AAPEL - Anxiety molecules studies

Benzodiazepines, SSRI, Molecules for anxiety.
Studies.

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Summary
BPD is an affective disregulation disorder including anxiety
Here are some studies about anxiety and BPD treatments.

(link : BPD molecules studies)

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Studies in this paper

Alprazolam (benzodiazepine)

Gardner, D.L. & Cowdry, R.W.

Am. J. Psychiatry. 1985 - Alprazolam-induced dyscontrol in borderline personality disorder.

The short-acting benzodiazepine alprazolam has been associated with precipitating serious dyscontrol in one placebo-controlled crossover study of patients with BPD

The authors suggest that caution be used in prescribing alprazolam to patients with similar histories.

Alprazolam (benzodiazepine) / carbamazepine and trifluoperazine and tranylcypromine.

Cowdry RW, Gardner DL. - Intramural Research Program, National Institute of Mental Health, Bethesda

Arch Gen Psychiatry. 1988 - Pharmacotherapy of borderline personality disorder. Alprazolam, carbamazepine, trifluoperazine, and tranylcypromine.

Physicians rated patients as significantly improved relative to placebo while receiving tranylcypromine and carbamazepine. Patients rated themselves as significantly improved relative to placebo only while receiving tranylcypromine. Patients who tolerated a full trial of trifluoperazine showed improvement, those receiving carbamazepine demonstrated a marked decrease in the severity of behavioral dyscontrol, and those receiving alprazolam had an increase in the severity of the episodes of serious dyscontrol

Alprazolam (benzodiazepine)

Lane SD, Tcheremissine OV, Lieving LM, ... - Department of Psychiatry and Behavioral Sciences, Houston, USA.

Psychopharmacology (Berl). 2OO5 - Acute effects of alprazolam on risky decision making in humans.

OBJECTIVES: The present study was designed to demonstrate a dose-response relationship between acute alprazolam administration and human risk taking

RESULTS: Alprazolam administration produced dose-related changes in subjective effects, response rates, and, most importantly, dose-dependently increased selection of the risky response option

CONCLUSIONS: Alprazolam administration produced increases in human risk taking under laboratory conditions.

Alprazolam (benzodiazepine)

[No authors listed]

Med Lett Drugs Ther. 2OO5 - Alprazolam (Xanax, and others) revisited.

Alprazolam, a widely prescribed benzodiazepine, is effective for treatment of anxiety and panic disorder but sedation, withdrawal symptoms and abuse are common. SSRIs are also effective and safer. Cognitive-behavioral therapy is probably more effective in the long term.

EFFICACY — Benzodiazepines and SSRIs are both effective in reducing symptoms of anxiety. Benzodiazepines have a more rapid onset of action...

Several randomized controlled trials have shown that cognitive-behavioral therapy (CBT) is at least as efficacious as drugs for treatment of panic and other anxiety disorders; improvements are often maintained or increased in the 6-12 months after completion of treatment.

... Alprazolam can cause sedation, interfere with psychomotor performance and impair memory. In one study, a 1-mg dose of alprazolam impaired driving ability one hour after administration... paradoxical excitement or behavioral disinhibition may occur in some patients...

SSRIs are preferred for long-term treatment.

Alprazolam (benzodiazepine)

Verster JC, Volkerts ER. - Utrecht Institute for Pharmaceutical Sciences, Dept. of Psychopharmacology, University of Utrecht, The Netherlands

CNS Drug Rev. 2OO4 - Clinical pharmacology, clinical efficacy, and behavioral toxicity of alprazolam...

Alprazolam is a benzodiazepine derivative that is currently used in the treatment of generalized anxiety, panic attacks with or without agoraphobia, and depression. Alprazolam has a fast onset of symptom relief (within the first week); it is unlikely to produce dependency or abuse...

... alprazolam and imipramine are significantly more effective than placebo in the treatment of panic attacks, SSRIs appear to be superior to either of the two drugs. Therefore, alprazolam is recommended as a second line treatment option, when SSRIs are not effective or well tolerated. In addition to its therapeutic effects, alprazolam produces adverse effects, such as drowsiness and sedation.

