Abstract: Pharmacological treatment of generalized anxiety disorders
The treatment of resistant generalized anxiety disorders remains a question for future research but the use of imipramine or sedative antipsychotics could be an option when other treatments have floped to induce any improvement.
If [While] benzodiazepines may still be prescribed for a limited amount of moment (i.e. 6 to 12 weeks) due to the fluctuating nature of generalized anxiety, the chronic evolution of that disorder in most patients often justifies the long-term prescription of serotoninergic (5-HT) or dual-action (5HT-NA) antidepressants and sometimes of 5HT-1a partial agonists like buspirone.
[Article in French] Boulenger JP, Capdevielle D. Professeur de Psychiatrie Adulte, Service Universitaire de Psychiatrie Adulte et INSERM U-888, CHU de Montpellier (Universite Montpellier 1): Hopital La Colombiere, 39, avenue Charles Flahault, 34295 Montpellier cedex 5.. PMID: 17457298 [PubMed - in process] (Text has been reformatted for clarity, translation revised; ed.)
The rational use of pharmacological treatment in generalized anxiety disorders is still a matter of debate due to the uncertainties concerning the nature, diagnostic criteria and target-symptoms of that frequent and potentially invalidating invaliding disorder.
Because of its pharmacological profile buspirone remains however a useful option in patients with cognitive or addictive problems, particularly alcoholics. In that population the indication of specific pharmacological treatments should rely on a careful evaluation of the patients drug treatment history, of the duration, evolution and functional consequences of their symptoms and of the nature of their possible comorbidity.
Encephale.
The traditional use of other psychotropic agents such as hydroxyzine, an H1 histaminergic receptor antagonist, is only supported by limited scientific notes; that is plus the case of sedative typical antipsychotics which benefit/risk ratio should be carefully evaluated before being prescribed to generalized anxiety patients resistant to other psychotropic agents.
Imipramine, a tricyclic antidepressant was the first to demonstrate its efficacy in carefully selected patients; however, due to the side-effects of that molecule recent guidelines based on controlled clinical trials, propose to use either serotonergic antidepressants (SSRIs) or venlafaxine as a first-line treatment of generalized anxiety disorders.
At last [Finally] it is crucial to realize that most clinical trials in that field only include patients with non-comorbid generalized anxiety and that their conclusion may not always be generalizable to most psychiatric patients who are usually characterized by a high rate of comorbidity.
More recently, an anticonvulsant, pregabaline plus demonstrated its efficacy in several clinical trials but the symptomatic profile of generalized anxiety patients likely to reply to that GABA analog compared to other psychotropic treatments remain to be established.
Pharmacological treatment of generalized anxiety disorders: rationale and limitations. However, the possible use of atypical antipsychotics with a better tolerance profile than the typical ones in that indication is presently under research in several countries.
If [While] most SSRIs have demonstrated efficacy by placebo, head to head comparisons remain limited except for escitalopram which seem better tolerated than paroxetine in that indication.
Original post by Anxiety Insights
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