SSRI/SNRI and pregabalin are recommended therapies for the treatment of GAD, particularly in case of benzodiazepines refractory (BR) patients. The aim was to compare the use of anxiolytic treatments in BR GAD patients initiating treatment with pregabalin or SSRI/SNRI as add-on therapies.

BR outpatients with GAD (DSM-IV criteria) enrolled in a prospective, multicentre, observational cohort study were included in this post-hoc analysis. BR was defined as insufficient response with persistence of symptoms of anxiety (HAM-Anxiety scale ≥ 16) after a course of a standard dose of benzodiazepines, for 6 months. The use (% of users and dose) of pregabalin, SSRI/SNRI and benzodiazepines was evaluated during the 6-month study period.

128 subjects treated with pregabalin and 126 with SSRI/SNRI were analyzed. Both cohorts presented a similar pattern of anxiolytic drugs utilization at baseline: Alprazolam (33% pregabalin and 27% SSRI/SNRI), diazepam (20% vs. 11%) and lorazepam (17% vs. 30%) were among the most used benzodiazepines. At the 6 month visit, pregabalin treated patients showed a significant decrease in the % of users of alprazolam (16% vs. 27%; p = 0.032), lorazepam (14% vs. 27%; p = 0.013) or ketazolam (0% vs. 7%; p = 0.002) compared with SSRI/SNRI. 57% of patients in pregabalin group, compared with 87% in SSRI/SNRI, were still receiving a benzodiazepine concomitantly at the 6 month visit (p < 0.001).

Compared with SSRI/SNRI, initiating therapy with pregabalin reduced the use of concomitant anxiolotic treatment in BR outpatients with GAD in routine medical practice.