Pharmacotherapy of Anxiety Disorders: Promises and Pitfalls

Anxiety disorders are among the most common psychiatric disorders, with estimates of around 31% prevalence. They also are among the most common causes of disability and morbidity and pose a high healthcare cost burden. Although there continues to be ongoing research in anxiety, the majority of new drugs under development in psychiatry are for depression and mood disorders (bipolar) and schizophrenia. Anxiety disorders remain a woefully under-studied area in novel pharmacotherapeutics. There have been very few new medications under approval for anxiety disorders. Thus, psychiatrists in clinical practice who are presented with patients with anxiety disorders (in particular panic, generalized, anxiety and social anxiety) are left with the choice of first-line treatments like SSRIs, SNRIs and benzodiazepines. Most treatments focus on serotonergic, noradrenergic, and GABAergic pathways. Although anxiety disorders may respond to these treatments, along with effective forms of psychotherapy, most research on new pathways to treat anxiety has been at the pre-clinical level and has not yet translated to clinical practice in humans.

The purpose of this Research Topic is the study of the state of current pharmacotherapy for anxiety disorders, with the focus on panic disorder, generalized anxiety disorder, and social anxiety disorder. The goals are to review the evidence of current medications both approved and used (off-label) for anxiety disorders and to explore their safety and efficacy as well. The next goal is to evaluate the current trials of anxiolytics and examine what medications may be in the pipeline or what is an important area for future study in anxiety disorders.

Potential topics for articles:
- Paper(s) on benzodiazepines including:
o Safety (links to neurocognitive disorders, increased prescribing among the elderly, addiction/abuse potential)
o Tachyphylaxis with continued use
o Benzodiazepine prescribing in general, in particular among non-psychiatrists
- Use of non-benzodiazepines, both standing and as-needed, in particular off-label medications like gabapentin and antipsychotics
- Novel pharmacotherapeutics for anxiety disorders (pipeline)
o Glutamate modulators
o GABA allosteric modulators
o Neuropeptides
- Augmentation strategies like d-cycloserine and use of medications in conjunction with cognitive and other therapies
- Cannabinoids for anxiety and controversy on CBD oil
- Use of herbal and other supplements for anxiety: safety and efficacy
- New preclinical pathways for anxiety that may translate into new therapeutics