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NCDEU Festschrift

The Pharmacologic Treatment of Anxiety Disorders: A Review of Progress

Lakshmi N. Ravindran, MD, and Murray B. Stein, MD, MPH

Published: June 11, 2010

Article 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.

J Clin Psychiatry 2010;71(7):839-854

Submitted: May 4, 2010; accepted May 6, 2010.

Online ahead of print: June 11, 2010 (doi:10.4088/JCP.10r06218blu).

Corresponding author: Murray B. Stein, MD, MPH, 8939 Villa La Jolla Dr, Ste 200, La Jolla, CA 92037 (

Volume: 71

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