The burden of anxiety disorders is growing, but the efficacy of available anxiolytic treatments remains inadequate. Cognitive behavioural therapy for anxiety disorders focuses on identifying and modifying maladaptive patterns of thinking and behaving, and has a testable analogue in rodents in the form of fear extinction. A large preclinical literature has amassed in recent years describing the neural and molecular basis of fear extinction in rodents. In this review, we discuss how this work is being harnessed to foster translational research on anxiety disorders and facilitate the search for new anxiolytic treatments. We begin by summarizing the anatomical and functional connectivity of a medial prefrontal cortex (mPFC)-amygdala circuit that subserves fear extinction, including new insights from optogenetics. We then cover some of the approaches that have been taken to model impaired fear extinction and associated impairments with mPFC-amygdala dysfunction. The principal goal of the review is to evaluate evidence that various neurotransmitter and neuromodulator systems mediate fear extinction by modulating the mPFC-amygdala circuitry. To that end, we describe studies that have tested how fear extinction is impaired or facilitated by pharmacological manipulations of dopamine, noradrenaline, 5-HT, GABA, glutamate, neuropeptides, endocannabinoids and various other systems, which either directly target the mPFC-amygdala circuit, or produce behavioural effects that are coincident with functional changes in the circuit. We conclude that there are good grounds to be optimistic that the progress in defining the molecular substrates of mPFC-amygdala circuit function can be effectively leveraged to identify plausible candidates for extinction-promoting therapies for anxiety disorders.
LINKED ARTICLESThis article is part of a themed section on Animal Models in Psychiatry Research. To view the other articles in this section visit http://dx.doi.org/10. 1111/bph.2014.171.issue-20 Abbreviations ACC, anterior cingulate cortex; BA, basal nucleus of the amygdala; BLA, basolateral amygdala; CBT, cognitive behavioural therapy; CCK, cholecystokinin; CeA, central nucleus of amygdala; CeL, lateral nucleus of the central amygdala; CeM, medial nucleus of the central amygdala; CITZ, capsular infralimbic subregion target zone; CRF, corticotropin-releasing factor; FAAH, fatty acid amide hydrolase; GluA1, AMPA receptor subunit 1; GluA2, AMPA receptor subunit 2; GluN2B, NMDA receptor subtype 2B; GluN2C/D, NMDA receptor subtype 2C/D; GRP, gastrin-releasing peptide; HDAC, histone deacetylase; HAT, histone acetyltransferase ICN, intercalated cell nuclei; IN, main intercalated nucleus; KOP, κ-opioid; LA, lateral amygdala; mGlu, metabotropic glutamate receptor; mImp, medial paracapsular intercalated nucleus; MOP, μ-opioid; mPFC, medial prefrontal cortex; NPS, neuropeptide S; NPY, neuropeptide Y; PD, panic disorder; PEPA, 2- [2,6-difluoro-4-[[2-[(phenylsulfonyl)
Introduction
Prevalence and treatment of anxiety disordersAnxiety disorders consti...