Pharmacotherapy For Anxiety Disorders Research Articles

Treatment of Anxiety Disorders in Primary Care: What Nurse Practitioners Need to Know.

Anxiety disorders are the most common mental illnesses and frequently co-occur with other mental and somatic symptoms or disorders. Primary care nurse practitioners (NPs) are key in reducing the treatment gap through early identification, treatment, and/or referral to behavioral health providers. Confronting primary care NPs are problems with time constraints, multiple comorbidities, and limited mental health training, particularly in relation to the differences in pharmacokinetic and pharmacodynamic actions of first-line anxiety disorder medications across age groups. The current article provides a brief summary of evidence-based treatment focusing on pharmacotherapy for anxiety disorders in the primary care setting. [Journal of Psychosocial Nursing and Mental Health Services, 62(5), 7-10.].

Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options.

(Appeared originally in Frontiers in Psychiatry 2020 Dec 23; 11:595584)

Pharmacotherapy for Anxiety Disorders: From First-Line Options to Treatment Resistance.

In this review, the author examines the evidence for psychopharmacologic treatments among adults for generalized anxiety disorder, panic disorder, and social anxiety disorder derived from clinical trials. For each disorder, major categories of drugs are reviewed, and then the evidence-based medications in each category are discussed. The author reviews key safety and tolerability considerations for each of the medications or classes. Evidence-based dosing for most specific agents is displayed in a comprehensive reference table. Subsequently, the author synthesizes the available information to suggest a pragmatic stepwise approach to treatment that accounts for patient-specific factors. To inform the guidance, the author incorporates and refines perspectives from treatment guidelines already written by clinical professional organizations. The author also briefly reviews the relatively new quantitative systematic review methodology of network meta-analysis (NMA) and discusses how NMA may help guide pharmacologic treatment sequencing decisions in the future by way of ranking treatments according to effect size and the relative amount of study to which treatments have been subject. Caveats of NMA studies are briefly discussed, as are results of recent NMAs regarding the pharmacologic treatment of anxiety disorders.

The myth that psychotherapy is more effective than pharmacotherapy in anxiety disorders

The specific role of the striatum, especially its dorsolateral (DLS) and dorsomedial (DMS) parts, in male copulatory behavior is still debated. In order to clarify their contribution to male sexual behavior, we specifically ablated the major striatal neuronal subpopulations, direct and indirect medium spiny neurons (dMSNs and iMSNs) in DMS or DLS, and dMSNs, iMSNs and cholinergic interneurons in nucleus accumbens (NAc),The main results of this study can be summarized as follows:In DMS, dMSN ablation causes a reduction in the percent of mice that mount a receptive female, and a complex alteration in the parameters of the copulatory performance, that is largely opposite to the alterations induced by iMSN ablation.In DLS, dMSN ablation causes a widespread alteration in the copulatory behavior parameters, that tends to disappear at repetition of the test; iMSN ablation induces minor copulatory behavior alterations that are complementary to those observed after dMSN ablation.In NAc, dMSN ablation causes a marked reduction in the percent of mice that mount a receptive female and a disruption of copulatory behavior, while iMSN ablation induces minor copulatory behavior alterations that are opposite to those observed with dMSN ablation, and cholinergic neuron ablation induces a selective decrease in mount latency.Overall, present data point to a complex region and cell-specific contribution to copulatory behavior of the different neuronal subpopulations of both dorsal and ventral striatum, with a prominent role of the dMSNs of the different subregions.

Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options.

