The Journal of clinical psychiatry
-
Randomized Controlled Trial Comparative Study Clinical Trial
A double-blind evaluation of the safety and efficacy of abecarnil, alprazolam, and placebo in outpatients with generalized anxiety disorder. Abecarnil Work Group.
In a placebo-controlled, multicenter study, 180 male and female outpatients, ages 18-65, with DSM-III-R generalized anxiety disorder, were treated with abecarnil (a partial benzodiazepine agonist), alprazolam, or placebo for 4 weeks. This was followed by a rapid (1-week) taper, during which patients were assessed for any taper-related symptoms. All patients were identified via a structured clinical interview for DSM-III-R and randomly assigned to one of the three treatment groups. ⋯ Additionally, less residual improvement followed the taper in the alprazolam-treated and the placebo-treated groups. These data indicate that the partial benzodiazepine agonist abecarnil may be useful as a safe, effective, short-term treatment for anxiety. Theoretical and practical implications of these findings are discussed.
-
Sudden or tapered withdrawal from treatment with antidepressants, including monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), and serotonin selective reuptake inhibitors (SSRIs), can produce phenomena consisting of somatic and psychological symptoms. The literature about these discontinuation phenomena consists mainly of case reports and a limited number of controlled prospective studies. ⋯ Because the symptoms of antidepressant discontinuation include changes in mood, affect, appetite, and sleep, they are sometimes mistaken for signs of a relapse into depression. Thus, it is important to directly question patients about new symptoms that occur during antidepressant discontinuation to optimally manage treatment discontinuation.
-
Practitioners need to work effectively with managed care personnel to provide the best possible mental health care to patients with panic disorder. To do so, physicians must become familiar with the organization and administrative principles common to most managed care plans. Specific strategies can be used when working with managed care personnel. These strategies include using data to demonstrate that effective mental health treatment can reduce the social and economic costs of panic disorder.