Room for improvement in the pharmacological treatment of anxiety disorders.
Abstract
Anxiety disorders are common in community settings and in primary and secondary medical care. The associated societal burden is considerable, but many of those who might benefit from pharmacological or psychological treatment are not recognised or treated. By contrast, some patients receive unnecessary or inappropriate interventions. Recent evidence-based guidelines for pharmacological management of patients with anxiety disorders recommend initial treatment with either a selective serotonin reuptake inhibitor or a serotonin-norepinephrine reuptake inhibitor. However, there is considerable room for improvement in both the efficacy and tolerability of pharmacological treatment. For example, response rates to initial treatment can be disappointing and it is still not possible to predict reliably which patients will respond well and which will show only a limited response to treatment. Furthermore, many patients fear or experience unwanted and distressing adverse effects and this limits the effectiveness of pharmacological treatments in clinical practice. Because of the relative lack of longitudinal studies of clinical outcomes in anxiety disorders and the small number of placebo-controlled relapse prevention studies, the optimal duration of treatment after a satisfactory response to acute treatment is still uncertain. There have been comparatively few studies of the further management of patients who do not respond to initial treatment and there is a clear need for further randomised controlled trials of augmentation treatment, in patients who do not respond to a selective serotonin reuptake inhibitor, serotonin-norepinephrine reuptake inhibitor or other initial pharmacological approaches. Future treatment guidelines will be influenced by emerging data with both established and novel pharmacological interventions and through better identification of patient sub-groups that are likely to respond preferentially to particular interventions.
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Pharmacological therapies (benzodiazepine and antidepressant medications) result in response rates of 50.8-58.3% in adults with anxiety disorders.
“pharmacological therapies (benzodiazepine and antidepressant medications) resulting in response rates (typically defined as >50% decrease in symptoms relative to baseline) of 50.8–58.3% (4, 5)”
From Decreases in State and Trait Anxiety Post-psilocybin: A Naturalistic, Observational Study Among Retreat Attendees (2022) · cites this paper as [4]
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“Given the room for improvement in the recognition and treatment of patients with GAD (Baldwin 2008), and current uncertainty about how the condition is managed in secondary care mental health settings, we wished to deepen understanding of overall management and prescribing practice by conducting a…”
BackgroundSelf-citationMitra, R., Sapolsky, R. M., & Vyas, A. (2012) · Disease Models & Mechanisms · doi:10.1242/dmm.009928 · Cited by 66 · see citing works
“Current treatments have disappointing success rate 53 and substantial side-effects (Baldwin, 2008; Baldwin et al., 2010; Ravindran and Stein, 2010).”
Pregabalin Influences Insula and Amygdala Activation During Anticipation of Emotional Images
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“However, SSRIs are limited because of having a relatively slow onset of effects (eg, 2–4 weeks) and side effects such as sexual dysfunction or weight gain that can be of particular concern to patients (Baldwin, 2008).”
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“However, SSRIs are associated with side effects such as weight gain and sexual dysfunction, usually take 2–4 weeks to effect symptom reduction, and often fail to produce full remission (Baldwin, 2008).”
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“Of particular concern are the higher risks of experiencing sedative adverse effects [4] and physical dependence with the abuse liability of benzodiazepines [5-7].”
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“3% (Baldwin 2008; Otto et al. 2010), and cognitive behavioral therapies (CBT) resulting in response rates of 51.”
BackgroundManifesto for a European Anxiety Disorders Research Network
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EXPERIMENTAL EVALUATION OF ANXIOLYTIC ACTIVITY OF ALCOHOLIC EXTRACT OF CITRUS LIMON LEAVES ON RATS.
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Current awareness in human psychopharmacology
(2009) · Human Psychopharmacology Clinical and Experimental · doi:10.1002/hup.975
- Authors
- Baldwin, D.
- Affiliations
- Royal South Hants Hospital (GB)
- Corresponding author
- Baldwin, D.
- ORCID
- Baldwin, D.
- Venue
- Current Pharmaceutical Design
- Publisher
- Bentham Science Publishers Ltd.
- Published
- 2008-11-01
- Volume
- 14
- Issue
- 33
- Pages
- 3482-3491
- ISSN
- 1381-6128 (ISSN-L)
- OpenAlex
- W2053657613
- Cited by
- 24
- References
- 0
- Citations by year
- 2023: 1 · 2022: 1 · 2021: 1 · 2018: 1 · 2016: 3 · 2015: 1 · 2014: 1 · 2013: 3 · 2012: 2
- FWCI
- 4.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Pharmaceutical Design (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- anxiety disorders, pharmacotherapy, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, treatment response, treatment tolerability, adverse drug reactions, relapse prevention, treatment guidelines, patient subgroups
- MeSH terms
- Anxiety Disorders, Clinical Trials as Topic, Humans, Selective Serotonin Reuptake Inhibitors
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