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The Pharmacologic Treatment of Anxiety Disorders: A Review of Progress
Abstract
Anxiety disorders, as a group, are among the most common mental health conditions and frequently cause significant functional impairment. Both psychotherapeutic and pharmacologic techniques are recognized to be effective management strategies. This review provides a discussion of the major classes of psychotropic medications investigated in clinical trials of the following anxiety disorders: panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, and obsessive-compulsive disorder. Findings suggest that both selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are useful first-line agents for most of the anxiety disorders, particularly given the frequent comorbidity with mood disorders. Highly serotonergic agents are preferred for obsessive-compulsive disorder. Other antidepressants, such as tricyclic antidepressants or monoamine oxidase inhibitors, are generally reserved as second- and third-line strategies due to tolerability issues. Evidence for other agents, including anticonvulsants and atypical antipsychotics, suggests that they may have an adjunctive role to antidepressants in cases of treatment resistance, while azapirones have been used effectively for generalized anxiety disorder, and a substantial body of evidence supports benzodiazepine use in panic disorder and generalized anxiety disorder. Despite notable advances, many patients with anxiety disorders fail to adequately respond to existing pharmacologic treatments. Increased research attention should be focused on systematizing pharmacologic and combined pharmacologic-psychosocial strategies to address treatment resistance and developing novel treatments for anxiety disorders.
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“It is the most widely used pharmacological target for treating depression and anxiety (Belmaker and Agam, 2008; Ravindran and Stein, 2010)”
From Anatomically defined and functionally distinct dorsal raphe serotonin sub-systems (2018) · cites this paper as Ravindran and Stein, 2010
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Items 301–317 of 317
Piccoli, E., Vanzetto, S., Cerolini, L., Conti, D., Celebre, L., & Dell’Osso, B. M. (2024) · Cambridge University Press eBooks · doi:10.1017/9781009067287.019 · Cited by 1
Petrovick, M. S., Shcherbina, A., Farina, E. K., Thompson, L., Niro, P. J., McClung, J. P., & Lieberman, H. R. (2024) · Anxiety Stress & Coping · doi:10.1080/10615806.2024.2388850
“…serotonin reuptake inhibitors (SSRIs), such as fluoxetine and citalopram, as well as serotonin–norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Bartlett et al., 2017; Brady et al., 2000; Hammen, 2005; Penner-Goeke & Binder, 2019; Raposo-Lima & Morgado, 2020; Ravindran & Stein, 2010).”
Revealing and mitigating the inhibitory effect of serotonin on HRP-mediated protein labelling
Chan, Z. C.-K., Cheng, Q., Cai, Y., Li, X., & Ren, J. (2024) · Scientific Reports · doi:10.1038/s41598-024-83928-w
Linking the Biological Marker Goal-Conflict Specific Rhythmicity (GCSR) and Anxiety Disorder
McNaughton, N., & Glue, P. (2024) · Springer eBooks · doi:10.1007/978-3-031-32035-4_17-1
Grundlagen der Diagnostik und Therapie
(2024) · Elsevier eBooks · doi:10.1016/b978-3-437-22487-4.16001-0
The use of trazodone in GP practice
Tkáč, J. (2025) · Medicína pro praxi · doi:10.36290/med.2025.017
Linking the Biological Marker Goal-Conflict Specific Rhythmicity (GCSR) and Anxiety Disorder
McNaughton, N., & Glue, P. (2025) · Springer eBooks · doi:10.1007/978-3-031-73368-0_17
How food reward value induces positive memories to alleviate anxiety-related behavior in mice
Jiang, R., & Sakai, N. (2025) · Learning and Motivation · doi:10.1016/j.lmot.2025.102217
Vardanyan, R., & Vardanyan, G. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-33869-4.00043-0
Vardanyan, R., & Vardanyan, G. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-33869-4.00013-2
Martinetz, S. (2014) · University of Regensburg Publication Server (University of Regensburg) · doi:10.5283/epub.30767
Ketamine Metabolites Promote Anxiolysis and Hydrocortisone Stress Buffering in Zebrafish
Kelly, J. R., Brasfield, L. S., Kelsey, A. H., & Seal, G. E. (2026) · Behavioural Brain Research · doi:10.1016/j.bbr.2026.116230
Kandemir, Ü., Sağlik, G. T., Osmani̇ye, D., Kaplancıklı, Z. A., Can, Ö. D., & Özkay, Ü. D. (2026) · Pharmaceuticals · doi:10.3390/ph19050797
“Indeed, buspirone is an anxiolytic drug that exerts its pharmacological effect via partial agonism of the 5-HT 1A receptor [53].”
Roberts, L., Cumming, C., Budgeon, C. A., Preen, D. B., & Lee, K. (2026) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-026-02176-2
“Although psychotropic medications are effective in reducing anxiety symptoms [19–21], adverse effects including sexual dysfunction (reported in 30–50% of patients treated with selective serotonin reup-take inhibitors), weight gain, dependence, and withdrawal reactions may negatively affect QoL and…”
Mutlu, A. K., Serneels, B., Wiest, C., Trinh, A., Bardenhewer, R., Palumbo, F., Frisvold, O. B., Aukrust, I. K. F., Ostenrath, A. M., & Yaksi, E. (2026) · Nature Communications · doi:10.1038/s41467-026-75490-y · Cited by 5
Yuan, Q., Wang, S., & Tang, Z. (2026) · European Journal of Neuroscience · doi:10.1111/ejn.70653
Adams, A. M. J., Wu, K. L., Li, Z., Li, P., Pan, H., 黄祖奇, Migliarini, S., Dear, R., Sun, B., Chan, Z. C.-K., et al. (2026) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2611533123
Metadata
- Authors
- Ravindran, L. N., & Stein, M. B.
- Affiliations
- University of Toronto (CA)
- Corresponding author
- Stein, Murray B.
- ORCID
- Stein, Murray B.
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2010-06-11
- Volume
- 71
- Issue
- 07
- Pages
- 839-854
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2045726637
- Cited by
- 317
- References
- 0
- Citations by year
- 2026: 8 · 2025: 11 · 2024: 13 · 2023: 17 · 2022: 17 · 2021: 17 · 2020: 13 · 2019: 24 · 2018: 25 · 2017: 14 · 2016: 26 · 2015: 25 · 2014: 26 · 2013: 21 · 2012: 25
- FWCI
- 33.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (MH-64122, K24MH064122)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
- Keywords
- anxiety disorders, pharmacotherapy, panic disorder, social anxiety disorder, generalized anxiety disorder, post-traumatic stress disorder, obsessive-compulsive disorder, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors, antiepileptic drugs, atypical antipsychotics, azapirones, benzodiazepines, treatment resistance
- MeSH terms
- Anticonvulsants, Antidepressive Agents, Anxiety Disorders, Benzodiazepines, Buspirone, Humans, Obsessive-Compulsive Disorder, Phobic Disorders, Psychotropic Drugs, Stress Disorders, Post-Traumatic, Antipsychotic Agents, Randomized Controlled Trials as Topic, Panic Disorder
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