Treatment of Anxiety Disorders

Anxiety is a subjective emotional and physical state experienced by all at some point. Anxiety becomes problematic when it cannot be controlled and begins to interfere with an individual s ability to work, sleep, or concentrate. More than one-third of all clients who seek mental health treatment present with some type of anxiety-related problem, yet due primarily to diagnostic error only one in four people with anxiety disorders receive adequate intervention (Hales, 1995). It is alarming that so many individuals who suffer from anxiety are incorrectly diagnosed or inadequately treated, because most anxiety disorders respond to intervention with short-term success rates as high as 70% (Roth Fonagy, 1996). 

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Benzodiazepines, ie, the hiU BZR agonists, are prescribed for anxiety, insomnia, sedation, myorelaxation, and as anticonvulsants (97). Those benzodiazepines most commonly prescribed for the treatment of anxiety disorders are lorazepam (19), alprazolam (20), diazepam (21), bromazepam (22), chlorazepate (23), and oxazepam (24). These dmgs together represent about 70% of total... 

Anxiolytics are drugs used for the treatment of anxiety disorders. Apart from benzodiazpines, a frequently used anxiolytic is the 5HT1A (serotonin) receptor agonist buspiron, which has no sedative, amnestic or muscle-relaxant side effects, but whose action takes about a week to develop. Furthermore, it is less efficaceous than the benzodiazepines. Buspiron s mechanism of action is not fully understood. 

Benzodiazepines are amongst the most frequently prescribed drugs they have well-established uses in the treatment of anxiety disorders (anxiolytics) and insomnia, preanaesthetic sedation, suppression of seizures, and muscle relaxation. 

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. 

Lejoyeux et al. 1998). Similar to opioid-dependent persons, these patients reported that they use benzodiazepines to self-medicate anxiety, insomnia, and alcohol withdrawal and, less commonly, to enhance the effects of ethanol. Approximately l6%-25% of patients presenting for treatment of anxiety disorders abuse alcohol (Kushner et al. 1990 Otto et al. 1992). Controversy exists concerning appropriate benzodiazepine prescribing in this population (Cir-aulo and Nace 2000 Posternak and Mueller 2001). 

Pigott TA (1999). Gender differences in the epidemiology and treatment of anxiety disorders./Clin Psychiatry 60 (suppl. 18),... 

How might drugs with CNS depressant properties aid in the treatment of anxiety disorders ... 

Charney, D. S. and Deutch, A. A functional neuroanatomy of anxiety and fear implications for pathophysiology and treatment of anxiety disorders. Crit. Rev. Neurobiol. 10 419 46,1996. 

Data from American Psychiatric Association. Diagnostic and Statistical Manuai of Mental Disorders, 4th edv text revision. Washington, DC American Psychiatric Association, 2000 429-484 and Baldwin DS, Anderson iMr Nutt DJr et al. Evidence-based guidelines hr the pharmacological treatment of anxiety disorders Recommendations from the British Society for Psychopharmacology. J Psychopharmacology 2005 19 567-596. 

Buspirone (Buspar). The first nonsedating, nonbenzodiazepine specifically introduced as an anxiolytic, buspirone is FDA approved for the treatment of GAD. This medication acts as a partial agonist at the postsynaptic serotonin (5HT)-1A receptor. Like the antidepressants, buspirone has a delayed onset of action and effectively relieves the intrapsychic symptoms of GAD. Devoid of the muscle-relaxing properties of benzodiazepines, buspirone does not as effectively relieve the physical symptoms of GAD. Buspirone is not effective in the treatment of depression. Furthermore, its utility for the treatment of anxiety disorders other than GAD appears to be limited. 

Nemeroff CB. The role of GABA in the pathophysiology and treatment of anxiety disorders. Psychopharmacol Bull 2003 37 133-146. 

Interactions Between Corticotropin-Releasing Hormone and Serotonin Implications for the Aetiology and Treatment of Anxiety Disorders... 

When the CS is presented repeatedly in the absence of the US, a reduction in the condition fear response occurs. This process is called extinction. It forms the basis for exposure-based psychotherapies for the treatment of anxiety disorders characterized by exaggerated fear responses. Individuals who show an abihty to quickly attenuate learned fear through a powerful and efficient extinction processes are hkely to fimction more effectively under dangerous conditions. 

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... 

Pharmacology has provided powerful tools to characterize the neurochemical pathways of stress and anxiety in the brain, and how these pathways are involved in the pathophysiology and treatment of anxiety disorders. In the past, this work has largely focused on classical neurotransmitter systems, including the synthesis, release, and metabolism of monoamines and receptor subtypes that control presynaptic release of neurotransmitters and their postsynaptic effects. Increasing the specihcity of drugs but also the combination of mechanisms has been pursued to improve anxiolytic drugs. 

New drug targets have been generated by characterizing the importance of hormones and second messenger systems in the pathophysiology and treatment of anxiety disorders. Neuropeptides and neuroactive steroids are at least in part synthesized and released in the brain independent from their peripheral activity. 

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