Pharmacotherapy of anxiety disorders in the 21st century: A call for novel approaches

Abstract

While limited advances have occurred in the past 30 years in the pharmacological management of anxiety and stressrelated disorders, novel molecular pathways both within and without the monoamine systems are currently under investigation and offer promising new avenues for more effective future treatments. Enhancing psychotherapy approaches with pharmacological compounds offers the potential to not only transform the standard of care of these conditions, but more broadly would introduce a paradigm shift in the way medications and their role in psychiatric care are conceptualised. Although further human trials and more translational research are sorely needed, continuing to pursue innovative mechanisms and treatments is hoped to yield substantial results in the coming decades and a departure from the reliance on chemical agents of the 20th century.

Efficacy of Agomelatine 25–50 mg for the Treatment of Anxious Symptoms and Functional Impairment in Generalized Anxiety Disorder: A Meta-Analysis of Three Placebo-Controlled Studies

“…GAD is the most common anxiety disorder in primary care practice [ 1 – 3 ], and is often associated with both comorbidity (including major depression and other anxiety disorders) and morbidity (including psychosocial impairment and economic costs) [ 1 ]. While a number of different medication classes have demonstrated efficacy in the management of GAD and cognitive behavioural therapy remains an important treatment option [ 4 ], there is considerable interest in alternative therapies [ 5 – 7 ]. Indeed, many patients fail to respond to or cannot tolerate currently recommended pharmacotherapies, such as inhibitors of serotonin and/or noradrenaline reuptake [ 6 ].…”

Adolescent anxiety disorders and the developing brain: comparing neuroimaging findings in adolescents and adults

“…2 With high lifetime prevalence and high risk for recurrence, there is still a lack of effective treatments for anxiety disorders. 3 This may be related to the unclarity of the psychopathological mechanisms underlying emotional dysfunction. 4 Anxiety disorders have an early onset; their incidence among children and adolescents is higher than that among other age groups.…”

Traumatic grief research and care in the aftermath of the COVID-19 pandemic

“…Second, the phenomenology of PGD and its pathophysiology are posited to involve the attachment system. In line with this, recent data suggest that individuals with PGD may exhibit higher circulating levels of oxytocin compared to bereaved controls and those with depression (Bui et al, 2019), suggesting that compounds modulating the oxytocin system should also be explored. Third, accumulating data recently pointed to the central role of emotional pain in the development and maintenance of PGD (Frumkin et al, 2021;Robinaugh, Millner, & McNally, 2016).…”

“…Clearly, future research on the compounds targeting the pain pathways including the cannabinoid and opioid pathways, as suggested by some (Deckman, DeWall, Way, Gilman, & Richman, 2014;Nobile, Lutz, Olié, & Courtet, 2020) are warranted. Fourth, there has been a recent resurgent interest in psychedelic agents for mood and anxiety disorders (Bui, King, & Melaragno, 2019). In line with this, two recent observational studies reported large reductions in grief symptoms in chronically grieving bereaved individuals receiving ayahuasca, a brewed beverage derived from two Amazonian plant species, containing dimethyltryptamine (DMT) and its precursor, during a ceremonial (González et al, 2020).…”