Recent developments in the psychopharmacology of anxiety disorders.

Abstract

Anxiety disorders are the most prevalent mental disorders in the United States. In the past 3 decades, substantial advances have been made in the ability to identify and treat anxiety disorders including panic disorder (PD), social phobia (SP), obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD). It is now known that these common, usually chronic disorders confer significant disability to untreated sufferers. This overview highlights some of the important advances in pharmacological treatment of anxiety disorders. Evidence for efficacy of the various pharmacological agents (including relevant oral dosing and plasma-level data) and of acute and long-term treatment, and the disadvantages of medication treatment are discussed. Finally, some important clinical questions remaining to be addressed by psychopharmacological research are reviewed.

The Behavioral Profile of the Potent and Selective mGlu5 Receptor Antagonist 3-[(2-methyl-1,3-thiazol-4-yl)ethynyl]pyridine (MTEP) in Rodent Models of Anxiety

“…Problems with sedation, abuse, tolerance, dependence/ withdrawal, as well as cognitive impairment, are causes of concern with the use of benzodiazepines (Shader and Greenblatt, 1993). Issues with longer onset of symptom relief (4-6 weeks) as well as side effects including nausea, insomnia, restlessness, agitation, weight gain, and sexual side effects are associated with the use of SSRIs as anxiolytics (Davidson et al, 1999;Lydiard et al, 1996). Similarly treatment with buspirone is also characterized by a delayed onset of anxiolytic activity as well as gastrointestinal side effects (Rakel, 1990).…”

The Impact of Cost Sharing on Antidepressant Use Among Older Adults in British Columbia

“…Costs of psychotropic medications have increased 17% annually, far outpacing other mental health expenditures and spending increases on medications overall (15,16). Newer agents with potentially greater tolerability are widely available (16)(17)(18), making anti-depressants among the most widely prescribed classes of medications in most health care systems (19,20).…”

Terapia cognitivo-comportamental no transtorno de pânico

“…36,37 Cognitive-behavioral therapy and medication CBT is an excellent choice as a first-line treatment. It has good acceptability to patients, 13,17,38 a relatively fast onset of action, 39 strong acute efficacy and strong maintenance of treatment gains, 10,16 and strong cost-efficacy. 40 There is also evidence that CBT can be effective for PD patients refractory to drug treatment (i.e., failure to respond adequately following treatment with the recommended dose and duration of pharmacotherapy, or intolerance to higher dose).…”

“…15 Cognitive-behavioral therapy (CBT) for PD is a therapeutic alternative that has good short-and long-term response for both core panic symptoms as well as the residual and often persistent symptoms of anticipatory anxiety, phobic avoidance, and agoraphobia. 10,11,13,16 Studies have confirmed that CBT can change PD course not only for preventing relapses, but also because it prolongs the time interval between them. 17,18 Brief treatment (often in the range of 12 sessions) with CBT is associated with high (75%) panic free rates among patients.…”

“…[10][11][12] Among the pharmacological options used in the treatment of PD are selective serotonin reuptake inhibitors (SSRI), tricyclic antidepressants (TAD), monoamine oxidase inhibitors (MAOI), serotonin and noradrenaline reuptake inhibitors (SNRI), and benzodiazepines. 13 However, many patients, although being under drug therapy, remain symptomatic and have recurrence of symptoms. Studies have shown that after 4 years on drug therapy about 30% of patients are asymptomatic, 40-50% are better, but still symptomatic, and 20-30% remain the same or worse.…”