From the Guidelines
There is no strong evidence to support the use of progesterone or other hormones as a primary treatment for generalized anxiety disorder (GAD) or panic disorder. The current evidence does not provide sufficient data to recommend progesterone as a standard treatment for anxiety disorders.
Current Treatments for GAD and Panic Disorder
- First-line treatments for GAD and panic disorder remain selective serotonin reuptake inhibitors (SSRIs) like sertraline (50-200 mg daily) or escitalopram (10-20 mg daily)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (75-225 mg daily) are also effective
- Benzodiazepines can be used for short-term relief, but their use should be limited due to the risk of dependence and withdrawal symptoms Some studies suggest that hormonal changes during the menstrual cycle, pregnancy, or perimenopause may contribute to anxiety symptoms in some women 1.
Hormonal Component of Anxiety
- Addressing hormonal imbalances might help manage anxiety symptoms in these cases, but this should be done under medical supervision
- The relationship between sex hormones and anxiety is complex, and more research is needed to fully understand the potential role of progesterone and other hormones in anxiety disorders Recent studies have focused on the management of anxiety and depression in adult survivors of cancer, and have found that psychosocial interventions, stress reduction strategies, and a combination of cognitive-behavioral therapy (CBT), hypnosis, and support can be effective in reducing anxiety symptoms 1.
Future Research Directions
- Further research is needed to explore the potential benefits and risks of using progesterone or other hormones as a treatment for anxiety disorders
- Studies should investigate the effects of hormonal therapies on anxiety symptoms in different populations, including women with hormonal imbalances or those experiencing anxiety symptoms related to menstrual cycle or menopausal changes.
From the Research
Generalized Anxiety Disorder (GAD) and Panic Disorder Treatment
- The use of selective serotonin reuptake inhibitors (SSRIs) has been proven efficacious in the treatment of generalized anxiety disorder (GAD) and panic disorder 2, 3.
- SSRIs, such as fluvoxamine, fluoxetine, paroxetine, sertraline, and citalopram, have been shown to be superior to placebo in treating panic disorder and agoraphobia 3.
- Benzodiazepines are also effective in treating panic disorder, but treatment guidelines favor SSRIs due to concerns about benzodiazepine adverse effects 4.
- However, a meta-analysis found that SSRIs cause more adverse events than benzodiazepines in short-term panic disorder treatment, including diaphoresis, fatigue, nausea, diarrhea, and insomnia 4.
Pharmacotherapy for GAD
- Randomized controlled trials support the efficacy of SSRIs, selective serotonin norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, and other medications in treating GAD 5.
- SSRIs and SNRIs are considered first-line treatments for GAD in adults, while second-line treatments include buspirone, benzodiazepines, and pregabalin 5.
- In pediatric patients with GAD, SSRIs are considered the first-line pharmacotherapy, and psychotherapy can enhance antidepressant response 5.
Dose-Response Curve of SSRIs and SNRIs
- A meta-analysis found that higher doses of SSRIs, but not SNRIs, are associated with significantly greater symptom improvement and likelihood of treatment response in anxiety disorders 6.
- However, higher doses of both SSRIs and SNRIs are associated with an increased likelihood of dropout due to side effects 6.
- The greatest treatment benefits were observed for social anxiety disorder with both medication classes 6.