Anxiety disorders are the most prevalent psychiatric disorders and a leading cause of disability. While there continues to be expansive research in posttraumatic stress disorder (PTSD), depression and schizophrenia, there is a relative dearth of novel medications under investigation for anxiety disorders. This review's first aim is to summarize current pharmacological treatments (both approved and off-label) for panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and specific phobias (SP), including selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), azapirones (e.g., buspirone), mixed antidepressants (e.g., mirtazapine), antipsychotics, antihistamines (e.g., hydroxyzine), alpha- and beta-adrenergic medications (e.g., propranolol, clonidine), and GABAergic medications (benzodiazepines, pregabalin, and gabapentin). Posttraumatic stress disorder and obsessive-compulsive disorder are excluded from this review. Second, we will review novel pharmacotherapeutic agents under investigation for the treatment of anxiety disorders in adults. The pathways and neurotransmitters reviewed include serotonergic agents, glutamate modulators, GABAergic medications, neuropeptides, neurosteroids, alpha- and beta-adrenergic agents, cannabinoids, and natural remedies. The outcome of the review reveals a lack of randomized double-blind placebo- controlled trials for anxiety disorders and few studies comparing novel treatments to existing anxiolytic agents. Although there are some recent randomized controlled trials for novel agents including neuropeptides, glutamatergic agents (such as ketamine and d-cycloserine), and cannabinoids (including cannabidiol) primarily in GAD or SAD, these trials have largely been negative, with only some promise for kava and PH94B (an inhaled neurosteroid). Overall, the progression of current and future psychopharmacology research in anxiety disorders suggests that there needs to be further expansion in research of these novel pathways and larger-scale studies of promising agents with positive results from smaller trials.

Neurobiology of Anxiety Disorders

In recent years, advances in the fields of neuroimaging and experimental psychology increased our understanding of the basic mechanisms of classical conditioning and learning, contributing to our knowledge of the neurobiology of anxiety disorders. Research has shown that the amygdala is the cornerstone of fear circuitry and that abnormalities in amygdala pathways can affect the acquisition and expression of fear conditioning. Activation of the amygdala in response to disorder-relevant stimuli has been observed in anxiety disorders. The roles of the hippocampus, nucleus accumbens, periaqueductal gray, and insular and medial prefrontal cortices in response to fear have been identified as well. Neurotransmitters such as serotonin, dopamine, γ-aminobutyric acid, glutamate, and some neurosteroids play an important part in the neurobiology of anxiety disorders. Neuropeptides such as oxytocin, neuropeptide Y, galanin, and cholecystokinin have been shown to modulate stress response. Drugs such as N-methyl-d-aspartate (NMDA) antagonists and blockers of voltage-gated calcium channels in the amygdala are anxiolytic. Fear extinction, which entails new learning of fear inhibition, is the mechanism of effective antianxiety treatments such as d-cycloserine, a partial NMDA agonist. Extinction is thought to occur by the medial prefrontal cortex, which inhibits the lateral amygdala under hippocampal modulation. Harnessing extinction to delink neutral stimuli from aversive responses is an important goal of the psychotherapy and pharmacotherapy of anxiety disorders. Discovery of the role of microRNAs in the etiology of anxiety disorders and their possible utility as targets to treat these disorders is fascinating. In this review, we discuss the neurobiology of anxiety disorders, which will help us better manage them clinically. This review contains 5 figures, 6 tables, and 39 references. Key words: Amygdala, anxiety disorders, neurobiology, fear conditioning, neurocircuitry, neurotransmitters, neuropeptides, neurosteroids, endogenous opioids.

