Anxiety Disorders: An Introduction to Clinical Management and Research

Abstract

The vast preponderance of the evidence reviewed here is from short-term studies with either SSRIs or atypical antidepressants. These studies are valuable, but there are some significant limitations to these data. First, the subjects tend to be a rarefied group of healthy patients, usually with only one current Axis I disorder. Therefore, these studies tell us little about the best pharmacotherapies for complex patients with multiple psychiatric and medical conditions. A second limitation is that the majority of these studies extend less than 3 months in duration; therefore, it is difficult to gather objective data about either side effects or long-term efficacy from these studies. There is a tremendous need for carefully collected long-term treatment data. Carefully designed long-term studies would provide important data or efficacy and safety and might help us understand better the natural history and course of these anxiety disorders when treated. Studies should go beyond measuring recent change in rating scales and focus on developing and validating definitions of recovery, response, and relapse. Another major area in which acute and long-term data would be beneficial is investigating the value of combined pharmacotherapy and psychotherapy. The majority of long-term data have focused on studies of panic disorder. These data have mixed results, and it is unclear whether combined therapy confers additional benefits over either psychotherapy or pharmacotherapy. A third area in which future research is needed is how to treat individuals who are refractory to initial therapeutic interventions. Despite the initial presentation of algorithms for anxiety disorders in the early 1990s, there are few carefully done studies investigating where to proceed after an initial treatment option has failed. This is an important, yet neglected, area of research in anxiety disorders. The focus of this review has been current treatment data for OCD, panic disorder, social phobia, and GAD. Reviewed are short-term pharmacotherapy, because this is where good, rigorous, double-blind, placebo-controlled data can be found. The data presented here suggest treatments that are effective in palliating the signs and symptoms of most of these anxiety disorders for the majority of patients.