Anxiety disorders remission

O The goals of therapy for generalized anxiety disorder are to acutely reduce the severity and duration of anxiety symptoms and restore overall functioning. The long-term goal in generalized anxiety disorder is to achieve and maintain remission. 

Anxiety disorders are characterized as chronic in nature with low rates of spontaneous symptom remission and high rates of relapse. Research illustrates that symptoms of anxiety disorders tend to wax and wane, with less than a third of patients remitting spontaneously.7 In a 12-year follow-up study of anxiety disorder patients, recurrence rates were similar between PD with and without agoraphobia (56% and 58%, respectively) despite great differences seen in reported rates of remission (48% and 82% with treatment, respectively).8 Fifty-eight percent of treated GAD patients experienced symptom remission, with 55% experiencing recurrence during the follow-up period. While individuals with SAD had the lowest remission rate with treatment (37%), those who did respond had the lowest rate of recurrence (39%) compared with patients with other anxiety disorders. 

Several controlled studies of IMI involved less homogeneous samples of anxious children. Neither IMI nor alprazolam (a BZ) was superior to placebo in an 8-week study of 24 children (ages 7-18 years) with school refusal, which included subjects with anxiety and depression (Bernstein et ah, 1990). A more recent placebo-controlled study of IMI -I- CBT for 47 adolescents (ages 12-18 years) with school refusal, anxiety, and/or depression was designed to address the limitations of previous studies of TCA treatment for pediatric anxiety disorders (Bernstein et ah, 2000). Accordingly, sample size was based on proposed power analysis IMI dose and serum level were monitored to ensure adequate exposure (mean IMI dose 180 mg/day mean serum IMI180 pg/L and mean IMI -I- DMI 250 pg/L at week 3 and week 8) and CBT was manual based and closely monitored. Fifty-four percent of subjects treated with IMI -I- CBT met remission criteria (defined as > 75% school attendance at the end of the study), compared to 17% of subjects treated with placebo -I- CBT. No between-group differences were noted... 

Like other anxiety disorders, GAD is also relatively common, with a lifetime prevalence of about 5% and a 12-month prevalence of about 3% (Kessler et al., 1994). GAD occurs rarely in children, and although it may start early, it tends to increase in prevalence in the 30s and 40s, making it the most diagnosed anxiety disorder after midlife. It also tends to be chronic, with exacerbation and amelioration of symptoms over time, even with periods of remission. Women are affected twice as much as men, and the rates appear to increase very snbstantially in women once they reach their 40s. Psychiatric comorbidity is common, especially with depression and other anxiety disorders. GAD can be seriously disabling and can lead to substantial impairment in familial, social, and occupational functioning. As with other anxiety disorders, a partial genetic transmission model is suspected. 

For chronic anxiety disorders, the goal of treatment is complete remission of symptoms as well as prevention of future relapses... 

Continue treatment of depression and anxiety disorders until all symptoms are gone (remission)... 

For chronic anxiety disorders, the goai of treatment is compiete remission ot symptoms as weli as prevention ot tuture reiapses... 

For secondary insomnia, if underlying condition (e.g., depression, anxiety disorder) is in remission, trazodone treatment may be discontinued if insomnia does not reemerge... 

Sheehan DV. Attaining remission in generaiized anxiety disorder veniafaxine extended reiease comparative data. J Ciin Psychiatry 2001 62 Suppi 19 26-31. 

The long-term goal in generalized anxiety disorder is remission with minimal or no anxiety symptoms and no functional impairment. 

Doyle AC, Pollack MH. Establishment of remission criteria for anxiety disorders. J Clin Psychiatry 2003 64(Suppl 15) 40 5. 

Advances in pharmacotherapy in the past decade have provided clinicians with many safe and effective medications for the treatment of patients with OCD. The SSRIs and clomipramine (an SRI) are the first-line pharmacological therapies for patients with OCD. The treatment of OCD patients with SSRIs is unique in that a selective efficacy exists (other non-SRI antidepressants are ineffective in OCD), a longer therapeutic lag occurs, and higher doses are often required than in treating patients with major depression or other anxiety disorders. The SSRIs provide clinically significant relief in up to 70% of OCD patients, although most do not reach full remission. Clinical experience with the SSRIs suggests that they alleviate the symptoms of OCD, but they do not cure the illness. No one SSRI has been demonstrated to be superior to the others in head-to-head trials. 

Ballenger jC. Remission rates in patients with anxiety disorders treated with paroxetine, j Clin Psychiatry 2004 65 1696-1 707. 

In a 12-week, open, fiexible-dose study of quetiapine in 40 out-patients with generalized anxiety disorder who had not achieved remission after at least 8 weeks of adequate doses of standard therapy, the most common adverse reactions were sedation (n — 29), dry mouth (n = 12), and sexual dysfunction (n = 10) [109 j. Mean total weight gain from pre-treatment to week 12 was about 0.5 kg and 14% of patients had a 7% weight gain. Seven patients withdrew because of adverse events sedation (n = 5), panic attacks (n = 1), and bilateral iritis (n = 1). 

The main objectives of treatment are to reduce the severity and frequency of panic attacks, reduce anticipatory anxiety and agoraphobic behavior, and minimize symptoms of depression or other comorbid disorders.48 The long-term goal is to achieve and sustain remission. 

A 30-year-old man with a history of major depression and panic disorder had been in remission for a year with citalopram 20 mg/day, valproate 600 mg/day, and alprazolam 3 mg/day (23). The citalopram was tapered over 3 weeks to 5 mg/day and then withdrawn. The day after the last dose he experienced anxiety and irritability together with frequent short-lasting bursts of dizziness, not having had the latter previously panic and depression did not recur and after a week the symptoms resolved spontaneously. 

EV is a 21-year-old college student suffering from an acute episode of major depressive disorder with severe symptomatology. Although her symptoms went into remission after 8 weeks of venlafaxine, she now complains of sudden dizziness, anxiety, and shooting pains in her legs. What is the most likely explanation for these complaints ... 

The goal of therapy in panic disorder is remission. Patients should be free of panic attacks, have no or minimal anticipatory anxiety and agoraphobic avoidance, and no functional impairment. Naturalistic studies indicate that after pharmacotherapy, over 50% of patients have occasional panic attacks, 40% experience agoraphobic avoidance, and most continue to take medications. ... 

The long-term goal of therapy for GAD, panic disorder, and SAD is remission of core anxiety symptoms with no impairment in functionality, minimal anxiety, and no depressive symptoms. Clinicians can use the pharmacological armamentarium effectively to achieve this goal for patients. 

Studies clearly support that the neurochemical-based treatments for depression such as antidepressant medications and ECT are effective in lifting depressed moods. Controlled studies using neurochemically based treatments specifically for the treatment of major depression indicated that 78% of the depressed individuals improved with ECT, and 70% with the newer antidepressants medications (Maxmen Ward, 1995). In practice, it is estimated that 50% of individuals who take antidepressant medicines report feeling better or achieve complete remission. In addition, antidepressant medications can be used to treat related conditions such as obsessive compulsive disorder and overwhelming anxiety (Brophy, 1991). Antidepressants are often used to treat excessive anxiety since they can block the symptoms of panic including rapid heartbeat, terror, dizziness, chest pains, nausea, and breathing problems. 

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