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CLINICAL SYNTHESIS   |    
Advances in Psychopharmacology for Anxiety Disorders
Amir Garakani, M.D.; James W. Murrough, M.D.; Dan V. Iosifescu, M.D., M.Sc.
FOCUS 2014;12:152-162. doi:10.1176/appi.focus.12.2.152
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Author Information and CME Disclosure

Amir Garakani, M.D., Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY; Silver Hill Hospital, New Canaan, CT; Department of Psychiatry, Yale University School of Medicine, New Haven, CT

James W. Murrough, M.D., Department of Psychiatry and Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY

Dan V. Iosifescu, M.D., M.Sc., Department of Psychiatry and Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY

Dr. Garakani reports no financial relationships with commercial interests. In the past 2 years, Dr. Murrough has received research support from NIMH, the American Foundation for Suicide Prevention, the Doris Duke Charitable Foundation, Janssen Pharmaceuticals, and Avanir Pharmaceuticals; he has served on advisory boards for Genentech and Janssen Pharmaceuticals and has received consulting fees from ProPhase. Dr. Iosifescu has received research funding through Mount Sinai School of Medicine from NIMH, AstraZeneca, Brainsway, Euthymics, Neosync, and Roche; he has received consulting fees from Avanir, CNS Response, Otsuka, Lundbeck, Servier, and Sunovion.

Address correspondence to Dan V. Iosifescu, M.D., M.Sc., Director, Mood and Anxiety Disorders Program, Associate Professor of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY 10029; e-mail: dan.iosifescu@mssm.edu

Abstract

Anxiety disorders are among the most prevalent psychiatric disorders, but compared with mood and psychotic disorders, are understudied in terms of newer pharmacotherapeutic approaches. Certain anxiety disorders, such as generalized anxiety disorder, and related conditions such as posttraumatic stress disorder (PTSD), may be refractory to the approved first-line treatments, like selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). Here we will review the most recent pharmacological treatment modalities under investigation for anxiety disorders and related conditions such as PTSD. The review includes a discussion of neurotransmitter and peptide pathways. We will present novel treatment options from medication classes that are widely studied in anxiety, such as the serotonin and gamma-aminobutyric acid (GABA) system, and also more novel mechanisms like glutamate modulators (e.g., ketamine, riluzole and d-cycloserine), corticotropin releasing factor and vasopressin receptor antagonists, neuropeptides such as neuropeptide Y and oxytocin, anticonvulsants such as pregabalin and gabapentin, mifepristone, and adrenergic agents such as propranolol and prazosin. Our review of the literature suggests that while there are some agents under investigation that may appear promising in the future, most of them are relatively early in development and there are very few new medications that carry immediate promise for the treatment of anxiety disorders. We hope this review encourages further investigation of novel therapeutics for anxiety, focusing primarily on new drug development of nonmonoamine and peptide systems.

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Table 1.Anxiety Disorders
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Table 2. Current Treatments for Anxiety Disorders
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Which of the following medications requires very slow titration because of the risk of orthostatic hypotension?

See Stan and Tamminga: Pharmacokinetics, Formulation and Metabolism, p 128
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Which of the following medications is formulated solely as a sublingual tablet?

See Stan and Tamminga: Pharmacokinetics, Formulation and Metabolism, p 128
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Which of the following medications requires administration with a meal of at least 350 calories for optimal absorption?

See Stan and Tamminga: Pharmacokinetics, Formulation and Metabolism, p 128
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