Generalized Anxiety Disorder: Revisited

Showraki, Mostafa; Showraki, Tiffany; Brown, Kimberly

doi:10.1007/s11126-020-09747-0

Cited by 33 publications

(26 citation statements)

References 41 publications

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“…while another study's sample size was only 14 in the 60 mg/day group and 9 in the 30 mg/day group [14]. A review of the literature revealed that the present study was the rst with a large sample size to systematically determine the safety and e cacy of 60 mg/day tandospirone to treat GAD.…”

Section: Discussionmentioning

confidence: 88%

“…GAD is more common in the community and general hospitals [4]. Treatment requires a greater emphasis on e cacy and tolerability [14]. Tandospirone is an effective drug for GAD treatment [15]; nevertheless, few evidence-based studies have explored its e cacy.…”

Section: Discussionmentioning

confidence: 99%

“…Tandospirone is an effective drug for GAD treatment [15]; nevertheless, few evidence-based studies have explored its e cacy. One study involved a variable-dose single arm [11], while another study's sample size was only 14 in the 60 mg/day group and 9 in the 30 mg/day group [14]. A review of the literature revealed that the present study was the rst with a large sample size to systematically determine the safety and e cacy of 60 mg/day tandospirone to treat GAD.…”

Section: Discussionmentioning

confidence: 99%

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Safety and Efficacy of Two Doses of Tandospirone Citrate for Generalized Anxiety Disorder: A Multicenter Randomized Controlled Trial

Zhang

Lin

et al. 2021

Preprint

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Background This study aimed to determine the safety and efficacy of different doses of tandospirone to treat generalized anxiety disorder (GAD). Methods This parallel randomized controlled trial involved patients with GAD from eight centers in China between 01/2012 and 09/2018. Patients were randomly assigned to 60 mg/day and 30 mg/day groups. The primary endpoint was the overall response rate at the end of week 6. The secondary endpoints included significant response rate, change in Hamilton Anxiety Scale (HAMA) total score, HAMA subscale score, Hamilton Depression Scale-17 (HAMD-17), and adverse drug reactions. Results No significant difference was found in the overall response rate (65.7% vs 58.4%, P > 0.05) between 60 mg/day and 30 mg/day groups. The significant response rate (34.3% vs 22.6%, P = 0.032) was better in the 60 mg/day group. The reduction in HAMA total score, somatic anxiety factor, cardiovascular symptom factor, gastrointestinal symptom factor, and HAMD-17 score were better in the 60 mg/day group (all P < 0.05). The incidence of dizziness and gastrointestinal reactions of the 60 mg/day group was higher than that of the 30 mg/day group. However, there was no significant difference in the proportion of withdrawal due to adverse events. Conclusions For GAD treatment, the overall response rate of high-dose tandospirone was similar to that of low-dose tandospirone. The safety in the two groups was tolerable. Patients with good compliance might benefit from a high-dose regimen. Trial registration: The trial registration no. was NCT01614041(07/06/2012).

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Safety and Efficacy of Two Doses of Tandospirone Citrate for Generalized Anxiety Disorder: A Multicenter Randomized Controlled Trial

Zhang

Lin

et al. 2021

Preprint

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“… 40 Another example is provided by active Social Interaction with an unknown conspecific: 26 , 41 this is of note because there is increasing interest in overlapping features and cellular substrates of GAD and social anxiety. 42 , 43 In these and certain other procedures of potential anxiolytic properties, agomelatine displayed robust efficacy, though it has not invariably proven active in elevated plus maze and conditioned ultrasonic vocalization (USV) procedures 23 , 24 , 26 , 41 , 44 , 45 ( Table 1 ). Where active, the anxiolytic actions of agomelatine are expressed both acutely and upon sustained (several weeks) administration.…”

Section: Anxiolytic Properties Of Agomelatine: Actions In Animal Modelsmentioning

confidence: 99%

Agomelatine for the treatment of generalized anxiety disorder: focus on its distinctive mechanism of action

