Antidepressants In Anxiety Disorders Research Articles

To continue or discontinue antidepressants in anxiety disorders? A dilemma for patients and clinicians.

A 35-year-old woman presented seeking advice on whether to discontinue antidepressants. Several years previously she had suffered from a panic disorder that was effectively treated with cognitive behavioural therapy (CBT). A few years following remission, she began having frequent panic attacks in

A Preliminary Investigation on the Effects of Atenolol for Treating Symptoms of Anxiety.

Anxiety disorders are among the most commonly diagnosed of psychiatric disorders. Many symptoms of posttraumatic stress disorder are also anxiety-related. Traditional medications used to treat these disorders, such as antidepressants and benzodiazepines, are often ineffective, not well-tolerated, and can be habit forming. An alternative agent is, therefore, needed. Beta-blockers are one class of medication with potential to treat anxiety-related disorders; however, current evidence remains limited and requires further characterization. To this end, this retrospective study aims to present a novel preliminary report on the use of the beta-blocker, atenolol, to potentially treat anxiety-related disorders. Ninety-two patients were identified from outpatient military mental health clinics in Okinawa, Japan, who had received atenolol for mental health-related symptoms. Primary measures collected were the rates of patient-reported (1) general beneficial/positive effect of atenolol, (2) adverse effects from atenolol, and (3) preference of atenolol to propranolol. Data were collected from patients who were given binary response options to report their perceived experiences for each primary measure. This study was approved by the Naval Medical Center San Diego Institutional Review Board. The results showed 86% of patients reporting a positive effect and continuing to take atenolol, including 87% with a diagnosis of posttraumatic stress disorder, 100% with diagnosis of other specified trauma- and stressor-related disorder, and 81% diagnosed with anxiety disorders. In total, 90% of patients denied adverse effects or found the adverse effects tolerable. Additionally, 100% of patients who had previously taken propranolol for anxiety reported that they preferred atenolol. The present preliminary observational data suggests that atenolol may be well-tolerated and effective among persons with anxiety disorders. These data also suggest that atenolol may be more effective and better tolerated than propranolol, which is the most commonly prescribed beta-blocker for these conditions; however, more rigorously controlled empirical studies are needed to further substantiate this claim. Despite an overwhelmingly high rate of positive reports from patients' self-evaluations of atenolol treatment for anxiety-related disorders, this early investigation was not placebo-controlled nor double-blinded, and formal outcome measures were not assessed due to a lack of availability. More detailed examinations are needed to further determine whether atenolol is a viable alternative or augmenting agent to propranolol, benzodiazepines, and antidepressants for anxiety disorders and trauma-related disorders.

