Bose A, Korotzer A, Zheng H. Escitalopram in the treatment of generalized anxiety disorder: double-blind, placebo controlled, flexible-dose study. Depress Anxiety. 2004;19(4):234–40. doi:10.1002/da.10146.

    Article  CAS  PubMed  Google Scholar 

  20. Goodman WK, Bose A, Wang Q. Treatment of generalized anxiety disorder with escitalopram: pooled results from double-blind, placebo-controlled trials. J Affect Disord. 2005;87(2–3):161–7. doi:10.1016/j.jad.2004.11.011.

    Article  CAS  PubMed  Google Scholar 

  21. Bandelow B, Chouinard G, Bobes J, Ahokas A, Eggens I, Liu S, et al. Extended-release quetiapine fumarate (quetiapine XR): a once-daily monotherapy effective in generalized anxiety disorder. Data from a randomized, double-blind, placebo- and active-controlled study. Int J Neuropsychopharmacol. 2010;13(3):305–20. doi:10.1017/S1461145709990423.

    Article  CAS  PubMed  Google Scholar 

  22. Khan A, Joyce M, Atkinson S, Eggens I, Baldytcheva I, Eriksson H. A randomized, double-blind study of once-daily extended release quetiapine fumarate (quetiapine XR) monotherapy in patients with generalized anxiety disorder. J Clin Psychopharmacol. 2011;31(4):418–28. doi:10.1097/JCP.0b013e318224864d.

    Article  CAS  PubMed  Google Scholar 

  23. Merideth C, Cutler AJ, She F, Eriksson H. Efficacy and tolerability of extended release quetiapine fumarate monotherapy in the acute treatment of generalized anxiety disorder: a randomized, placebo controlled and active-controlled study. Int Clin Psychopharmacol. 2012;27(1):40–54. doi:10.1097/YIC.0b013e32834d9f49.

    Article  PubMed  Google Scholar 

  24. Hartford J, Kornstein S, Liebowitz M, Pigott T, Russell J, Detke M, et al. Duloxetine as an SNRI treatment for generalized anxiety disorder: results from a placebo and active-controlled trial. Int Clin Psychopharmacol. 2007;22(3):167–74. doi:10.1097/YIC.0b013e32807fb1b2.

    Article  PubMed  Google Scholar 

  25. Koponen H, Allgulander C, Erickson J, Dunayevich E, Pritchett Y, Detke MJ, et al. Efficacy of duloxetine for the treatment of generalized anxiety disorder: implications for primary care physicians. Prim Care Companion J Clin Psychiatry. 2007;9(2):100–7.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Rynn M, Russell J, Erickson J, Detke MJ, Ball S, Dinkel J, et al. Efficacy and safety of duloxetine in the treatment of generalized anxiety disorder: a flexible-dose, progressive-titration, placebo-controlled trial. Depress Anxiety. 2008;25(3):182–9. doi:10.1002/da.20271.

    Article  CAS  PubMed  Google Scholar 

  27. Endicott J, Svedsater H, Locklear JC. Effects of once-daily extended release quetiapine fumarate on patient-reported outcomes in patients with generalized anxiety disorder. Neuropsychiatr Dis Treat. 2012;8:301–11. doi:10.2147/ndt.s32320.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Katzman MA, Brawman-Mintzer O, Reyes EB, Olausson B, Liu S, Eriksson H. Extended release quetiapine fumarate (quetiapine XR) monotherapy as maintenance treatment for generalized anxiety disorder: a long-term, randomized, placebo-controlled trial. Int Clin Psychopharmacol. 2011;26(1):11–24. doi:10.1097/YIC.0b013e32833e34d9.

    Article  PubMed  Google Scholar 

  29. Mezhebovsky I, Mägi K, She F, Datto C, Eriksson H. Double-blind, randomized study of extended release quetiapine fumarate (quetiapine XR) monotherapy in older patients with generalized anxiety disorder. Int J Geriatr Psychiatry. 2013;28(6):615–25. doi:10.1002/gps.3867.

    Article  PubMed  Google Scholar 

  30. Woelk H, Schlafke S. A multi-center, double-blind, randomised study of the lavender oil preparation Silexan in comparison to lorazepam for generalized anxiety disorder. Phytomedicine. 2010;17(2):94–9.

    Article  CAS  PubMed  Google Scholar 

  31. Endicott J, Russell JM, Raskin J, Detke MJ, Erickson J, Ball SG, et al. Duloxetine treatment for role functioning improvement in generalized anxiety disorder: three independent studies. J Clin Psychiatry. 2007;68(4):518–24.

    Article  CAS  PubMed  Google Scholar 

  32. Allgulander C, Dahl AA, Austin C, Morris PL, Sogaard JA, Fayyad R, et al. Efficacy of sertraline in a 12-week trial for generalized anxiety disorder. Am J Psychiatry. 2004;161(9):1642–9. doi:10.1176/appi.ajp.161.9.1642.

