Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2025-01-05T12:37:22.310Z Has data issue: false hasContentIssue false
  • English
  • Français

Overview of Diagnosis and Drug Treatments of Anxiety Disorders

Published online by Cambridge University Press:  07 November 2014

David J. Nutt
Get access Rights & Permissions [Opens in a new window]

Abstract

Anxiety disorders are common and often disabling. They fall into five main categories: panic disorder, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder and posttraumatic stress disorder, each of which have characteristic symptoms and cognitions. All anxiety disorders respond to drugs and psychological treatments. This review will focus on drug treatments. Recent research has emphasized the value of antidepressants especially the selective serotonin reuptake inhibitors, benzodiazepines, and related sedative-like compounds. The common co-existence of depression with all of the anxiety disorders means that the selective serotonin reuptake inhibitors are now generally considered to be the first-line treatments but the benzodiazepines have some utility especiaRy in promoting sleep and working acutely to reduce extreme distress.

Type
Review Article
Information
CNS Spectrums , Volume 10 , Issue 1 , January 2005 , pp. 49 - 56
Copyright
Copyright © Cambridge University Press 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Nutt, DJ, Ballenger, JC, eds. Anxiety Disorders. London, England: Blackwell Science; 2003.Google Scholar
2. Bell, CJ, Nutt, DJ. Serotonin and panic. Br J Psychiatry. 1998;172:465–471.Google Scholar
3. Malizia, AL, Cunningham, VJ, Bell, CJ, Liddle, PF, Jones, T, Nutt, DJ. Decreased brain GABA(A)-benzodiazepine receptor binding in panic disorder: preliminary results rrom a quantitative PET study. Arch Gen Psychiatry. 1998;55:715–720.CrossRefGoogle Scholar
4. Tiihonen, J, Kuikka, J, Rasanen, P, et al. Cerebral benzodiazepine receptor binding and distribution in generalized anxiety disorder: a fractal analysis. Mol Psychiatry. 1997;2:463–471.CrossRefGoogle ScholarPubMed
5. Bremner, JD, Innis, RB, White, T, et al. SPECT [I-123]iomazenil measurement of the benzodiazepine receptor in panic disorder. Biol Psychiatry. 2000;47:96–106.CrossRefGoogle ScholarPubMed
6. Williams, DD, McBride, A. Benzodiazepines: time for reassessment. Br J Psychiatry. 1998;173:361–362.Google Scholar
7. Nutt, DJ. Death and dependence: current controveries over the SSRIs. J Psychopharmacol. 2003;17:355–364.CrossRefGoogle Scholar
8. Task Force Report of the American Psychiatric Association. Washington, DC: American Psychiatric Association; 1990.Google Scholar
9. Practice Guidelines for the Treatment of Patients with Panic Disorder. Washington, DC: American Psychiatric Association; 1998.Google Scholar
10. Bonnet, U, Moclobemide: therapeutic use and clinical studies. CNS Drug Rev. 2003;9:97–140.CrossRefGoogle ScholarPubMed
11. Melichar, JK, Haida, A, Rhodes, C, et al. Venlafaxine occupation at the noradrenaline reuptake site: in-vivo determination in healthy volunteers. J Psychopharmacol. 2001;15:9–12.Google Scholar
12. Lenox-Smith, AJ, Reynolds, A. A double-blind, randomised, placebo controlled study of venlafaxine XL in patients with generalised anxiety disorder in primary care. Br J Gen Pract. 2003;53:772–777.Google Scholar
13. Rickels, K, Mangano, R, Khan, A. A double-blind, placebo-controlled study of a flexible dose of venlafaxine ER in adult outpatients with generalized social anxiety disorder. J Clin Psychopharmacol. 2004;24:488–496.CrossRefGoogle Scholar
14. Barkin, RL, Chor, PN, Braun, BG, Schwer, WA. A trilogy case review highlighting the clinical and pharmacologic applications of mirtazapine in reducing polypharmacy for anxiety, agitation, insomnia, depression, and sexual dysfunction. Prim Care Companion J Clin Psychiatry. 1999;1:142–145.Google ScholarPubMed
15. Asnis, GM, Kohn, SR, Henderson, M, Brown, NL. SSRIs versus non-SSRIs in post-traumatic stress disorder: an update with recommendations. Drugs. 2004;64:383–404.Google Scholar
16. Gross, C, Zhuang, X, Stark, K, et al. Serotonin1A receptor acts during development to establish normal anxiety-like behaviour in the adult. Nature. 2002;416:377–380.CrossRefGoogle ScholarPubMed
17. Nash, JR, Sargent, PA, Rabiner, EA, et al. Altered 5HT1A binding in panic disorder demonstrated by PET scanning. J Psychopharmacology. 2003;17:A30.Google Scholar