Neurobiology of Anxiety Disorders

In recent years, advances in the fields of neuroimaging and experimental psychology increased our understanding of the basic mechanisms of classical conditioning and learning, contributing to our knowledge of the neurobiology of anxiety disorders. Research has shown that the amygdala is the cornerstone of fear circuitry and that abnormalities in amygdala pathways can affect the acquisition and expression of fear conditioning. Activation of the amygdala in response to disorder-relevant stimuli has been observed in anxiety disorders. The roles of the hippocampus, nucleus accumbens, periaqueductal gray, and insular and medial prefrontal cortices in response to fear have been identified as well. Neurotransmitters such as serotonin, dopamine, γ-aminobutyric acid, glutamate, and some neurosteroids play an important part in the neurobiology of anxiety disorders. Neuropeptides such as oxytocin, neuropeptide Y, galanin, and cholecystokinin have been shown to modulate stress response. Drugs such as N-methyl-d-aspartate (NMDA) antagonists and blockers of voltage-gated calcium channels in the amygdala are anxiolytic. Fear extinction, which entails new learning of fear inhibition, is the mechanism of effective antianxiety treatments such as d-cycloserine, a partial NMDA agonist. Extinction is thought to occur by the medial prefrontal cortex, which inhibits the lateral amygdala under hippocampal modulation. Harnessing extinction to delink neutral stimuli from aversive responses is an important goal of the psychotherapy and pharmacotherapy of anxiety disorders. Discovery of the role of microRNAs in the etiology of anxiety disorders and their possible utility as targets to treat these disorders is fascinating. In this review, we discuss the neurobiology of anxiety disorders, which will help us better manage them clinically. This review contains 5 figures, 6 tables, and 39 references. Key words: Amygdala, anxiety disorders, neurobiology, fear conditioning, neurocircuitry, neurotransmitters, neuropeptides, neurosteroids, endogenous opioids.

Treating Anxiety During Pregnancy: Patient Concerns About Pharmaceutical Treatment.

The purpose of the current study was to describe anxious pregnant women's concerns about using pharmacotherapy to treat anxiety symptoms, and the relationship of such concerns to women's willingness to use pharmacotherapy during pregnancy. Between April 2011 and May 2012, 148 women who were pregnant and reported elevated anxiety symptoms, as measured by the GAD-2, completed an online survey assessing their concerns about, and willingness to use, pharmacotherapy to treat anxiety symptoms during pregnancy. Qualitative responses were coded, and linear regression was used to assess the relationship between concerns and willingness. Pregnant women with elevated anxiety symptoms reported low willingness to use pharmacotherapy to treat anxiety symptoms during pregnancy. The most common concerns reported were about negative effects on the baby or the self, and a general opposition to taking any medications during pregnancy. These concerns were significantly related to women's willingness to try pharmacotherapy (ps < .016). Our findings underscore the importance of a pregnant woman's perceptions of potential side-effects and long-term effects of pharmacotherapy, both for herself and her offspring. These results point to specific factors that may be important to address in communication with patients about pharmacotherapy for anxiety disorders during pregnancy. Such an understanding may help clinicians provide more effective guidance and information about treatment options for anxiety disorders during pregnancy, and increase patients' willingness to engage in those treatments.

Ambulatory Pharmacotherapy of Five Psychiatric Disorders in Bahrain: a Descriptive Study.

We examined the outpatient prescription pattern of psychotropic drugs used for the treatment of five major psychiatric diseases in Bahrain. Setting outpatient department of the main psychiatric hospital in Bahrain. Methods This was a retrospective, cross-sectional study in which we targeted randomly selected prescriptions (n = 992, 56.1% males, 43.9% females) from 1st of January until 31st of December, 2017. Main outcome measure the types of outpatient psychotropic drugs prescribed by the physicians. Results The pharmacotherapy of schizophrenia consisted of atypical anti-psychotics (92.8%), or typical anti-psychotics (17.8%). The anti-depressants used were: Selective-serotonin reuptake inhibiters (SSRIs) (41.6%), Serotonin-norepinephrine reuptake inhibiters (SNRIs) (34.5%), tricyclic anti-depressants (TCAs) (12.8%), and atypical anti-depressants (10.6%). Combination anti-depressants was employed in (12.4%) of cases. The pharmacotherapy for anxiety disorders was composed of benzodiazepines (59.5%), atypical anti-psychotics (45.2%), SSRIs (40.5%), SNRIs (28.6%), TCAs (14.3%), and anti-convulsants (16.7%) and atypical anti-psychotics (7.1). The medications prescribed for bipolar disorder were atypical anti-psychotics (78.6%), anti-convulsants (66.5%), benzodiazepines (27.7%), typical anti-psychotics (8.9%) and lithium (6.7%). Schizoaffective disorder patients received atypical anti-psychotics (97.3%), anti-convulsants (47.8%), benzodiazepines (27.4%), SNRIs (25.7%), SSRIs (15%), typical anti-psychotics (10.6%), atypical anti-depressants (10.6%) and TCAs (6.2%). A combination of antipsychotics and anti-depressants was employed in 33.6% and 4.7% of all subjects regardless of the diagnosis, respectively. Conclusions With a few exceptions, the pharmacotherapy of psychiatric diseases in Bahrain was in line with the latest recommendations. However, psychotropic polypharmacy was observed and calls for immediate attention.