It is evident from these studies that alprazolam may impair performance in a variety of skills in healthy volunteers as well as in patients

Alprazolam (benzodiazepine)

Patterson JF. - Psychiatry Service, Harry S. Truman Memorial Veterans Hospital, Columbia

J Clin Psychiatry. 1990 - Withdrawal from alprazolam dependency using clonazepam: clinical observations.

Clinical observations of 37 alprazolam-dependent patients are presented. Seventeen inpatients and 20 outpatients, the majority suffering from posttraumatic stress disorder, were withdrawn from alprazolam by means of clonazepam substitution in an open-label fashion

... it was found that this method of discontinuation is safe and effective and, in particular, does not pose a danger of withdrawal seizures

Clonazepam (benzodiazepine)

Paroxetine (SSRI)

Seedat S, Stein MB. - Anxiety and Traumatic Stress Disorders Program, Psychiatry Service, VA San Diego Healthcare System

J Clin Psychiatry. 2OO4 - Double-blind, placebo-controlled assessment of combined clonazepam with paroxetine... for generalized social anxiety disorder.

BACKGROUND: Generalized social anxiety disorder (GSAD) is a pervasive form of social anxiety...

Among evidence-based pharmacologic treatments for the disorder, selective serotonin reuptake inhibitors (SSRIs) have become widely used and are known to be efficacious. Monotherapy with the benzodiazepine clonazepam is also efficacious for GSAD, but the adjunctive use of clonazepam with an SSRI to potentially improve outcomes has not been studied to date.

RESULTS: At the end of the 10-week double-blind treatment, there was a trend favoring the paroxetine/clonazepam group, who had a 79% response rate compared with a 43% response rate for the paroxetine/placebo group.

However, no significant differences on other outcome measures were noted between the 2 groups during treatment...

CONCLUSION: Coadministration of clonazepam with an SSRI, in contrast to findings in panic disorder, did not lead to more rapid resolution of symptoms in GSAD. On the other hand, there is some evidence that the clonazepam-added group had superior global outcomes, although power to detect such differences in this study was small. These observations suggest that a role for adjunctive benzodiazepines in patients with GSAD (e.g., for augmenting SSRI partial response or nonresponse) is deserving of further controlled investigation.

Clonazepam (benzodiazepine)

Connor KM, Davidson JR, Potts NL,... - Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham

J Clin Psychopharmacol. 1998 - Discontinuation of clonazepam in the treatment of social phobia.

Patients with social phobia who responded well to 6 months of open-label treatment with clonazepam were assigned to receive either continuation treatment (CT) with clonazepam for another 5 months, or to undergo discontinuation treatment (DT).

Clinical efficacy was compared between the CT and DT groups using three different social phobia scales. Benzodiazepine withdrawal symptoms were also measured....

At the end of 11 months of treatment with clonazepam, however, a more rapid withdrawal rate was associated with greater distress. This study offers preliminary evidence to suggest that continuation therapy with clonazepam in the treatment of social phobia is safe and effective, producing a somewhat greater clinical benefit than a slow-taper discontinuation regime.... The study can be taken as supportive of benefit for longterm clonazepam treatment in social phobia, as well as being compatible with a reasonably good outcome after short-term treatment and slow taper.

Clonazepam (benzodiazepine)

Worthington JJ 3rd, Pollack MH, Otto MW,... - Department of Psychiatry, Massachusetts General Hospital, Boston

Psychopharmacol Bull. 1998 - Long-term experience with clonazepam in patients with a primary diagnosis of panic disorder.

Of 204 patients followed over a 2-year period, 46 percent were receiving clonazepam alone or in combination with an antidepressant... The main variables assessed in this analysis included global severity of the panic disorder and stability of clonazepam dose. All treatment groups tended to improve over time without significant differences in outcome between groups. Clonazepam doses remained stable over time. Results of this study suggest that treatment of panic disorder with the HPB clonazepam achieved and maintained a therapeutic benefit similar to that obtained with alternative pharmacologic treatments, without the development of tolerance as manifested by dose escalation or worsening of clinical status.

