Therapy-refractory panic: current research areas as possible perspectives in the treatment of anxiety

Diemer, Julia; Vennewald, Nadja; Domschke, Katharina; Zwanzger, Peter

doi:10.1007/s00406-010-0143-9

Cited by 13 publications

(4 citation statements)

References 41 publications

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“…Moreover, pharmacotherapy has been confirmed to be beneficial in the treatment of PD with/without agoraphobia ( Bandelow et al, 2008 ). However, up to one third of patients do not respond sufficiently to either approach ( Diemer et al, 2010 , Taylor et al, 2012 ). Several factors contributing to this phenomenon have been observed, e.g.…”

Section: Introductionmentioning

confidence: 99%

Neurobiological and clinical effects of fNIRS-controlled rTMS in patients with panic disorder/agoraphobia during cognitive-behavioural therapy

Deppermann

Vennewald²,

Diemer³

et al. 2017

NeuroImage: Clinical

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BackgroundA relevant proportion of patients with panic disorder (PD) does not improve even though they receive state of the art treatment for anxiety disorders such as cognitive-behavioural therapy (CBT). At the same time, it is known, that from a neurobiological point of view, PD patients are often characterised by prefrontal hypoactivation. Intermittent Theta Burst Stimulation (iTBS) is a non-invasive type of neurostimulation which can modulate cortical activity and thus has the potential to normalise prefrontal hypoactivity found in PD. We therefore aimed at investigating the effects of iTBS as an innovative add-on to CBT in the treatment for PD.MethodsIn this double-blind, bicentric study, 44 PD patients, randomised to sham or verum stimulation, received 15 sessions of iTBS over the left prefrontal cortex (PFC) in addition to 9 weeks of group CBT. Cortical activity during a cognitive as well as an emotional (Emotional Stroop) paradigm was assessed both at baseline and post-iTBS treatment using functional near-infrared spectroscopy (fNIRS) and compared to healthy controls.ResultsIn this manuscript we only report the results of the emotional paradigm; for the results of the cognitive paradigm please refer to Deppermann et al. (2014).During the Emotional Stroop test, PD patients showed significantly reduced activation to panic-related compared to neutral stimuli for the left PFC at baseline. Bilateral prefrontal activation for panic-related stimuli significantly increased after verum iTBS only. Clinical ratings significantly improved during CBT and remained stable at follow-up. However, no clinical differences between the verum- and sham-stimulated group were identified, except for a more stable reduction of agoraphobic avoidance during follow-up in the verum iTBS group.LimitationsLimitations include insufficient blinding, the missing control for possible state-dependent iTBS effects, and the timing of iTBS application during CBT.ConclusionPrefrontal hypoactivity in PD patients was normalised by add-on iTBS. Clinical improvement of anxiety symptoms was not affected by iTBS.

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Section: Introductionmentioning

confidence: 99%

Neurobiological and clinical effects of fNIRS-controlled rTMS in patients with panic disorder/agoraphobia during cognitive-behavioural therapy

Deppermann

Vennewald²,

Diemer³

et al. 2017

NeuroImage: Clinical

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“…To date, no internationally endorsed evidence‐based guidelines exist for the treatment of patients with TR‐AD. Clinical recommendations 13,18,19,26,116‐119 comprise switching medication within one class or to a different class; augmentation strategies with other antidepressants, antipsychotics or anticonvulsants; combining pharmacotherapy and psychotherapy, as well as treating comorbid mental and/or somatic disorders complicating the treatment course. The present Delphi method‐based consensus operational criteria for TR‐AD may help to foster clinical trials probing innovative pharmacological, psychotherapeutic and non‐invasive brain stimulation approaches in order to establish more effective treatment options for this condition.…”

Section: Discussionmentioning

confidence: 99%

The definition of treatment resistance in anxiety disorders: a Delphi method‐based consensus guideline