The role of beta-adrenolytic drugs in treating anxiety disorders

Summary Introduction: Beta blockers are mainly used in treating cardiovascular diseases. However, it has been observed that these drugs have also an anxiolytic potential. Over the years, a number of clinical trials have been conducted aimed at determining the effectiveness of beta blockers in treating anxiety disorders. The aim of the article: The main objective of the article is to present the significance and position of adrenolytic drugs in the pharmacotherapy of anxiety disorders on the basis of available literature. Moreover, the authors also decided to take into account the data from current research results, considering the problem of side effects of using adrenolytic drugs - especially the controversial reports on their effect on the development of affective disorders. Method: An analysis was conducted of articles from Medline/PubMed database, selected on the basis of the following key words: anxiety disorders, beta blockers, adrenolytic drugs, as well as on the basis of their dates of publication: 1960-2017. In order to conduct a reliable and complete review of literature, the authors decided to include works from quite an extended period of time. The articles included in the review were published in Polish and English. Results: The review of articles concerning the treatment of anxiety disorders clearly suggests that propranolol is effective in reducing the frequency of panic attacks and the tendency for avoidance behavior in patients with agoraphobia. Other studies report on potential benefits in terms of early interventional prevention and treating posttraumatic stress disorder with propranolol. However, there is lack of randomized clinical trials concerning the therapeutic effect of other adrenolytic drugs in treating anxiety disorders. Early research works reported that (mainly lipophilic) beta blockers may have a depressogenic effect; however, the latest studies have not confirmed it. The contemporary research on the therapeutic potential of beta blockers in treating anxiety disorders is insufficient. What seems to be most promising, however, are reports concerning the desirable effects of using adrenolytic drugs in treating posttraumatic stress disorder, which implicates the necessity of conducting further research verifying the validity of their application.

An Overview on Anxiety:Etiology and Therapy

Purpose : Anxiety disorders have turned out to be the most common mental health conditions prevailing all over the world. The symptoms of anxiety are very common in the community, not only affecting the younger generations but also the elderly. There have been a number of advances in the pharmacotherapy of anxiety disorders in recent decades. Normal anxiety is a kind of emotion that mainly helps to face the threats and problems awaiting an individual. But when this emotion exceeds a certain limit, it causes harm to the same individual. Thus, this paper gives an overall review on what exactly anxiety is, how is it caused and the different treatment methods used so far for anxiety. Apart from this the future aspects has also been covered in this paper. Approaches : The data were collected from various sources like journal articles, textbooks, internet, related materials in library and databases such as pubmed, google scholar and so on. Findings : New developments are forthcoming in the field of alternative strategies for managing anxiety and for treatment-resistant cases. Conclusion : As a word, anxiety may seem very small to read but when it comes to a person's life it can be life threatening. There are varieties of conventional treatment methods available for anxiety and many promising therapies are yet to come.

Pharmacotherapy of anxiety disorders in patients with chronic cerebral ischemia

To compare the effects of the daytime anxiolytic adaptol and the tranquilizer/nootropic drug noophen on target symptoms related to anxiety spectrum disorders in patients with chronic cerebral ischemia (CCI). Sixty-two patients with CCI and comorbid anxiety spectrum disorders were randomized to adaptol group (n=29) and noophen group (n=33). Results of treatment were assessed with CGI, MFI-20, HADS-A and HADS-D, MMSE. Both drugs showed the comparable efficacy and speed of achievement of anxiolytic effect. Anxiety symptoms were stopped in 79.0% of the patients. Adaptol was superior to noophen in regard to nonspecific somatic symptoms (р=0.037). Asthenia and sleep disorders have decreased significantly in the noophen group. Use of target symptoms in the individual choice of anxiolytic therapy in patients with anxiety spectrum disorders associated with CCI can increase treatment efficacy.

