Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options

Summary & key facts

This review summarizes drug treatments for adult anxiety disorders (panic disorder, generalized anxiety disorder, social anxiety disorder, and specific phobias). It says well-known drugs such as SSRIs and SNRIs are commonly used and approved for some anxiety disorders. The authors found that research into truly new medications is limited, many recent trials have been negative, and larger, better trials are needed for the few promising agents.

Key facts:

• Anxiety disorders affect about 32% of people in the United States over a lifetime, according to the review.
• An estimated 264 million people worldwide have an anxiety disorder, which the review says is a 15% increase since 2005.
• FDA-approved drug classes for panic disorder, generalized anxiety disorder, and social anxiety disorder include several SSRIs (for example fluoxetine, sertraline, escitalopram, paroxetine) and SNRIs (for example duloxetine, venlafaxine).
• The review reports that 60–85% of patients with anxiety disorders respond to current biological and psychological treatments (response defined as at least 50% improvement).
• Only about half of those who respond go on to achieve recovery, defined in the review as minimal anxiety symptoms.
• The authors state there are relatively few randomized, double-blind, placebo-controlled trials testing novel medications for anxiety disorders.
• Recent trials of new agents—such as neuropeptides, glutamatergic drugs (including ketamine and d-cycloserine), and cannabinoids (including cannabidiol)—have mostly been negative, especially in generalized and social anxiety disorder.
• The review notes small positive signals for kava and for PH94B (an inhaled neurosteroid), but says larger-scale studies are needed to confirm benefit.
• This review focused only on adult patients and on four DSM-5 anxiety disorders (panic disorder, generalized anxiety disorder, social anxiety disorder, and specific phobias); it excluded PTSD and OCD.

Abstract

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.

Topics

Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Pharmacological Receptor Mechanisms and Effects Tryptophan and brain disorders

Categories

Experimental and Cognitive Psychology Psychology Social Sciences

Tags

Anxiety Anxiolytic Buspirone Generalized anxiety disorder Internal medicine Medicine Panic disorder Pregabalin Psychiatry Psychology Receptor Serotonin