ANTIDEPRESSANTS FOR ANXIETY DISORDERS IN LATE-LIFE: A SYSTEMATIC REVIEW

Introduction Anxiety disorders are encountered frequently in late life, and contribute to distress, disability, and increased mortality. Late-life GAD has been linked to increased risk of incident stroke [3]. Anxiety is associated with an increased risk for cognitive impairment and dementia in community dwelling older adults independent of psychosocial risk factors [6]. Despite these impairments, late-life anxiety disorders are largely untreated in primary care, with only 36.3% of recurrent cases in a community sample receiving treatment [7]. Antidepressants are considered to be first-line pharmacological treatment for anxiety disorders [8]. Current evidence for the treatment of anxiety disorders in the elderly is extrapolated from studies on younger adults. However, older adults suffer from medical conditions that affect renal, hepatic, and cardiac function. Pharmacokinetic considerations such as variable drug absorption and decreased volume of distribution may also contribute to reduced safety and tolerability of antidepressants in the elderly [5]. To date, there has not been a systematic review on the use of antidepressants for anxiety disorders in older adults. The aim of this systematic review is to provide updated information on the efficacy and tolerability of antidepressants in treatment of anxiety disorders among older adults from randomized controlled studies. Methods This systematic review was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The objective of this review is to summarize the results from published randomized controlled clinical trials of antidepressants for late-life anxiety. We performed a literature search of PubMed, MEDLINE, EMBASE, PsychINFO, and Cochrane collaboration databases through October 18th, 2018, using the following keywords: “late life”, “elderly”, aged, “senior citizen”, or “geriatric” combined with the keywords “anxiety” or “anxiety disorder”, and “antidepressant” or “antidepressive agents” or their pharmaceutical names. The search was restricted to English-language studies conducted in human subjects. We reviewed the bibliographic databases of the published articles for additional studies. Results Our search yielded a total of 12 randomized controlled trials. Two of these studies [14, 15] were pooled analyses of randomized controlled trials, which have been included as they fulfilled our selection criteria. We found 8 trials of selective serotonin reuptake inhibitors (SSRIs): 3 studies on sertraline [16, 17, 18], 2 each on citalopram [19, 20] and escitalopram [21, 22], and 1 trial of paroxetine [23]. We found 3 studies on serotonin-norepinephrine reuptake inhibitors (SNRIs), including 1 study on duloxetine [24], and 1 study each on duloxetine [14] and venlafaxine [15] reporting pooled analyses. There was 1 study of a tricyclic antidepressant (TCA), namely imipramine [25]. Three studies were rated “good”, 8 were rated “fair” and 1 was rated “poor” according to our quality appraisal criteria. Conclusions This systematic review supports the use of antidepressants as an efficacious and well-tolerated treatment option for late-life anxiety. Future research should focus on other anxiety disorders such as phobias and post-traumatic stress disorders, and should include older adults as well as those with cognitive impairment to increase their generalizability to community settings. Long term trials are needed to assess the efficacy of antidepressants in maintenance and prevention of relapse of anxiety, and provide necessary data on long-term tolerability. Head-to-head trials of antidepressants and other agents used for anxiety such as gabapentin and quetiapine are needed to compare their efficacy and safety. Future studies should include treatment modalities commonly used in the elderly such as problem-solving therapy, as well as newer modes of service delivery such as tele-psychiatry and home-visits to conceptualize efficacious treatment options for anxiety disorders in late-life that are commonly encountered in clinical settings. This research was funded by The authors did not receive any funding for this study

Reporting Bias Found in Trials of Antidepressants for Anxiety Disorders

Reporting Bias Found in Trials of Antidepressants for Anxiety Disorders

Consumption of antidepressants in Italy: recent trends and their significance for public health.

The study assessed the consumption of antidepressants in Italy between 2000 and 2011 and identified trends in use. Data on use of antidepressant drugs between 2000 and 2011 were collected from the Italian Medicines Agency database. Data were expressed as the daily defined dose (DDD) per 1,000 inhabitants. Trends in drug consumption were ascertained by logarithmic transformation of incidence rates by using the formula ln(y)=b × x, where y is the incidence rate, b is the regression coefficient, and x represents the calendar years. Time trends were expressed as expected annual percentage change (EAPC). A significance level of .05 was chosen. Antidepressant consumption increased drastically between 2000 and 2011, from 8.18 to 36.12 DDD per 1,000 inhabitants per day. A single joinpoint (time point with a significant trend change) occurred in 2002 (EAPC=56.4%, 2000-2002, and 6.2%, 2002-2011). The trend analysis stratified by type of drug showed a huge increase in consumption of selective serotonin reuptake inhibitors and other antidepressants and a decrease in consumption of tricyclic antidepressants. Mental disorders are less stigmatized now than in the past. In Italy and elsewhere, antidepressant use is growing, and it would be important to monitor this trend, especially considering the possible effects of the current economic crisis on mental health. In this scenario, the role of public health in mental health promotion has become fundamental.

Efficacy and Tolerability of Benzodiazepines versus Antidepressants in Anxiety Disorders: A Systematic Review and Meta-Analysis