    Article  PubMed  Google Scholar 

  33. Ball SG, Kuhn A, Wall D, Shekhar A, Goddard AW. Selective serotonin reuptake inhibitor treatment for generalized anxiety disorder: a double-blind, prospective comparison between paroxetine and sertraline. J Clin Psychiatry. 2005;66(1):94–9.

    Article  CAS  PubMed  Google Scholar 

  34. Kasper S, Gastpar M, Muller WE, Volz HP, Moller HJ, Schlafke S, et al. Lavender oil preparation Silexan is effective in generalized anxiety disorder—a randomized, double-blind comparison to placebo and paroxetine. Int J Neuropsychopharmacol. 2014;1–11. doi:10.1017/s1461145714000017.

  35. Bidzan L, Mahableshwarkar AR, Jacobsen P, Yan M, Sheehan DV. Vortioxetine (Lu AA21004) in generalized anxiety disorder: results of an 8-week, multinational, randomized, double-blind, placebo-controlled clinical trial. Eur Neuropsychopharmacol. 2012;22(12):847–57.

    Article  CAS  PubMed  Google Scholar 

  36. Mahableshwarkar AR, Jacobsen PL, Serenko M, Chen Y. A randomized, double-blind, fixed-dose study comparing the efficacy and tolerability of vortioxetine 2.5 and 10 mg in acute treatment of adults with generalized anxiety disorder. Hum Psychopharmacol. 2014;29(1):64–72.

    Article  CAS  PubMed  Google Scholar 

  37. Mezhebovsky I, Magi K, She F, Datto C, Eriksson H. Double-blind, randomized study of extended release quetiapine fumarate (quetiapine XR) monotherapy in older patients with generalized anxiety disorder. Int J Geriatr Psychiatry. 2013;28(6):615–25. doi:10.1002/gps.3867.

    Article  PubMed  Google Scholar 

  38. Endicott J, Nee J, Harrison W, Blumenthal R. Quality of Life Enjoyment and Satisfaction Questionnaire: a new measure. Psychopharmacol Bull. 1993;29(2):321–6.

    CAS  PubMed  Google Scholar 

  39. Sheehan DV, Harnett-Sheehan K, Raj BA. The measurement of disability. Int Clin Psychopharmacol. 1996;11(Suppl 3):89–95.

    Article  PubMed  Google Scholar 

  40. Sheehan DV. The anxiety disease. New York: Charles Scribner and Sons; 1983.

    Google Scholar 

  41. Leon AC, Olfson M, Portera L, Farber L, Sheehan DV. Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. Int J Psychiatry Med. 1997;27(2):93–105.

    Article  CAS  PubMed  Google Scholar 

  42. Sheehan DV, Meyers AL, Prakash A, Robinson MJ, Swindle RW, Russell JM, et al. The relationship between functional outcomes and the treatment of anxious and painful somatic symptoms in patients with generalized anxiety disorder. Curr Med Res Opin. 2008;24(9):2457–66. doi:10.1185/03007990802293643.

    Article  PubMed  Google Scholar 

  43. Ware JE Jr. Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.

    Article  PubMed  Google Scholar 

  44. EuroQol G. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199–208.

    Article  Google Scholar 

  45. Endicott J, Nee J. Endicott Work Productivity Scale (EWPS): a new measure to assess treatment effects. Psychopharmacol Bull. 1997;33(1):13–6.

    CAS  PubMed  Google Scholar 

  46. Lerner D, Amick BC 3rd, Rogers WH, Malspeis S, Bungay K, Cynn D. The Work Limitations Questionnaire. Med Care. 2001;39(1):72–85.

    Article  CAS  PubMed  Google Scholar 

  47. Demyttenaere K, Andersen HF, Reines EH. Impact of escitalopram treatment on Quality of Life Enjoyment and Satisfaction Questionnaire scores in major depressive disorder and generalized anxiety disorder. Int Clin Psychopharmacol. 2008;23(5):276–86. doi:10.1097/YIC.0b013e328303ac5f.

    Article  PubMed  Google Scholar 

Download references

Integrity of Research and Reporting

This study complies with the 1964 Declaration of Helsinki and its later amendments and the International Committee of Medical Journal Editors Guidelines. The manuscript does not contain clinical studies or patient data.

Acknowledgments

This research was supported by Evidera.

Financial support/conflict of interest

All authors are employed by Evidera, a healthcare research firm that provides consulting and other research services to pharmaceutical, device, government, and non-government organizations. In salaried positions, the authors work with a variety of companies and organizations. They received no payment or honoraria directly from any of these organizations for the work presented in this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dennis A. Revicki.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 89 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wilson, H., Mannix, S., Oko-osi, H. et al. The Impact of Medication on Health-Related Quality of Life in Patients with Generalized Anxiety Disorder. CNS Drugs 29, 29–40 (2015). https://doi.org/10.1007/s40263-014-0217-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40263-014-0217-8

Keywords

Navigation