Kava as a Pharmacotherapy of Anxiety Disorders: Promises and Concerns

Current standard pharmacotherapies for anxiety management come with a host of side-effects that may deter the patients from utilizing them. Kava, a traditional beverage from the South Pacific region, has been used as a natural medicine for centuries and has been hypothesized to contain anxiolytic properties. There are a few well-designed, randomly controlled trials that have evaluated the effectiveness of kava or its constituents against anxiety disorders. They have generally shown kava to be effective in managing the disease. However, there has been a serious concern about the hepatotoxic risk of kava, which greatly limits its anxiolytic development and application. This review attempts to summarize the recent anxiolytic trials using kava, the associated hepatotoxicity risks, the potential responsible chemicals for these two activities, and the mechanisms of action. Overall, kava has a great potential to be developed as a natural anxiolytic agent through a systematic approach, but the present form should be used with caution.

Adherence, Self-stigma and Discontinuation of Pharmacotherapy in Anxiety Disorders – Cross-sectional Study

Introduction Treatment adherence is one of the main factors affecting the success of treatment and, secondarily, the quality of life and social adaptation of the patients. The aim of this study was to investigate the association between self-stigmatization, treatment adherence and history of discontinuation of drug treatment. Methods The cross-sectional study was conducted on 120 (98 completed all the questionnaires) neurotic outpatients treated in the University Hospital Olomouc. The following variables were evaluated: the objective and subjective Clinical Global Impression (CGI) scale, Drug Attitude Inventory (DAI-10) questionnaire measuring adherence, Internalized Stigma of Mental Illness (ISMI) scale measuring self-stigma, and a demographic data questionnaire. Results Data analysis showed no correlation between self-stigmatization and age, age of onset or length of the post-hospitalization phase. However, there were significant correlations between self-stigmatization and the severity of the disorder (assessed by both objective and subjective CGI), number of previous hospitalizations, total number of psychiatrists visited by the patient, the arbitrary discontinuation of medication in the past, and the dose of an antidepressant. Furthermore, self-stigma was significantly negatively correlated with the current treatment adherence. The rate of adherence was negatively correlated with both objective and subjective CGI only. Conclusions Self-stigma significantly affects the current adherence to the treatment of neurotic spectrum disorders.

Current possibilities in pharmacotherapy of anxiety disorders in children and adolescents

To assess the efficacy and safety of children tenoten in the treatment of children and adolescents with anxiety disorders. It was conducted a multicenter, double-blind, placebo-controlled trial of the drug tenoten children at a dose of 1 tablet 3 times a day for 12 weeks. The study included 98 patients (boys and girls from 5 to 15 years with a confirmed diagnosis of anxiety disorder), randomized into two groups: the first included 48 patients treated tenotenom children, in the second - 50 patients receiving placebo. Tenoten children has a strong anti-anxiety effect both on the results of self-assessment of patients, and on the reports of parents. This anxiolytic activity of the drug manifested most significantly in children aged 5 to 7 years. In addition, in patients 8-15 years of treatment spent tenotenom children to regress the symptoms of anxiety disorders by anxiety subscales SCAS «Separation anxiety», «panic attacks and agoraphobia» and «social phobia». Throughout the course of treatment tenoten children have been no adverse events.

Pharmacotherapy of anxiety disorders in German-speaking countries: current status and changes between 1994 and 2011.