Background: Placebo-controlled trials showed that both benzodiazepines (BDZ) and antidepressant drugs (AD) are effective in treating anxiety disorders. However, in the last years a progressive shift in the prescribing pattern from BDZ to newer AD has taken place. The aim of this systematic review and meta-analysis is to analyze whether controlled comparisons support such a shift. Methods: CINHAL, the Cochrane Library, MEDLINE, PubMed and Web of Science were searched from inception up to December 2012. A total of 22 studies met the criteria for inclusion. They were mostly concerned with tricyclic antidepressants (TCA; 18/22) and involved different anxiety disorders. In order to reduce clinical heterogeneity, only the 10 investigations that dealt with the comparison between TCA and BDZ in panic disorder were submitted to meta-analysis, whereas the remaining papers were individually summarized and critically examined. Results: According to the systematic review, no consistent evidence emerged supporting the advantage of using TCA over BDZ in treating generalized anxiety disorder (GAD), complex phobias and mixed anxiety-depressive disorders. Indeed, BDZ showed fewer treatment withdrawals and adverse events than AD. In panic disorder with and without agoraphobia our meta-analysis found BDZ treatments more effective in reducing the number of panic attacks than TCA (risk ratio, RR = 1.13; 95% CI = 1.01-1.27). Furthermore, BDZ medications were significantly better tolerated than TCA drugs, causing less discontinuation (RR = 0.40; 95% CI = 0.20-0.57) and side effects (RR = 0.41; 95% CI = 0.34-0.50). As to newer AD, BDZ trials resulted in comparable or greater improvements and fewer adverse events in patients suffering from GAD or panic disorder. Conclusions: The change in the prescribing pattern favoring newer AD over BDZ in the treatment of anxiety disorders has occurred without supporting evidence. Indeed, the role and usefulness of BDZ need to be reappraised.

Long-term outcome of anxiety disorders: a review of double-blind studies

Although anxiety disorders are acknowledged as chronic, the issue of the pharmacological treatment duration remains unsettled. This review focuses on the long-term outcome of patients with anxiety disorders as demonstrated by randomized controlled trials. Results from long-term randomized controlled trials of antidepressants in anxiety disorders indicate that maintenance treatment significantly reduces the odds of relapse, whatever the anxiety disorder is. This result appears to be similar to what is reported in long-term studies in depressive disorders. In addition, regarding the natural course of depressive disorders, acknowledged as mostly recurrent, some patients may require very long-term treatment, that is, more than 2 years. Moreover, naturalistic studies in anxiety disorders indicate that the relapse risk after discontinuation is not associated with the treatment duration. Finally, there is no predictor to identify those patients who require long-term pharmacotherapy for anxiety disorders. In light of this review, other long-term studies in anxiety disorders have to be undertaken to identify predictors of relapse after treatment discontinuation. As it is now acknowledged for depressive disorders, some patients may require very long-term pharmacological treatment for anxiety disorders.

Recurrence of suicidal ideation due to treatment with antidepressants in anxiety disorder: a case report

This report describes a patient suffering from panic disorder who developed repeated suicidal ideation specifically due to the treatment with Venlafaxine. A first suicide attempt years ago occurred while being treated with Venlafaxine. Subsequent treatment with SSRIs or other antidepressants involved no suicidal ideation. Re-commencement of Venlafaxine four years later immediately led to a second suicide attempt. This unwanted effect subsided immediately after switching to another SNRI (i.e. Duloxetine). The case report underlines the importance of onset of suicide risk in panic disorders due to specific antidepressants.

S.21.01 Comparative efficacy and tolerability of antidepressants in anxiety disorders

S.21.01 Comparative efficacy and tolerability of antidepressants in anxiety disorders

Antidepressant drugs in the treatment of anxiety disorders

In March 1997 APT published two reviews of the use of benzodiazepines, buspirone, beta-blocking drugs and antidepressants in the treatment of anxiety disorders (Cowen, 1997; Tyrer, 1997). These were followed by a paper on the practical pharmacotherapy of anxiety (Nutt & Bell, 1997). The present review was originally prompted for several reasons. A number of large-scale investigations of the use of antidepressants in anxiety disorders have been completed since those papers were published. Indeed, several antidepressant drugs have since been licensed to treat anxiety disorders, and more applications are being considered. El-Khayat & Baldwin (1998) found that the prescription of antipsychotic drugs for anxiety disorders was widespread, but concluded there was no methodologically sound evidence to support their prescription. They suggested that this use of antipsychotic drugs reflected the fears of practitioners about the risks associated with benzodiazepines. There is no reason why the prescription of antidepressant drugs should arouse such fears, and it seemed timely to produce an up-to-date review of their efficacy in the treatment of anxiety disorders. This view was reinforced while this manuscript was in preparation, when the Committee on Safety of Medicines issued a statement in December 2000 that restricted the indications for the prescription of thioridazine because of concerns about rare but serious cardiotoxicity; thioridazine was no longer to be indicated for the treatment of anxiety or psychomotor agitation.