Combination Pharmacotherapy and Psychotherapy for the Treatment of Major Depressive and Anxiety Disorders

2015 ◽  
Author(s):  
Cindy J. Aaronson ◽  
Gary Katzman ◽  
Rachel L. Moster
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Posttraumatic Stress ◽  
Obsessive Compulsive Disorder ◽  
Randomized Clinical Trials ◽  
Stress Disorder ◽  
Obsessive Compulsive ◽  
Major Depressive ◽  
Compulsive Disorder

Clinical wisdom and intuition suggest that when treating major depression and/or anxiety disorders, combining two documented efficacious treatments such as antidepressants and psychotherapy would improve outcome. However, the data do not completely support this conclusion. This chapter reviews randomized clinical trials comparing combined pharmacotherapy and psychotherapy with monotherapy for the treatment of major depressive disorder, panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder, generalized anxiety disorder, and social anxiety disorder in adults. Although DSM-V no longer categorizes posttraumatic stress disorder and obsessive-compulsive disorder as anxiety disorders, the authors continue to include them in this chapter.

scholarly journals Anxiety Disorders

Psychology ◽  
2013 ◽  
Author(s):  
Jeannette M. Reid ◽  
Dean McKay
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Posttraumatic Stress ◽  
Obsessive Compulsive Disorder ◽  
Generalized Anxiety Disorder ◽  
Stress Disorder ◽  
Generalized Anxiety ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

Recent epidemiological research has shown that anxiety disorders, collectively, are the most common set of psychiatric disorders. Lifetime prevalence estimates suggest that nearly 30 percent of the population will experience an anxiety disorder at some point in their life (Kessler, et al. 2005, cited under Phobias). Bolstering the concern, anxiety disorders (as a group) tend to be associated with a host of cognitive impairments (e.g., perseveration, visual memory deficits), diminished quality of life (e.g., in areas of work and social functioning), and both psychiatric and medical comorbidities. Anxiety disorders may be roughly classed into two groups: (1) those characterized primarily by acute fear (e.g., phobias) and (2) those associated with lower level, but chronic, anxiety and apprehension (with the clearest example being generalized anxiety disorder). Cognitive and behavioral explanations of anxiety predominate, with related treatments showing most consistent research support among psychosocial interventions. (While standard pharmacological practices are mentioned wherever relevant, a more in-depth discussion of pharmacological interventions for anxiety disorders is outside the scope of this chapter.) In general, the etiology of anxiety disorders is likely best understood through the lens of the diathesis-stress model—such that individuals have a genetic predisposition/vulnerability and situational factors mediate symptomatology. (Certainly, a sudden expression of symptoms following brain damage would be an exception. However, as these presentations—albeit fascinating—are in the minority, a related discussion will be beyond the scope of this bibliography.) Within this article, the following anxiety disorders will be discussed in detail: phobias, panic with and without agoraphobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. Factors of current interest in the field will be attended to specifically—for instance, comorbidity in obsessive-compulsive disorder and differential risk in posttraumatic stress disorder. Throughout the discussion, pertinent works will be delineated and summarized.

scholarly journals Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options

2020 ◽  
Vol 11 ◽  
Author(s):  
Amir Garakani ◽  
James W. Murrough ◽  
Rafael C. Freire ◽  
Robyn P. Thom ◽  
Kaitlyn Larkin ◽  
...  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Posttraumatic Stress ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Stress Disorder ◽  
Controlled Trials ◽  
Beta Adrenergic ◽  
Adrenergic Agents ◽  
Compulsive Disorder

Anxiety disorders are the most prevalent psychiatric disorders and a leading cause of disability. While there continues to be expansive research in posttraumatic stress disorder (PTSD), depression and schizophrenia, there is a relative dearth of novel medications under investigation for anxiety disorders. This review's first aim is to summarize current pharmacological treatments (both approved and off-label) for panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and specific phobias (SP), including selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), azapirones (e.g., buspirone), mixed antidepressants (e.g., mirtazapine), antipsychotics, antihistamines (e.g., hydroxyzine), alpha- and beta-adrenergic medications (e.g., propranolol, clonidine), and GABAergic medications (benzodiazepines, pregabalin, and gabapentin). Posttraumatic stress disorder and obsessive-compulsive disorder are excluded from this review. Second, we will review novel pharmacotherapeutic agents under investigation for the treatment of anxiety disorders in adults. The pathways and neurotransmitters reviewed include serotonergic agents, glutamate modulators, GABAergic medications, neuropeptides, neurosteroids, alpha- and beta-adrenergic agents, cannabinoids, and natural remedies. The outcome of the review reveals a lack of randomized double-blind placebo- controlled trials for anxiety disorders and few studies comparing novel treatments to existing anxiolytic agents. Although there are some recent randomized controlled trials for novel agents including neuropeptides, glutamatergic agents (such as ketamine and d-cycloserine), and cannabinoids (including cannabidiol) primarily in GAD or SAD, these trials have largely been negative, with only some promise for kava and PH94B (an inhaled neurosteroid). Overall, the progression of current and future psychopharmacology research in anxiety disorders suggests that there needs to be further expansion in research of these novel pathways and larger-scale studies of promising agents with positive results from smaller trials.

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