Over the past years, international treatment guidelines have been established for the treatment of anxiety disorders. Nevertheless, little is known as to whether the actual inpatient treatment follows these guidelines. The main goal of this study was to answer the question whether patients with anxiety disorder are treated according to treatment guidelines. A total of 2,573 psychiatric inpatients with the diagnosis of anxiety disorder (920 men, 1,653 women) were identified on the basis of the data of the international drug safety programme in psychiatry AMSP. Of these patients, 25.3% presented with phobia, 26.6% with panic disorder, 18.7% with generalized anxiety disorder (GAD), and 29.4% with other diagnoses of anxiety. In all of the patients, 12.7% did not receive any psychotropic medication and 22.9% were not treated with antidepressants. Only 59.3% of patients with GAD, 73.9% of patients with panic disorder, and 52.1% of patients with phobia were treated according to diagnostic guidelines. The majority (60.3%) of all patients received one or two psychotropic drugs, and only 3.7% received five or more psychotropic drugs. In two groups of patients (one group with phobia and one with panic disorder), the annual prescription rate of antidepressants significantly increased over time. The prescription rate for anticonvulsants in patients with GAD increased from 0% in 1997 to 41.7% in 2011, and for antipsychotics, from 40.7% in 1997 to 47.2% in 2011. In particular, patients with GAD were commonly treated with antipsychotics.

Pharmacotherapy for anxiety disorders in children and adolescents

Anxiety disorders are the most common mental health diagnoses in youth, and carry risks for ongoing impairments and subsequent development of other psychiatric comorbidities into adulthood. This article discusses considerations for assessment and treatment of anxiety disorders in youth, with a focus on the evidence base of pharmacologic treatment and important clinical considerations to optimize care. We then briefly describe the impact of anxiety on neuronal elements of fear circuitry to highlight how treatments may ameliorate impairments through enhanced plasticity Overall, pharmacotherapy for anxiety disorders is effective in improving clinical symptoms, particularly in combination with psychotherapy. Response is typically seen within several weeks, yet longitudinal studies are limited. Selective serotonin reuptake inhibitors are thought to be relatively safe and effective for acute treatment of several classes of anxiety disorders in youth, with increasing evidence supporting the role of neuronal plasticity in recovery.

Pharmacotherapy of anxiety disorders: a critical review

Given the enormous contribution of anxiety disorders to the burden of disease, it is key to optimize their prevention and treatment. In this critical review we assess advances in the pharmacotherapy of anxiety disorders, as well as remaining challenges, in recent decades, the field has seen rigorous clinical trial methods to quantify the efficacy and safety of serendipitously discovered agents, more focused development of medications with selective mechanisms of action, and the gradual translation of insights from laboratory research into proof-of-principle clinical trials. On the positive side, a considerable database of studies shows efficacy and relative tolerability of the selective serotonin reuptake inhibitors in the major anxiety disorders, and secondary analyses of such datasets have informed questions such as optimal definition of response and remission, optimal dose and duration, and comparative efficacy of different agents. Significant challenges in the field include barriers to appropriate diagnosis and treatment of anxiety disorders, failure of a significant proportion of patients to respond to first-line pharmacotherapy agents, and a limited database of efficacy or effectiveness studies to guide treatment in such cases.

Les études de coûts-efficacité des traitements pharmacologiques et psychologiques des troubles anxieux : une recension des écrits

This article reviews the literature on economic studies of evidence-based cognitive-behavioral treatment and pharmacotherapy for anxiety disorders. Articles were identified through electronic search of medical and psychological databases between 1980 and 2008. Seven studies were identified and included panic disorder, generalized anxiety disorder, specific phobia and social phobia. Results show that evidence-based cognitive-behavior therapy and pharmacotherapy are cost-effective, usually more than usual care. Although the evidence base needs to be strengthened, it appears beneficial in increasing access to evidence-based treatments for anxiety disorders from a societal perspective.

Commentary on ‘Pharmacotherapy for anxiety disorders in children and adolescents’ with a response from the review authors

AbstractThis is a commentary on a Cochrane review, published in this issue of EBCH, first published as: Ipser JC, Stein DJ, Hawkridge S, Hoppe L. Pharmacotherapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD005170. DOI: 10.1002/14651858.CD005170.pub2.Further information for this Cochrane review is available in this issue of EBCH in the accompanying Summary article. Copyright © 2010 John Wiley &amp; Sons, Ltd.