Millan

2022

Therapeutic Advances in Psychopharmacology

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Generalized anxiety disorder (GAD), the most frequently diagnosed form of anxiety, is usually treated by cognitive-behavioural approaches or medication; in particular, benzodiazepines (acutely) and serotonin or serotonin/noradrenaline reuptake inhibitors (long term). Efficacy, compliance, and acceptability are, however, far from ideal, reinforcing interest in alternative options. Agomelatine, clinically employed in the treatment of major depression, expresses anxiolytic properties in rodents and was effective in the treatment of GAD (including severely ill patients) in several double-blind, short-term (12 weeks) and relapse-prevention (6 months) studies. At active doses, the incidence of adverse effects was no higher than for placebo. Agomelatine possesses a unique binding profile, behaving as a melatonin (MT1/MT2) receptor agonist and 5-HT2C receptor antagonist, yet recognizing neither monoamine transporters nor GABAA receptors. Extensive evidence supports a role for 5-HT2C receptors in the induction of anxious states, and their blockade likely plays a primary role in mediating the anxiolytic actions of agomelatine, including populations in the amygdala and bed nucleus of stria terminalis, as well as the hippocampus. Recruitment of MT receptors in the suprachiasmatic nucleus, thalamic reticular nucleus, and hippocampus appears to fulfil a complimentary role. Downstream of 5-HT2C and MT receptors, modulation of stress-sensitive glutamatergic circuits and altered release of the anxiogenic neuropeptides, corticotrophin-releasing factor, and vasopressin, may be implicated in the actions of agomelatine. To summarize, agomelatine exerts its anxiolytic actions by mechanisms clearly distinct from those of other agents currently employed for the management of GAD. Plain Language Summary How agomelatine helps in the treatment of anxiety disorders Introduction: • Anxiety disorders have a significant negative impact on quality of life. • The most common type of anxiety disorder, called generalized anxiety disorder (GAD), is associated with nervousness and excessive worry. • These symptoms can lead to additional symptoms like tiredness, sleeplessness, irritability, and poor attention. • GAD is generally treated through either cognitive-behavioural therapy or medication. However, widely used drugs like benzodiazepines and serotonin reuptake inhibitors have adverse effects. • Agomelatine, a well-established antidepressant drug, has shown anxiety-lowering (‘anxiolytic’) properties in rats and has been shown to effectively treat GAD with minimal side effects. • However, exactly how it acts on the brain to manage GAD is not yet clear. • Thus, this review aims to shed light on agomelatine’s mechanism of action in treating GAD. Methods: • The authors reviewed studies on how agomelatine treats anxiety in animals. • They also looked at clinical studies on the effects of agomelatine in people with GAD. Results: • The study showed that agomelatine ‘blocks’ a receptor in nerve cells, which plays a role in causing anxiety, called the 5-HT2C receptor. • Blocking this receptor, especially in specific brain regions such as nerve cells of the amygdala, bed nucleus of stria terminalis, and hippocampus, produced the anxiety reduction seen during agomelatine treatment. • Agomelatine also activates the melatonin (MT) receptor, which is known to keep anxiety in check, promote sleep, and maintain the sleep cycle. • Agomelatine should thus tackle sleep disturbances commonly seen in patients with GAD. • Beyond 5-HT2C and MT receptors, signalling molecules in nerve cells that are known to be involved in anxiety disorders (called ‘neurotransmitters’ and ‘neuropeptides’) are also affected by agomelatine. Conclusion: • Agomelatine’s anxiolytic effects are caused by mechanisms that are distinct from those of other medications currently used to treat GAD. • This explains its therapeutic success and minimal adverse side effects.

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“…The disorder usually starts in population who are between 18-20 years old [2]. About 77% of people who suffered from GAD were diagnosed at adolescence and only 14% of the total population asked for medical care during their teens [4]. There are some factors that might increase the risk of developing GAD, such as trauma, low socioeconomic status, family history, and other concurrent psychiatric disorder.…”

Section: Introductionmentioning

confidence: 99%

Pharmaceutical Management of General Anxiety Disorder

Hafiz

Fairaq

Alfawzan

et al. 2021

JPRI

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Generalized anxiety disorder (GAD) is a mental disorder defined as excessive worrying over little things. It is a one of the most common types of anxiety disorders. A study stated that 1-5% of the general population suffers from GAD. The condition affects the quality of life of a patient negatively and activities in their everyday life. In this review article, we highlighted several studies that compared combined therapy of psychotherapy and pharmacotherapy to either therapy alone, results were conflicting and differ from one study to another. Provide a thorough and comprehensive review of the different approaches of GAD management, several database websites were searched for articles discussing the pharmacological management of general anxiety disorder. Clinical trials, clinical guidelines, systematic reviews, meta-analyses and review articles were all reviewed and considered for inclusion. The review emphasizes the importance of taking the decision of therapy after counseling the patient, taking into account, the cost effectiveness of the treatment, patient’s symptomatology, comorbidity, medical conditions, concomitant using medications, previous trials and preference. Accordingly, thorough assessment should be done before moving to management plan, and a trial of other group or other therapies should be taken if there is no response seen. However, generalized anxiety disorder is one of the most common types of anxiety disorders. It has a lifetime prevalence around 5%, it can include intolerable cognitive, emotional and physical symptoms. Thus, GAD can adversely affect the patient’s life aspects, including personal, functional, social or educational. There are options to be taken among psychotherapy, pharmacotherapy or combined therapy.

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Generalized Anxiety Disorder: Revisited

Cited by 33 publications

References 41 publications

Safety and Efficacy of Two Doses of Tandospirone Citrate for Generalized Anxiety Disorder: A Multicenter Randomized Controlled Trial

Safety and Efficacy of Two Doses of Tandospirone Citrate for Generalized Anxiety Disorder: A Multicenter Randomized Controlled Trial

Agomelatine for the treatment of generalized anxiety disorder: focus on its distinctive mechanism of action

Pharmaceutical Management of General Anxiety Disorder

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