Anxiety disorders therapeutics

Buspirone. Buspirone (3) hydrochloride has been approved for the symptomatic management of generali2ed anxiety disorder (Table 3). This dmg is of special iaterest because it does not exert its therapeutic actions via modulation of the GABA receptor complex. This compound is stmcturaHy... 

The definition of desired therapeutic and side effects in the case of the benzodiazepines very much depends on the clinical problem in question. The sedative and hypnotic actions are desired effects in the treatment of insomnia, but undesired effects in the treatment of anxiety disorders. Effects that are usually undesired include daytime drowsiness, potentiation of the sedative effects of ethanol, and anterograde amnesia. They are mediated via the benzodiazepine site of GABAa receptors, since they can be antagonized with flumazenil. 

Holmes A, Picciotto MR (2006) Galanin a novel therapeutic target for depression, anxiety disorders and drag addiction CNS Neurol Disord Drag Targets 5 225-232... 

Identify the desired therapeutic outcomes for patients with generalized anxiety, panic, and social anxiety disorders. 

Baldessaiini RJ (2001) Drugs and the treatment of psychiatric disorders depression and anxiety disorders. In Hardman JG, Limbird LE (eds) Goodman Gilman s the pharmacological basis of therapeutics, 10th edn. McGraw-Hill, New York, pp 447 83... 

For much of the second half of the twentieth century the benzodiazepines were the mainstay of the treatment of anxiety. Despite well-publicised concerns about their long-term safety, they remain an important therapeutic option. The anticonvulsants contain a number of drugs that act via GABA or glutamate neurotransmission and have a limited but interesting role in the treatment of particular anxiety disorders. 

Both acute and chronic anxiety can be treated with benzodiazepines, although it is anticipated that for most anxiety disorders counseling will also play an important role. Benzodiazepines employed in the treatment of anxiety should be used in the lowest effective dose for the shortest duration so that they will provide maximum benefit to the patient while minimizing the potential for adverse reactions. For most types of anxiety, none of the benzodiazepines is therapeutically superior to any other. Choice of a particular agent is usually made on the basis of pharmacokinetic (Table 30.2) considerations. A benzodiazepine with a long half-life should be considered if the anxiety is intense and sustained. A drug with a short half-life may have advantages when the anxiety is provoked by clearly defined circumsfances and is likely to be of short duration. 

Anxiety disorders PO (Immediate-Release) Initially, 0.25 mg 2-3 times a day. Gradually increase to optimum therapeutic response. Debilitated patients, Patients with hepatic disease orbw serum albumin. Initially, 0.25 mg 2-3 times a day. Gradually increase to optimum therapeutic response. PO (Orally Disintegrating) 0.25-0.5 mg 3 times a day. Maximum 4 mg/day in divided doses. 

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. 

Goa and Ward 1986 Pecknold et al. 1989 Rickels et al. 1982]. In contradistinction to benzodiazepines, the therapeutic effect of buspirone has a lag period similar to that of antidepressants in depression, suggesting that its therapeutic benefits derive from receptor modulation. In addition, buspirone seems to act preferentially in those patients who are not responsive to benzodiazepines, suggesting a possible subgrouping of generalized anxiety disorders. 

As other indications are sought for the SSRls, it is clear that their action extends beyond depression, dysthymia, and the anxiety disorders, and the broad spectrum of therapeutic action of these antidepressants becomes apparent. For example, based on the evidence from placebo-controlled studies [A. Wood 1993], fluoxetine has been licensed in Europe for the treatment of bulimia, and several SSRls are reported to be effective in the treatment of premenstrual syndrome. 

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