Long-Term Pharmacological Treatments of Anxiety Disorders: An Updated Systematic Review

Abstract

Many aspects of long-term pharmacological treatments for anxiety disorders (AnxDs) are still debated. We undertook an updated systematic review of long-term pharmacological studies on panic disorder (PD), generalized anxiety disorder (GAD), and social anxiety disorder (SAD). Relevant studies dating from January 1, 2012 to August 31, 2015 were identified using the PubMed database and a review of bibliographies. Of 372 records identified in the search, five studies on PD and 15 on GAD were included in the review. No studies on SAD were found. Our review confirms the usefulness of long-term pharmacological treatments for PD and GAD and suggests that they can provide further improvement over that obtained during short-term therapy. Paroxetine, escitalopram, and clonazepam can be effective for long-term treatment of PD. However, further studies are needed to draw conclusions about the long-term benzodiazepine use in PD, particularly for the possible cognitive side-effects over time. Pregabalin and quetiapine can be effective for long-term treatment of GAD, while preliminary suggestions emerged for agomelatine and vortioxetine. We did not find any evidence for determining the optimal length and/or dosage of medications to minimize the relapse risk. Few investigations have attempted to identify potential predictors of long-term treatment response. Personalized treatments for AnxDs can be implemented using predictive tools to explore those factors affecting treatment response/tolerability heterogeneity, including neurobiological functions/clinical profiles, comorbidity, biomarkers, and genetic features, and to tailor medications according to each patient's unique features.

Prevalence and structure of anxiety-depression in an Australian community sample

“…Pharmacological agents such as benzodiazepines and selective-serotonin reuptake inhibitors (SSRIs) have been prescribed for anxiety for some time [1,46], but recent review data support the use of pregabalin and quetiapine for the long-term treatment of anxiety [47]. Psychological therapies for anxiety are usually cognitively and/or behaviorally based [48], and may involve relaxation [49] or other concentration treatments such as mindfulness therapy [50].…”

Beyond Prescriptions Monitoring Programs: The Importance of Having the Conversation about Benzodiazepine Use

“…When patient care becomes contingent on prescriber perceptions, this increases the potential harms to those who are dependent or misusing their BDZ. Importantly, dependence on BDZs is clinically distinct from other forms of drug dependence, as it is often iatrogenic in nature, characterized by low-doses and without dose escalation [85][86][87]. This means that it can often go unnoticed and increases the likelihood that it is disregarded.…”

Angst und Panik

“…Obwohl nur wenige Studien ihre Wirksamkeit untersucht haben, werden Neuroleptika bei Angsterkrankungen regelmäßig verschrieben, in den USA zwischen 2004 und 2007 bei 21,3 % der ambulanten Vorstellungen wegen einer Angsterkrankung [61]. Speziell bei der Panikstörung sehen aktuelle Reviews allerdings keine ausreichende Evidenz für die Wirksamkeit von Antipsychotika [62,63].…”