Pharmacological Treatments for Panic Disorder, Generalized Anxiety Disorder, Specific Phobia, and Social Anxiety Disorder

Abstract

Selective serotonin reuptake inhibitors (SSRIs) are now considered by most experts to be the first-line pharmacological treatment for panic disorder based on their low rate of side effects, lack of dietary restrictions, and absence of tolerance and withdrawal symptoms. Similarly, SSRIs are an attractive first-line treatment for social anxiety disorder. The pharmacological treatments of choice for generalized anxiety disorder are buspirone and antidepressants, including SSRIs and venlafaxine. Both buspirone and antidepressants provide a promising alternative to benzodiazepines. Benzodiazepines, although effective for all these disorders, carry with them the risk of physiological dependence and withdrawal symptoms and ineffectiveness for comorbid depression. Their greatest utility at present seems to be as an initial or adjunctive medication for patients with disabling symptoms requiring rapid relief and for those unable to tolerate other medications. Chronic treatment with benzodiazepines is generally safe and effective but should probably be reserved for patients who are nonresponsive or intolerant to other agents. Controlled trials are necessary to determine whether patients with specific phobias respond to pharmacological agents, particularly serotonin reuptake inhibitors.