The Mount Sinai journal of medicine, New York
-
This article reviews the evidence from randomized, placebo-controlled trials and meta-analyses of pharmacological treatments of the following anxiety disorders: generalized anxiety disorder, panic disorder, social anxiety disorder, and post-traumatic stress disorder. There is evidence from multiple randomized, placebo-controlled trials to support the use of selective serotonin reuptake inhibitors as first-line pharmacotherapy in these disorders, and a number of the selective serotonin reuptake inhibitors have received US Food and Drug Administration approval for these indications. ⋯ Benzodiazepines are also effective treatments for anxiety disorders, and although this medication class has the advantage of a rapid onset of action, their use is limited by their potential for abuse and lack of antidepressant properties. In addition to reviewing the clinical trials that have investigated the anxiolytic effects of these commonly used medications, we review the evidence for novel uses of other agents, including anticonvulsants and atypical antipsychotics, in anxiety disorders.
-
Significant advances over the past 20 years in our understanding of the phenomenology and pathophysiology of obsessive-compulsive disorder, made in part from structural and functional neuroimaging and genetics research, can guide treatments that target brain regions, circuits, and neurotransmitter systems specific to obsessive-compulsive disorder, the disruption of which may alleviate obsessive-compulsive disorder symptoms. We discuss here our current understanding of the underlying neurobiology and heritability of obsessive-compulsive disorder and integrate that understanding with a review of the current pharmacological, neurosurgical, and brain stimulation treatments of refractory obsessive-compulsive disorder. Expanding on these studies, we hope that new pharmacological and psychological treatment strategies and research-driven targets for lesioning, stimulation, or other types of focal neuromodulation can be identified that could lead to future research directions. Cross-species translational research and neuroimaging of the physiological and anatomical pathways implicated in the pathophysiology and treatment response in obsessive-compulsive disorder will advance our understanding of the neural basis of obsessive-compulsive disorder and lead to more targeted and effective treatment options.