Antipsychotic drugs for non-psychotic patients: assessment of the benefit/risk ratio in generalized anxiety disorder

Antipsychotic drugs (neuroleptics, major tranquillizers) are frequently prescribed for the relief of anxiety symptoms. A recent survey of a representative sample of psychiatrists found that these drugs are often given to patients who are not suffering from psychotic disorders, a practice that also appears to be common among general practitioners. Many authors have commented on the value of antipsychotics in relieving anxiety symptoms, both in the short and long term, as an alternative to benzodiazepines (with their associated risk of possible tolerance and dependence), although few recent papers recommend their use in this respect. This paper summarizes the evidence from treatment studies of antipsychotic drugs in patients with generalized anxiety disorder (GAD), and compares this with the advice given in major psychiatric textbooks. Most of the studies identified on the use of antipsychotic drugs in GADs appear to have major methodological flaws, and no study has considered the benefit/risk ratio carefully.