General Anxiety Disorder treatments - Sertraline (SSRI)

Dahl AA, Ravindran A, Allgulander C,... - Department of Clinical Cancer Research, University of Oslo, Norway.

Acta Psychiatr Scand. 2OO5 - Sertraline in generalized anxiety disorder: efficacy in treating the psychic and somatic anxiety factors.

OBJECTIVE: The objective was to study the efficacy of sertraline on symptoms of psychic and somatic anxiety in patients suffering from moderate-to-severe generalized anxiety disorder (GAD).

METHOD: Out-patients with DSM-IV GAD were randomized to 12 weeks of double-blind treatment with placebo...

RESULTS: Treatment with sertraline resulted in significantly greater ... improvement than placebo on both psychic and somatic anxiety factors.

CONCLUSION: Sertraline treatment demonstrated efficacy for both the psychic and somatic anxiety symptoms of GAD.

Anxiety Disorders

Tajima O. - Department of Mental Health, Kyorin University, School of Health Sciences. Japan

Seishin Shinkeigaku Zasshi. 2OO4 - [Pharmacotherapy for anxiety disorders]

Although SSRIs are considered to be a first-line treatment for the most of anxiety disorders benzodiazepines are still widely used in clinical practice despite the risk of dependence and strong recommendation for their use as a second-line. Combination of the SSRIs and the benzodiazepines is widely used. Recently it has been suggested that the combination of SSRI and benzodiazepine is rational, because each drug has a different mechanism of action.... Recent Imaging studies suggested the hyperactivity of the amygdala in the patients with generalized social anxiety disorder and successful treatment with cognitive behavioral therapy or SSRI might significantly reduce the hyperactivity of the amygdala.

It was suggested that the rational combination of SSRIs and benzodiazepines seems to be an effective and practical way of treatment for most anxiety disorders

General Anxiety Disorder treatments

Benzodiazepines

Venlafaxine (SSRI)

Paroxetine (SSRI)

Struzik L, Vermani M, Coonerty-Femiano A,... - Faculty of Medicine,University of Toronto, Canada.

Expert Rev Neurother. 2OO4 - Treatments for generalized anxiety disorder.

Generalized anxiety disorder is characterized by excessive chronic anxiety in association with many somatic symptoms. The disorder has pervasive effects on quality of life, including work, social and educational aspects and requires long-term therapy. Available studies in patients are the DSM III R and fourth edition, which have defined generalized anxiety disorder and demonstrate the efficacy of benzodiazepines, azapirones, some antidepressants and psychotherapy. Benzodiazepines are effective anxiolytics for short-term use but are accompanied by many adverse events. The antidepressants, paroxetine and venlafaxine (Effexor), have demonstrated efficacy in patients with generalized anxiety disorder with mild side-effect profiles...

Long-term efficacy has been shown with venlafaxine in the treatment of this chronic condition, confirming that as in depression, the goal must not just be remission beyond simple symptom resolution but also on to improved functioning and quality of life. Psychotherapy with applied relaxation, cognitive therapy and cognitive behavioral therapy show the most promise in resolving and maintaining treatment gains in the long-term...

Based on current evidence, the recommended approach to achieving long-term benefits for patients with generalized anxiety disorder is antidepressant therapy with paroxetine or venlafaxine in combination with cognitive behavioral therapy

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Warning:
All the information in this site is aimed at helping people understand a "rather particular" and puzzling kind of disease
But more especially, to support everyone affected by it, sick or not. In any case, it is ESSENTIAL to see a therapist who specialises in this field they can confirm or give an alternative diagnosis
The name of what you’ve got doesn’t matter so much, getting the right treatment for the right patient does
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last update 2019
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Author, Alain Tortosa, founder of the Aapel
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