Anxiety disorders pharmacotherapy

Iwata N, Cowley DS, Radel M, et al Relationship between a GABA alpha g Pro385Ser substitution and benzodiazepine sensitivity. Am] Psychiatry 156 1447—1449,1999 Jacobson AF, Dominguez RA, Goldstein B, et al Comparison of buspirone and diazepam in generalized anxiety disorder. Pharmacotherapy 5 290—296, 1985 Jaffe JH, Ciraulo DA, Nies A, et al Abuse potential of halazepam and diazepam in patients recently treated for acute alcohol withdrawal. Clin Pharmacol Ther 34 623-630, 1983... 

Benzodiazepines. Although a cornerstone of anxiety disorder pharmacotherapy, in general, there is snrprising little data regarding benzodiazepine therapy for OCD. Controlled stndies of clonazepam have produced mixed results. Consequently, benzodiazepines are seldom used in the treatment of OCD. 

Up to 30% of COPD patients suffer from anxiety disorder or depression, and should be treated with conventional pharmacotherapy. 

Davidson JRT (1998). Pharmacotherapy of social anxiety disorder. / Clin Psychiatry 59(suppl.l7)>47-5l. 

Recommend psychotherapy and pharmacotherapy interventions for patients with generalized anxiety, panic, and social anxiety disorders. 

Pharmacotherapy of social anxiety disorder should lead to improvement in physiologic symptoms of anxiety and fear, functionality, and overall well-being. 

Reprinted, with permission, from Kirkwood CK, Melton ST. Anxiety disorders I. Generalized anxiety, panic, and social anxiety disorders. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw Hill 2005 1294. 

Assess the patient s symptoms and level of functional impairment to determine if pharmacotherapy is appropriate for the anxiety disorder. 

Inform patients of treatment options for anxiety disorders and the expected benefits of each (e.g., pharmacotherapy, psychotherapy, and combination treatment). 

Rickels R, Ryan M. Pharmacotherapy of generalized anxiety disorder. J Clin Psychiatry 2002 63(suppl 14) 9—16. 

Stein, D. J., Stein, M. B., Pitts, C. D., Kumar, R. et al. (2002). Predictors of response to pharmacotherapy in social anxiety disorder an analysis of three placebo-controlled paroxetine trials. /. Clin. Psychiatry, 63, 152-5. 

Baldwin DS and Polkinghorn C (2005) Evidence-based pharmacotherapy of Generalized Anxiety Disorder. Int J Neuropsychopharmacol 8(2) 293-302 Ballard C, Hanney ML, Theodoulou M et al. (2009) The dementia antipsychotic withdrawal trial (DART-AD) long-term follow-up of a randomised placebo-controlled trial. The Lancet Neurology DOI 10.1016/S 1474-4422(08)70295-3... 

When is medication indicated in the treatment of psychiatric illness There is no short answer to this question. At one end of the continuum, patients with schizophrenia and other psychotic disorders, bipolar disorder, and severe major depressive disorder should always be considered candidates for pharmacotherapy, and neglecting to use medication, or at least discuss the use of medication with these patients, fails to adhere to the current standard of mental health care. Less severe depressive disorders, many anxiety disorders, and binge eating disorders can respond to psychotherapy and/or pharmacotherapy, and different therapies can target distinct symptom complexes in these situations. Finally, at the opposite end of the spectrum, adjustment disorders, specific phobias, or grief reactions should generally be treated with psychotherapy alone. 

There has been little formal study of maintenance therapy for social anxiety disorder. Limited data indicates that continued pharmacotherapy provides significant prophylactic protection against relapse. Furthermore, growing evidence indicates that patients with social anxiety disorder experience a high rate of relapse after treatment discontinuation. CBT, however, may afford continued prophylactic benefit long after conclusion of the therapy, though the data to support this contention is limited. 

The growth during the 1990s in the use of antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), for the treatment of anxiety disorders represented a major advance in the pharmacotherapy of anxiety. The efficacy of tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) had been established alongside their antidepressantw actions several decades... 

The current state on the pharmacotherapy of anxiety disorders is summarized by J.R. Nash and D.J. Nutt. The recent shift in clinical practice towards the use of antidepressants, particularly SSRIs, for the first-fine treatment of anxiety disorders is supported by research evidence from randomized controlled trials. It is only in recent years that drugs acting via GABA neurotransmission have been supplanted as first-line treatments, and new drugs in this class with improved tolerability compared to the benzodiazepines are likely to be marketed in the near future. 

Uhlenhuth, E.H., Balter, M.B., Ban, T.A., and Yang, K. (1999) International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications VI. Trends in recommendations for the pharmacotherapy of anxiety disorders, 1992-1997. Depres Anxiety 9 107—116. 

March, J. (1999) Current status of pharmacotherapy for pediatric anxiety disorders. In Beidel, D., ed. Treating Anxiety Disorders in Youth Current Problems and Puture Solutions (ADAA/NIMH) Washington, DC Anxiety Disorders Association of America, pp. 42-62. 

Inattentiveness, impulsivity, hyperactivity 50% will continue to manifest the disorder into adulthood Stimulants (70% response for uncomplicated ADHD caution in patients with tic disorders) TCAs (70% response, first line for patients with comorbid MD or anxiety disorders, and for patients with ADHD + tics) requires serum levels and cardiovascular monitoring Bupropion Clonidine, guan-facine (first line for patients with ADHD + tics) MAOIs Combined pharmacotherapy for treatment-resistant cases... 

The safety and efficacy of combined SSRI and stimulant pharmacotherapy have been addressed in two open studies. Gammon and Brown (1993) reported on the successful addition of fluoxetine to stimulants in the treatment of 32 patients with ADHD with comorbid depressive and anxiety disorders (Gammon and Brown 1993). These children with comorbid conditions had failed to respond to methylphenidate alone. Another report detailed the addition of methylphenidate to SSRI treatment (Findling, 1996). Depressed children and adults with comorbid ADHD were treated with either fluoxetine or sertraline. While depressive symptoms remitted, ADHD symptoms persisted. Methylphenidate was added and successfully treated the ADHD symptoms. In both investigations, the combined treatment was well tolerated. 

Comorbid anxiety has been associated with differential treatment response. This association predicts at times a better response to CBT and TCAs (Hughes et ah, 1990 Brent et ah, 1998). Treatment of comorbid anxiety, which most often precedes depression, is essential because the treatment contributes to improvement and may prevent future depressive episodes (Ko-vacs et ah, 1989 Hayward et ah, 2000). Fortunately, pharmacotherapy and psychotherapy treatments found useful for the treatment of MDD have also been found to be beneficial for treatment of youths with anxiety disorders (Kendall, 1994 RUPP Anxiety Group, 2001). 

Goodman, W. K. Selecting Pharmacotherapy for Generalized Anxiety Disorder. /ourna/ of Clinical Psychiatry 65 Suppl. 13 (2005) 8-13. 

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