P. Pancheri, R. Delle Chiaie - Vol. 7, Marzo 2001, num.1
Testo Immagini Bibliografia Summary Riassunto Indice
Terapia sintomatica e terapia patogenetica
dell’ansia generalizzata
Symptomatic and pathogenetic therapy of generalized anxiety
Anxiety has been treated for a considerable period of time only symptomatically
(first with barbiturates, then with benzodiazepines). However, at the current
stage, the use of drugs defined as "antidepressants" is gaining space. These
drugs were first tried in panic disorder, but proved to be useful in various
anxiety disorders, where they proved to be equally effective or better than
the benzodiazepines. These "antidepressant" compounds may be considered as
"pathogenetic" drugs, since serotonin was found to be involved in the regulation
of anxiety, in contrast to the benzodiazepines, which are increasingly confined
to a role of "symptomatic" anxiolytics.
Method
In the present review the results of the main controlled clinical studies
carried-out to date with drugs first marketed as antidepressants to assess
their efficacy in generalised anxiety disorder. Currently, results are available
for the use of imipramine, venlafaxine, mianserine, fluoxetine, fluvoxamine,
sertraline. The results of these studies reviewed, together with the pooled
results of a group of four clinical trials carried-out on a total of 1864
patients with generalised anxiety disorder, in which the efficacy of paroxetine
was assessed in double-blind vs. placebo.
Results
In the treatment of patients with generalised anxiety disorder, antidepressants
proved to be effective similarly to or better than the benzodiazepines. In
particular, antidepressants were more effective than the benzodiazepines in
improving the psychological symptoms of anxiety, as compared to the physical
ones, and their peak effect was seen during the fourth rather than the second
week of treatment, as seen with the benzodiazepines. Paroxetine showed significant
effectiveness in generalised anxiety, combined with safety. Stability of results
and the ability of this drug to prevent relapses were seen also at long-term
follow-up (24 weeks).
Conclusions
The results of clinical trials here taken into account show that antidepressants
are effective against symptoms of anxiety. Much experimental evidence indicates
that their action on the modulation of serotonergic transmission appears to
be involved in their control of anxiety symptoms. In fact, paroxetine, which
is most selective in inhibiting the re-uptake of serotonin, proved to be effective
in other anxiety disorders as well, such as panic disorder, obsessive-compulsive
disorder, social phobia, and post-traumatic stress disorder, and was found
to be much effective also in generalised anxiety disorder. On the basis of
these results, the use of this "antidepressant" as a "pathogenetic" anxiolytic
in the dimensional treatment of generalised anxiety disorder appears to be
promising.