Domschke,

Seuling,

Schiele

et al. 2024

World Psychiatry

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Anxiety disorders are very prevalent and often persistent mental disorders, with a considerable rate of treatment resistance which requires regulatory clinical trials of innovative therapeutic interventions. However, an explicit definition of treatment‐resistant anxiety disorders (TR‐AD) informing such trials is currently lacking. We used a Delphi method‐based consensus approach to provide internationally agreed, consistent and clinically useful operational criteria for TR‐AD in adults. Following a summary of the current state of knowledge based on international guidelines and an available systematic review, a survey of free‐text responses to a 29‐item questionnaire on relevant aspects of TR‐AD, and an online consensus meeting, a panel of 36 multidisciplinary international experts and stakeholders voted anonymously on written statements in three survey rounds. Consensus was defined as ≥75% of the panel agreeing with a statement. The panel agreed on a set of 14 recommendations for the definition of TR‐AD, providing detailed operational criteria for resistance to pharmacological and/or psychotherapeutic treatment, as well as a potential staging model. The panel also evaluated further aspects regarding epidemiological subgroups, comorbidities and biographical factors, the terminology of TR‐AD vs. “difficult‐to‐treat” anxiety disorders, preferences and attitudes of persons with these disorders, and future research directions. This Delphi method‐based consensus on operational criteria for TR‐AD is expected to serve as a systematic, consistent and practical clinical guideline to aid in designing future mechanistic studies and facilitate clinical trials for regulatory purposes. This effort could ultimately lead to the development of more effective evidence‐based stepped‐care treatment algorithms for patients with anxiety disorders.

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“…GAD, also known as "chronic anxiety," is characterized by excessive anxiety, which is generalized and persistent, often exhibiting somatic symptoms, including headache and gastrointestinal symptoms [1]. PD, also known as "acute anxiety," is a type of acute recurrent episodes of severe anxiety (panic) characterized by sudden high levels of fear (often reaching a peak within a few minutes [2]) which may be accompanied by palpitations and difficulty in breathing, profuse sweating, dizziness, general numbness, and other physical symptoms. e pathogenesis of anxiety disorders is complex, and it has not been elucidated yet.…”

Section: Introductionmentioning

confidence: 99%

Study on the Antianxiety Mechanism of Suanzaoren Decoction Based on Network Pharmacology and Molecular Docking

Gao

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Objective. Suanzaoren Decoction (SZRT) is a classic decoction to calm the nerves in traditional Chinese medicine (TCM). It has been extensively treated as an antianxiety drug in modern times, but the material basis and pharmacological mechanisms are still unclear. To explore the material basis and corresponding potential targets, as well as to elucidate the mechanism of SZRT, network pharmacology and molecular docking methods were utilized. Methods. The main chemical compounds and potential targets of SZRT were collected from the pharmacological database analysis platform (TCMSP). Anxiety targets were obtained from the GeneCards database. Then, a target compound network was established using overlapping genes and the corresponding potential compounds. Protein interaction analysis, GO enrichment, and KEGG pathway enrichment were performed using the STRING database, DAVID database, and KOBAS database. Finally, molecular docking was conducted between MAOB and its corresponding active compound in SZRT to further verify the results. Results. A total of 137 active components in SZRT were screened from the TCMSP database, and 210 corresponding targets were predicted. A total of 5434 anxiety-related targets were obtained from the disease target database, and finally 22 potential targets of SZRT on antianxiety were obtained. The constructed C-T network showed that the average degree of active components was 5.4, and four of them interacted with six or more targets. PPI analysis shows that key genes such as MAOA, MAOB, IL1B, TNF, NR3CI, and HTR3A were identified as potential therapeutic targets. A pathway analysis showed that SZRT may participate in neurotransmitter regulation and immunoregulation in a synergistic way to treat anxiety. The binding energy between the active compounds and MAOB was low, indicating good binding. The results of molecular docking showed that all the 10 active ingredients were able to successfully dock with MAOB, and the binding energy of coumaroyltyramine with MAOB was the lowest, that is, −9.6 kcal/mol, and the binding method was hydrogen bonding. Conclusions. SZRT produces antianxiety effects mainly by affecting the neurotransmitter release, transmission, and immunoregulation. This study provides a new approach to elucidating the molecular mechanism and material basis of SZRT in the treatment of anxiety, and it will also benefit the application of TCM in modern medicine.

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Therapy-refractory panic: current research areas as possible perspectives in the treatment of anxiety

Cited by 13 publications

References 41 publications

Neurobiological and clinical effects of fNIRS-controlled rTMS in patients with panic disorder/agoraphobia during cognitive-behavioural therapy

Neurobiological and clinical effects of fNIRS-controlled rTMS in patients with panic disorder/agoraphobia during cognitive-behavioural therapy

The definition of treatment resistance in anxiety disorders: a Delphi method‐based consensus guideline

Study on the Antianxiety Mechanism of Suanzaoren Decoction Based on Network Pharmacology and Molecular Docking

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