18. Neumeister, A, Bain, E, Nugent, AC, et al. Reduced serotonin type 1A receptor binding in panic disorder. J Neurosci. 2004;24:589–591.CrossRefGoogle ScholarPubMed
19. El-Khayat, R, Baldwin, DS. Antipsychotic drugs for non-psychotic patients: assessment of the benefit/risk ratio in generalized anxiety disorder. J Psychopharmacol. 1998;12:323–329.CrossRefGoogle ScholarPubMed
20. Barnett, SD, Kramer, ML, Casat, CD, Connor, KM, Davidson, JR. Efficacy of olanzapine in social anxiety disorder: a pilot study. J Psychopharmacol 2002;16:365–368.Google Scholar
21. Bystritsky, A, Ackerman, DL, Rosen, RM, et al. Augmentation of serotonin reuptake inhibitors in refractory obsessive-compulsive disorder using adjunctive olanzapine: a placebo-controlled trial. J Clin Psychiatry. 2004;65:565–568.CrossRefGoogle ScholarPubMed
22. Pande, AC, Feltner, DE, Jefferson, JW, et al. Efficacy of the novel anxiolytic pregabalin in social anxiety disorder: a placebo-controlled, multicenter study. J Clin Psychopharmacol. 2004;24:141–149.Google Scholar
23. Stahl, SM. Anticonvulsants as anxiolytics, part 1: tiagabine and other anticonvulsants with actions on GABA. J Clin Psychiatry. 2004;65:291–292.Google Scholar
24. Stahl, SM. Anticonvulsants as anxiolytics, part 2: pregabalin and gabapentin as alpha(2)delta ligands at voltage-gated calcium channels. J Clin Psychiatry. 2004;65:460–461.Google Scholar
25. Ashton, H, Young, AH. GABA-ergic drugs: exit stage left, enter stage right. J Psychopharmacol. 2003;17:174–178.Google Scholar
26. Llorca, PM, Spadone, C, Sol, O, et al. Efficacy and safety of hydroxyzine in the treatment of generalized anxiety disorder: a 3-month double-blind study. J Clin Psychiatry. 2002;63:1020–1027.CrossRefGoogle ScholarPubMed
27. Lader, M, Scotto, JC. A multicentre double-blind comparison of hydroxyzine, buspirone and placebo in patients with generalized anxiety disorder. Psychopharmcology (Berl). 1998;139:402–406.CrossRefGoogle ScholarPubMed
28. Delgado, PL, Miller, HL, Salomon, RM, et al. Tryptophan-depletion challenge in depressed patients treated with desipramine or fluoxetine: implications for the role of serotonin in the mechanism of antidepressant action. Biol Psychiatry. 1999;46:212–220.CrossRefGoogle ScholarPubMed
29. Bell, C, Forshall, S, Adrover, M, et al. Does 5-HT restrain panic? A tryptophan depletion study in panic disorder patients recovered on paroxetine. J Psychopharmacol 2002;16:5–14.CrossRefGoogle Scholar
30. Argyropoulos, S, Hood, SD, Adrover, M, et al. Tryptophan depletion reverses the therapeutic effect of selective serotonin reuptake inhibitors in social anxiety disorder. Biol Psychiatry. 2004;56:503–509.Google Scholar
31. Barr, LC, Goodman, WK, McDougle, CJ, et al. Tryptophan depletion in patients with obsessive-compulsive disorder who respond to serotonin reuptake inhibitors. Arch Gen Psychiatry. 1994;51:309–317.CrossRefGoogle ScholarPubMed
32. Sargent, PA, Kjaer, KH, Bench, CJ, et al. Brain serotonin1A receptor binding measured by positron emission tomography with [11C]WAY-100635: effects of depression and antidepressant treatment. Arch Gen Psychiatry. 2000;57:174–180.CrossRefGoogle ScholarPubMed
33. Taylor, M, Bhagwagar, Z, Cowen, PJ, Sharp, T. GABA and mood disorders. Psychol Med. 2003;33:387–393.CrossRefGoogle ScholarPubMed
34. Barlow, DH, Gorman, JM, Shear, MK, Woods, SW. Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: a randomized controlled trial. JAMA. 2000;283:2529–2536.Google Scholar
35. Furmark, T, Tillfors, M, Marteinsdottir, I, et al. Common changes in cerebral blood flow in patients with social phobia treated with citalopram or cognitive-behavioral therapy. Arch Gen Psychiatry. 2002;59:425–433.CrossRefGoogle ScholarPubMed
36. Brody, AL, Saxena, S, Schwartz, JM, et al. FDG-PET predictors of response to behavioural therapy and pharmacotherapy in obsessive compulsive disorder. Psychiatry Res. 1998;84:1–6.Google Scholar
37. Weinstein, AM, Nutt, DJ. A cognitive dysfunction in anxiety and its amelioration by effective treatment with SSRIs. J Psychopharmacol. 1995;9:83–89.CrossRefGoogle ScholarPubMed
38. Ressler, KJ, Rothbaum, BO, Tannenbaum, L, et al. Cognitive enhancers and adjuncts to psychotherapy: use of D-cycloserine in phobics to facilitate extinction of fear. Psychopharmacobgy (Berl). 2004;61:1136–1144.Google ScholarPubMed